Obstetrics and Gynecology in Primary Care
Core concepts
Antenatal care, common complications of pregnancy, contraception counselling, abnormal uterine bleeding, cervical screening, and menopause management dominate. Also know ectopic pregnancy, pre-eclampsia, gestational diabetes screening, and postpartum care.
Question traps
- Ectopic pregnancy. Any woman of reproductive age with abdominal pain and/or bleeding has a pregnancy test first. The classic triad (pain, amenorrhoea, bleeding) is not always present; a negative pregnancy test excludes ectopic.
- Pre-eclampsia. Defined by new hypertension after 20 weeks with proteinuria or end-organ dysfunction. Delivery is the definitive treatment; antihypertensives and magnesium sulfate are for control and seizure prophylaxis.
- Contraception. Distinguish absolute contraindications (e.g. combined hormonal contraception in migraine with aura, smoking over 35, history of VTE) from relative ones. Progestogen-only methods are often the safe alternative.
- Abnormal uterine bleeding. Classify by age and pattern; postmenopausal bleeding always requires investigation for endometrial pathology.
- Cervical screening intervals and the role of HPV testing are frequently tested; know that screening guidelines differ from diagnostic colposcopy pathways.
Worked rule of thumb
For any reproductive-age woman with pelvic symptoms, the first step is exclude pregnancy (urine or serum hCG). This single rule resolves many stems and prevents the classic error of treating presumed gastroenteritis or dysmenorrhoea in an ectopic pregnancy.
Antenatal safety
When choosing drugs in pregnancy, remember the well-known teratogens and avoid them: ACE inhibitors, warfarin, isotretinoin, sodium valproate, and tetracyclines.