Obstetrics and Gynecology
Core concepts
Obstetrics and gynaecology questions hinge on gestational age and maternal stability. Know antenatal care and dating, preeclampsia and eclampsia, ectopic pregnancy and miscarriage, gestational diabetes, labour and delivery, postpartum haemorrhage, contraception, cervical screening and menopause.
Traps
- Preeclampsia can present without proteinuria; hypertension plus maternal organ dysfunction is enough. Severe features (BP at least 160/110, headache, visual changes, right upper quadrant pain, platelets below 100) mandate magnesium sulfate and delivery.
- Antihypertensives in pregnancy: labetalol, nifedipine and methyldopa are safe; ACE inhibitors and ARBs are contraindicated.
- Any woman of reproductive age with abdominal pain and bleeding has an ectopic until proven otherwise; an IUD does not exclude it.
- Give anti-D immunoglobulin to Rh-negative women with bleeding, after sensitising events, and postpartum if the baby is Rh-positive.
- Postpartum haemorrhage: call for help, rub up the uterus, give oxytocin, then tranexamic acid and further uterotonics; do not delay.
- Cervical screening is a preventive test, not a diagnostic test for symptomatic bleeding.
Worked example
A 34-week primigravida has BP 162/108, headache and 2+ proteinuria. This is severe preeclampsia. Admit, give magnesium sulfate for seizure prophylaxis, treat blood pressure with labetalol, give antenatal corticosteroids for fetal lung maturity, and plan delivery. Monitor reflexes, respiratory rate and urine output for magnesium toxicity; calcium gluconate is the antidote.
Rule of thumb
In pregnancy, the fetus is a passenger: stabilise the mother first, then think about delivery timing.