Obstetrics and Gynecology: Antepartum, Intrapartum, and Emergency Care
Obstetrics questions cluster around bleeding, hypertension, and labor progress. Know that antepartum hemorrhage after 20 weeks is placenta previa until proven otherwise, and that digital vaginal examination is contraindicated until previa is excluded by ultrasound. Placental abruption presents with painful bleeding, uterine tenderness, and fetal distress. Postpartum hemorrhage is most often due to uterine atony; the first step is uterine massage and uterotonics (oxytocin), followed by escalation.
Hypertensive disorders
Preeclampsia is new hypertension after 20 weeks with proteinuria or end-organ dysfunction; severe features (headache, visual changes, right upper quadrant pain, elevated liver enzymes, low platelets) mandate magnesium sulfate for seizure prophylaxis and delivery planning. Eclampsia is a medical emergency: magnesium sulfate, airway support, and delivery.
Labor and gynecology
Assess labor with cervical dilation, effacement, and fetal station. Arrest of dilation requires reassessment of fetal position and pelvis. In gynecology, distinguish ectopic pregnancy (amenorrhea, pain, positive pregnancy test, empty uterus) from miscarriage; a hemodynamically unstable patient with a positive pregnancy test needs urgent surgical management.
Traps
Examiners test contraindications: never give a vaginal exam with suspected previa, and avoid certain antihypertensives in pregnancy. Read carefully whether the question asks for diagnosis, immediate management, or definitive management.
Rule of thumb
In any pregnant patient with bleeding or severe hypertension, stabilize mother first - the fetus follows the mother's hemodynamics.