Obstetrics and Gynecology
Core concepts
Obstetrics and gynaecology questions centre on the leading causes of maternal death: haemorrhage, hypertensive disorders, sepsis, obstructed labour and unsafe abortion. Know antenatal care schedules and risk screening, the partograph, active management of the third stage of labour, diagnosis of pre-eclampsia, magnesium sulfate protocols, postpartum haemorrhage (the four Ts: tone, trauma, tissue, thrombin), puerperal sepsis, contraception including emergency methods, cervical cancer screening, ectopic pregnancy and gestational diabetes.
Traps
Performing a digital vaginal examination when placenta previa is suspected; giving ergometrine before delivery or in pre-eclampsia; missing magnesium toxicity, which presents with loss of deep tendon reflexes and respiratory depression and is reversed by calcium gluconate; and applying blood pressure thresholds from other guidelines. Another trap is treating pre-eclampsia without assessing severity features such as platelets, liver enzymes, creatinine and symptoms.
Worked example
A woman delivers and bleeds 800 mL with a soft uterus. Call for help, massage the uterus, give oxytocin 10 IU intramuscularly, give tranexamic acid 1 g intravenously within 3 hours, empty the bladder, and examine for tears and retained placenta. Escalate to misoprostol, balloon tamponade or surgery if bleeding continues.
Rule of thumb
Bleeding after 28 weeks is placenta previa until excluded: no digital examination until ultrasound has localised the placenta.