Obstetrics and Gynecology: Antepartum, Intrapartum, and Gynecologic Care
This domain rewards knowing normal physiology and its deviations across pregnancy and the menstrual cycle. Master dating and prenatal screening, hypertensive disorders of pregnancy, hemorrhage (antepartum and postpartum), fetal surveillance, and the major gynecologic presentations: abnormal uterine bleeding, pelvic pain, and adnexal masses.
Concepts to master
- Preeclampsia: new hypertension after 20 weeks with proteinuria or end-organ dysfunction; magnesium sulfate for seizure prophylaxis.
- Postpartum hemorrhage: uterine atony is most common; stepwise management (massage, uterotonics, tamponade, surgery).
- Ectopic pregnancy: risk factors, discriminatory hCG, transvaginal ultrasound findings, and the danger of rupture.
- Fetal heart rate interpretation: baseline, variability, accelerations, decelerations (early, variable, late) and their meaning.
- Contraception and menopause: mechanism, contraindications, and hormone therapy indications.
Traps
Questions frequently blur the line between chronic hypertension and preeclampsia (timing and end-organ signs decide). Another trap is choosing surgery before medical stabilization in hemorrhage. In fetal monitoring, late decelerations indicate uteroplacental insufficiency and demand intrauterine resuscitation, not immediate delivery in every case. Be cautious with absolute contraindications to combined hormonal contraception (e.g., migraine with aura, prior VTE).
Worked rule of thumb
For any pregnant patient with bleeding: confirm location (ultrasound), check Rh status, and quantify hemodynamics. A positive pregnancy test with pelvic pain and no intrauterine pregnancy on transvaginal ultrasound is ectopic until proven otherwise. For decelerations: early = head compression (benign), variable = cord compression (reposition), late = placental insufficiency (left lateral, oxygen, fluids, reassess).