Obstetrics and Gynaecology: Safety First in Two Patients
What you must understand
O&G questions test recognition of conditions where delay harms mother or fetus. Core content: (1) early pregnancy bleeding - ectopic pregnancy (always exclude in any woman of reproductive age with abdominal pain), miscarriage types, gestational trophoblastic disease; (2) hypertensive disorders - pre-eclampsia, eclampsia, HELLP syndrome; (3) antepartum haemorrhage - placenta praevia and abruption; (4) labour and delivery - fetal monitoring, shoulder dystocia, postpartum haemorrhage, cord prolapse; (5) gynaecology - abnormal uterine bleeding, pelvic inflammatory disease, ovarian torsion, contraception and emergency contraception; (6) screening and prevention - cervical screening, antenatal screening, anti-D prophylaxis, vaccination in pregnancy.
Traps that appear
- Never perform a digital vaginal examination in suspected placenta praevia or until praevia is excluded.
- Assuming pregnancy is excluded by a history of "periods" - always confirm with a pregnancy test.
- Confusing pre-eclampsia (proteinuria/oedema, hypertension) with gestational hypertension.
- Missing that a woman with an ectopic may have no vaginal bleeding.
- Choosing an intervention for the fetus when the mother is unstable - stabilise the mother first.
Rule of thumb
Any reproductive-age woman with abdominal pain or syncope gets a pregnancy test and urine dipstick. For pain plus a positive test, exclude ectopic before anything else.
Worked example
A 30-year-old woman, 7 weeks pregnant by dates, presents with sharp left iliac fossa pain and light spotting. Examination shows left adnexal tenderness. Which is the most appropriate next step? The answer is urgent pelvic ultrasound with quantitative beta-hCG and close observation for ectopic pregnancy - not reassurance, and not a routine antenatal booking.