Obstetrics and Gynecology: Risk Stratification Across Pregnancy
What the candidate must understand
Obstetric questions test the ability to separate normal physiology from pathology at each gestational stage. Know the diagnosis and management of hypertensive disorders of pregnancy, with the distinction between gestational hypertension, preeclampsia with and without severe features, and eclampsia; the causes and initial management of antepartum and postpartum hemorrhage; the recognition of placental abruption and placenta previa; and the principles of preterm labor, premature rupture of membranes, and fetal surveillance. In gynecology, understand abnormal uterine bleeding by age group, the evaluation of an adnexal mass, ectopic pregnancy, and the screening pathways for cervical and breast disease.
Traps that appear in questions
- Performing a digital vaginal examination in suspected placenta previa; ultrasound first.
- Treating hypertension in pregnancy without considering magnesium sulfate for seizure prophylaxis in severe preeclampsia.
- Missing ectopic pregnancy in a woman with abdominal pain and a positive pregnancy test, even with a normal-looking ultrasound.
- Confusing the timing of Rh immunoglobulin administration and the indications for anti-D prophylaxis.
- Choosing a contraceptive without checking for contraindications such as migraine with aura or uncontrolled hypertension.
Worked example: severe preeclampsia
A woman at 34 weeks has blood pressure 165/110 mmHg, platelets 90, and elevated liver enzymes. This is preeclampsia with severe features. The rule of thumb: give magnesium sulfate for seizure prophylaxis, treat blood pressure with agents safe in pregnancy such as labetalol or nifedipine, and plan delivery after stabilization, with corticosteroids for fetal lung maturity if gestational age permits and the maternal condition allows.
Rule of thumb
In pregnancy, maternal stabilization comes first, but gestational age always modifies the plan; state the gestational age before choosing management.