Gynaecology and Obstetrics: Cycles, Pregnancy and Emergencies
Core content
Obstetrics and gynaecology questions span the menstrual cycle, contraception, infertility, antenatal care, labour and its complications, and gynaecological emergencies. You must understand the hormonal control of the cycle, the physiology of pregnancy including cardiovascular and haematological changes, and the interpretation of antenatal screening. High-yield topics include ectopic pregnancy, pre-eclampsia, postpartum haemorrhage, miscarriage, and the stages of labour.
Traps and discriminations
- Ectopic pregnancy. Any woman of reproductive age with abdominal pain and amenorrhoea needs a pregnancy test before imaging. The trap is attributing pain to a urinary or gastrointestinal cause.
- Pre-eclampsia versus gestational hypertension. Proteinuria or end-organ features define pre-eclampsia; hypertension alone does not.
- Postpartum haemorrhage causes. Remember the four Ts: tone, trauma, tissue, thrombin. Uterine atony is commonest.
- Dating and viability. Use ultrasound criteria carefully; a sac without a fetus is not automatically a failed pregnancy.
- Contraception counselling. Consider contraindications such as migraine with aura and combined hormonal methods.
Worked example: the safety net rule
A woman at 34 weeks presents with headache and visual disturbance. Rule of thumb: check blood pressure and urine protein immediately. Severe hypertension with symptoms requires urgent antihypertensive treatment and magnesium sulphate for seizure prophylaxis, with delivery planned. The exam trap is reassuring the patient because the headache is mild; symptoms in pre-eclampsia can escalate quickly.
Labour and delivery
Know the stages of labour, the partogram, and indications for intervention. Fetal monitoring interpretation is commonly tested: late decelerations suggest placental insufficiency, while variable decelerations suggest cord compression.