Obstetrics and Gynecology: Prenatal Care, Bleeding, and Contraception
The Obstetrics and Gynecology domain tests prenatal care, common gynecologic problems, contraception, menopause, and pregnancy emergencies. The CFPC expects a family physician to risk-stratify pregnancy, recognize ectopic pregnancy and preeclampsia, provide postpartum care, and offer contraception concordant with the Canadian Contraception Consensus. The exam favours structured assessment and clear disposition over exhaustive lists.
Core rules and concepts
- Prenatal care: confirm gestational age, review medications, provide folic acid, screen for infections and gestational diabetes, offer prenatal genetic screening, and arrange anatomy ultrasound.
- Preeclampsia: new hypertension after 20 weeks with proteinuria or end-organ dysfunction; assess symptoms, blood pressure, platelets, liver enzymes, and creatinine; arrange urgent obstetric review.
- First-trimester bleeding: quantitative beta-hCG and transvaginal ultrasound; ectopic pregnancy is the diagnosis to exclude. Check Rh status and give anti-D immunoglobulin if Rh-negative.
- Contraception: review contraindications, effectiveness, and patient preference; long-acting reversible contraception is first-line for many patients.
- Postpartum care: screen for postpartum depression, assess breastfeeding, and discuss contraception and immunization.
Worked example
A 28-year-old woman, gravida 2 para 1, presents at 8 weeks by last menstrual period with cramping and light vaginal bleeding. She is hemodynamically stable. Her cervix is closed; there is no adnexal tenderness.
Reasoning: obtain a quantitative beta-hCG and transvaginal ultrasound. If the uterus is empty and beta-hCG is above the discriminatory zone, treat as pregnancy of unknown location or suspected ectopic until proven otherwise; arrange close follow-up and repeat beta-hCG in 48 hours. Check blood group and Rh; give anti-D if Rh-negative. Review pain and bleeding precautions and return precautions. Do not reassure with a single normal examination. The key feature is excluding ectopic pregnancy and arranging safe follow-up.
Traps that cost marks
- Missing ectopic pregnancy in a stable patient with bleeding.
- Forgetting Rh status and anti-D immunoglobulin.
- Not checking blood pressure and urine protein at prenatal visits.
- Offering contraception without reviewing contraindications.
- Failing to screen for postpartum depression.