Czech Gynaecology and Obstetrics Board Exam cheat sheet

Prenatal visit schedule in the Czech Republic: first visit as early as possible (ideally before 10+0 weeks), then every 4 weeks to 28 weeks, every 2 weeks to 36 weeks, then weekly until delivery; a minimum of 9 visits is required for a normal pregnancy.

Physiological plasma volume rises ~40–50% by 32 weeks; red cell mass rises only ~20–25%, so dilutional anaemia is physiological - Hb <105 g/L in the 2nd–3rd trimester is the threshold for investigating iron deficiency.

Cardiac output increases 30–50%, peaking around 28–32 weeks; heart rate rises 10–20/min, blood pressure falls 5–10 mmHg in mid-pregnancy and returns to baseline at term.

First-trimester combined screening (11+0–13+6 weeks): nuchal translucency, free β-hCG, PAPP-A plus maternal age; detection of trisomy 21 around 85–90% at a 3–5% false-positive rate.

Second-trimester biochemistry (15–20 weeks): AFP, total or free β-hCG, uE3, inhibin-A (quadruple test) - used when combined screening was missed.

Gestational age is set by crown–rump length at 7–13+6 weeks (CRL); after 14 weeks use biparietal diameter/head circumference, femur length and abdominal circumference.

OGTT (75 g) at 24–28 weeks is the standard for gestational diabetes screening; fasting glucose ≥5.1 mmol/L, 1-hour ≥10.0 mmol/L or 2-hour ≥8.5 mmol/L is diagnostic.

Folic acid 400 µg daily from at least 4 weeks before conception to the end of the first trimester; 5 mg daily for prior neural tube defect, diabetes, obesity (BMI >30), epilepsy on valproate/carbamazepine.

Anti-D prophylaxis for RhD-negative non-sensitised women: 250–300 µg (1500 IU) at 28 weeks (and often 34 weeks) plus within 72 hours of delivery, abortion, amniocentesis or antepartum haemorrhage.

Preeclampsia definition: hypertension ≥140/90 mmHg on two occasions ≥4 h apart after 20 weeks plus proteinuria ≥300 mg/24 h (or protein/creatinine ratio ≥30 mg/mmol), or hypertension with maternal organ dysfunction (thrombocytopenia <100×10⁹/L, renal, hepatic, neurological or pulmonary involvement, or uteroplacental dysfunction).

Severe features: BP ≥160/110 mmHg, platelets <100×10⁹/L, ALT/AST >2× upper limit, creatinine >97 µmol/L, pulmonary oedema, new headache or visual symptoms; delivery is the definitive treatment and magnesium sulphate (4 g IV loading, 1 g/h) prevents/treats eclampsia.

Aspirin 75–150 mg nightly from 12–16 weeks reduces early preeclampsia in high-risk women (prior preeclampsia, chronic hypertension, diabetes, renal disease, autoimmune disease, multiple pregnancy).

Preterm labour: tocolysis buys 48 hours for antenatal corticosteroids (betamethasone 12 mg IM ×2, 24 h apart) at 24+0–34+0 weeks; magnesium sulphate before 32 weeks reduces cerebral palsy.

PPROM before 34 weeks: expectant management with antibiotics (erythromycin or penicillin), corticosteroids, and delivery by 34 weeks unless infection or fetal compromise supervenes.

RhD alloimmunisation: rising anti-D titres, middle cerebral artery peak systolic velocity >1.5 multiples of the median indicates fetal anaemia; treat with intrauterine transfusion.

Gestational diabetes targets: fasting <5.3 mmol/L, 1-hour postprandial <7.8 mmol/L, 2-hour <6.7 mmol/L; metformin or insulin if diet fails; delivery usually 38–40 weeks.

Twin pregnancy: dichorionic delivered around 37–38 weeks, monochorionic-diamniotic around 36–37 weeks; monochorionic twins need ultrasound surveillance for twin-to-twin transfusion syndrome every 2 weeks from 16 weeks.

Placenta praevia: painless bleeding, avoid digital/vaginal examination; delivery by caesarean at 36–37 weeks for major praevia; vasa praevia requires elective caesarean before labour.

First stage: latent phase to 5 cm with irregular contractions; active phase from 5 cm, expected dilatation ≥1 cm/h in nulliparas; full dilatation = 10 cm.

Second stage: in nulliparas birth expected within 3 hours (with epidural), in multiparas within 2 hours; prolonged second stage is an indication for operative vaginal delivery or caesarean.

Cardiotocography: baseline 110–160 bpm, variability 5–25 bpm, accelerations ≥15 bpm for 15 s; decelerations - early (head compression, benign), variable (cord compression), late (uteroplacental insufficiency).

Category III/abnormal CTG: late or prolonged decelerations with reduced variability - act immediately: maternal left lateral position, IV fluid, stop oxytocin, consider tocolysis and expedite delivery.

Operative vaginal delivery prerequisites: full dilatation, engaged head at or below station 0, known position, empty bladder, adequate analgesia, no cephalopelvic disproportion, experienced operator; ventouse for mid-cavity, forceps for rotation/aftercoming head.

Shoulder dystocia: McRoberts manoeuvre plus suprapubic pressure first; then internal rotation (Woods screw, Rubin II), posterior arm delivery, all-fours; never fundal pressure or excessive traction.

Postpartum haemorrhage: >500 mL after vaginal or >1000 mL after caesarean birth; first-line - uterine massage, oxytocin 5 IU slow IV/10 IU IM, tranexamic acid 1 g IV within 3 hours, then ergometrine, carboprost, misoprostol; balloon tamponade or surgery if refractory.

Uterine inversion: do not remove the placenta before replacement; replace manually with tocolysis and resuscitation, then give uterotonics after replacement.

Cord prolapse: elevate presenting part, fill bladder or use tocolysis, immediate caesarean if not fully dilated; in theatre, consider vaginal delivery if fully dilated and head low.

Cervical cancer screening: cytology (Pap) from 15 years historically, now HPV testing as primary screening from 30 years in the Czech programme; colposcopy for abnormal results, ASC-US/HPV-positive or LSIL+ triage.

Cervical cancer staging is clinical (FIGO 2018) with imaging allowed: stage IB1 ≤2 cm, IB2 >2 cm to ≤4 cm, IB3 >4 cm; early stages treated surgically (radical hysterectomy with pelvic lymphadenectomy or sentinel node), locally advanced with chemoradiotherapy (cisplatin + external beam + brachytherapy).

Endometrial cancer: most common gynaecological malignancy; risk factors - obesity, unopposed oestrogen, diabetes, nulliparity, tamoxifen, Lynch syndrome; diagnosis by endometrial biopsy; treatment total hysterectomy with bilateral salpingo-oophorectomy ± lymphadenectomy.

Ovarian cancer: CA-125 for monitoring, transvaginal ultrasound for adnexal masses; risk of malignancy index (RMI) = CA-125 × menopausal status × ultrasound score; suspected early disease requires staging laparotomy; advanced disease - debulking plus platinum–taxane chemotherapy.

Germ cell tumours (dysgerminoma, yolk sac, immature teratoma) occur in young women; markers AFP, β-hCG, LDH; fertility-sparing surgery plus BEP chemotherapy.

Breast cancer: triple assessment - clinical examination, imaging (mammography from 45 years in the Czech screening programme, ultrasound in dense breasts/young women) and core biopsy; receptor status ER/PR/HER2 guides endocrine or anti-HER2 therapy.

Breast cancer risk factors: age, early menarche, late menopause, nulliparity, HRT >5 years, obesity postmenopause, alcohol, BRCA1/2 mutations; BRCA carriers offered risk-reducing mastectomy or salpingo-oophorectomy.

Gestational trophoblastic disease: complete mole - 46,XX (all paternal), high β-hCG, snowstorm ultrasound; follow β-hCG to zero, chemotherapy (methotrexate) if plateau or rise.

Abnormal uterine bleeding (PALM-COEIN): structural - polyp, adenomyosis, leiomyoma, malignancy; non-structural - coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified.

Endometriosis: ectopic endometrial tissue; dysmenorrhoea, deep dyspareunia, chronic pelvic pain, infertility; diagnosis by laparoscopy (visual + histology); treatment - NSAIDs, combined oral contraceptives, progestins, GnRH agonists, surgical excision.

Adenomyosis: endometrial glands within myometrium; bulky tender uterus, heavy painful periods; ultrasound/MRI shows asymmetric thickening, myometrial cysts; treatment hormonal or hysterectomy.

Uterine fibroids: FIGO classification 0–8; submucosal (0–2) cause heavy bleeding and infertility - hysteroscopic resection; intramural/subserosal - myomectomy or embolisation; hysterectomy if family complete.

Ovarian cysts: simple cysts <5 cm in premenopausal women can be followed; complex or persistent masses need RMI and gynaecological oncology referral; torsion presents with acute pain and requires urgent laparoscopy.

Pelvic organ prolapse quantification (POP-Q): points Aa, Ba, C, D, Ap, Bp, gh, pb, tvl; stage I >−1 cm, stage II −1 to +1 cm, stage III >+1 cm but not complete, stage IV complete eversion.

Stress urinary incontinence: leakage with effort/sneeze; urodynamics optional; conservative treatment - pelvic floor muscle training 3 months, weight loss, vaginal pessary; surgery - tension-free vaginal tape or colposuspension.

Overactive bladder: urgency, frequency, nocturia with or without urge incontinence; bladder training, antimuscarinics or mirabegron, intradetrusor botulinum toxin, sacral neuromodulation.

Infertility definition: failure to conceive after 12 months of regular unprotected intercourse (6 months if woman ≥35 years); investigate both partners - semen analysis, ovulation assessment, tubal patency and uterine cavity.

Ovulation assessment: cycle length 21–35 days, mid-luteal progesterone >16 nmol/L (or >30 nmol/L depending on assay), basal body temperature, urinary LH kits; day 2–5 FSH/LH, oestradiol and AMH for ovarian reserve.

PCOS (Rotterdam criteria, 2 of 3): oligo/anovulation, clinical or biochemical hyperandrogenism, polycystic ovaries on ultrasound (≥12 follicles 2–9 mm or ovarian volume ≥10 mL); treatment - lifestyle, metformin, letrozole or clomiphene, gonadotropins, IVF.

WHO anovulation groups: group I (hypogonadotropic, low FSH - pulsatile GnRH or gonadotropins), group II (normogonadotropic, PCOS - clomiphene/letrozole), group III (hypergonadotropic, ovarian failure - donor oocytes).

Controlled ovarian stimulation: antagonist or long agonist protocol; hCG trigger at ≥3 follicles ≥17–18 mm; OHSS prevention - freeze-all, cabergoline, GnRH agonist trigger in antagonist cycles.

IVF/ICSI: ICSI for severe male factor, previous fertilisation failure, or preimplantation genetic testing; embryo transfer day 3 or blastocyst day 5; single embryo transfer is recommended to reduce multiple pregnancy.

Luteal phase support with vaginal progesterone after IVF; pregnancy test 12–14 days after transfer; ectopic pregnancy must be excluded by early ultrasound.

Menopause: FSH >30 IU/L with 12 months amenorrhoea; HRT is the most effective treatment for vasomotor symptoms; combined oestrogen–progestogen for women with a uterus to protect the endometrium.

Anterior compartment prolapse = cystocele; posterior = rectocele; apical = uterine/vault prolapse; enterocoele involves the pouch of Douglas.

Pelvic floor muscle training is first-line for stress and mixed urinary incontinence - supervised programme for at least 3 months before surgery.

Urodynamic stress incontinence is demonstrated by involuntary leakage during filling cystometry with increased abdominal pressure, in the absence of detrusor contraction.

Tension-free vaginal tape (TVT) or transobturator tape (TOT) for stress incontinence; complications - bladder/vessel injury, tape erosion, voiding dysfunction, de novo urgency.

Colposuspension (Burch) is an alternative for stress incontinence, especially with concurrent abdominal prolapse surgery; success rates around 70–80% at 5 years.

Sacrospinous fixation or sacrocolpopexy for apical prolapse; vaginal hysterectomy with McCall culdoplasty for uterine prolapse; mesh use is restricted after safety warnings and requires informed consent.

Pessaries are a valid conservative option for prolapse and incontinence in frail or elderly women; follow-up for erosion and discharge.

Recurrent urinary tract infection in women: ≥3 episodes/year or ≥2 in 6 months; consider post-void residual, pelvic floor dysfunction and oestrogen deficiency; vaginal oestrogen reduces recurrence in postmenopausal women.

Laparoscopy: pneumoperitoneum with CO₂ at 12–15 mmHg; open (Hasson) entry for previous abdominal surgery, obesity or suspected adhesions; Veress needle at Palmer's point in obese women.

Absolute contraindications to laparoscopy include haemodynamic instability, severe cardiopulmonary disease, and bowel obstruction with distension; relative - large masses, extensive adhesions, pregnancy beyond certain stages.

Diagnostic laparoscopy for chronic pelvic pain and suspected endometriosis; operative - adhesiolysis, endometrioma stripping, myomectomy, hysterectomy, salpingectomy for ectopic.

Hysteroscopy: distension with saline (bipolar) or glycine/sorbitol (monopolar); fluid deficit limit 1000 mL with saline, 750 mL with hypotonic media - risk of TURP syndrome (hyponatraemia, hypervolaemia).

Hysteroscopic resection of submucosal fibroids (types 0–2), polyps, uterine septum and intrauterine adhesions (Asherman); diagnostic hysteroscopy for abnormal uterine bleeding and infertility.

Laparoscopic hysterectomy approaches: total (LTH), supracervical (LSH), and laparoscopically assisted vaginal (LAVH); ureter identification crucial at the pelvic brim and crossing the uterine artery.

Complications of laparoscopy: trocar injury to vessels or bowel, gas embolism, subcutaneous emphysema, port-site hernia, thermal injury; early recognition and conversion to laparotomy if needed.

Enhanced recovery after surgery: avoid prolonged fasting, multimodal analgesia, early mobilisation and feeding, limited drains and catheters - shortens hospital stay after gynaecological surgery.

Bacterial vaginosis: clue cells, thin grey discharge, pH >4.5, positive whiff test; treatment metronidazole 400–500 mg twice daily for 5–7 days or vaginal clindamycin; partner treatment not required.

Vulvovaginal candidiasis: thick white discharge, itching, pH <4.5; topical imidazole or oral fluconazole 150 mg single dose; recurrent disease needs longer induction and maintenance.

Trichomoniasis: frothy yellow-green discharge, motile trichomonads on wet mount; treat with metronidazole 2 g single dose and treat partners.

Chlamydia trachomatis: most common bacterial STI; nucleic acid amplification test on first-void urine or swab; doxycycline 100 mg twice daily for 7 days or azithromycin 1 g; test and treat partners; complications - PID, ectopic pregnancy, tubal infertility.

Gonorrhoea: ceftriaxone 1 g IM single dose (plus azithromycin in some guidelines); culture for resistance; co-infections with chlamydia common.

Syphilis: VDRL/RPR screening with treponemal confirmation (TPHA, ELISA); benzathine penicillin G 2.4 million IU IM for early syphilis; screen in pregnancy to prevent congenital syphilis.

HPV: types 16 and 18 cause about 70% of cervical cancers; vaccination is recommended for girls and boys before sexual debut; condoms reduce but do not eliminate transmission.

HIV in pregnancy: combined antiretroviral therapy, viral load suppression, elective caesarean if high viral load, avoid breastfeeding; vertical transmission can be reduced below 1%.

Hepatitis B: universal antenatal HBsAg screening; newborns of HBsAg-positive mothers receive vaccine plus immunoglobulin within 12 hours.

Dating scan 7–13+6 weeks: confirm intrauterine pregnancy, number of gestations, chorionicity, crown–rump length for dating; viability by fetal heart activity.

First-trimester screening 11+0–13+6 weeks: nuchal translucency, nasal bone, ductus venosus, tricuspid flow; combined with biochemistry for aneuploidy risk.

Second-trimester anomaly scan 18–22 weeks: assess fetal anatomy (brain, face, spine, heart, abdominal wall, kidneys, limbs), placental localisation, amniotic fluid and cervical length.

Fetal growth assessment: estimated fetal weight from head circumference, biparietal diameter, abdominal circumference and femur length; growth restriction defined as EFW or AC <10th centile with Doppler abnormalities.

Umbilical artery Doppler: absent or reversed end-diastolic flow indicates severe placental insufficiency and prompts delivery depending on gestational age.

Ovarian ultrasound: simple cyst anechoic thin-walled; endometrioma homogeneous low-level echoes; dermoid with echogenic shadowing; malignancy features - thick septa, solid areas, ascites, papillary projections.

IOTA simple rules and RMI help triage adnexal masses; postmenopausal cysts >5 cm or any complex cyst warrant gynaecological oncology referral.

Hysterosalpingography assesses tubal patency and uterine cavity; saline infusion sonohysterography is better for intracavitary lesions; MRI is used for staging gynaecological malignancy and complex endometriosis.

Informed consent is required for every diagnostic and therapeutic procedure; the patient has the right to refuse treatment, to be informed of alternatives, and to withdraw consent at any time.

Medical confidentiality applies to all health information; disclosure without consent is permitted only where required by law (e.g. certain infectious diseases, gunshot wounds, child abuse) or with patient consent.

Abortion in the Czech Republic is legal on request up to 12 weeks of gestation, with a waiting period and counselling; later termination only for genetic or maternal indications under statutory conditions.

Sterilisation requires the patient's written request and informed consent, with a waiting period; it is not performed on request for minors or persons without legal capacity except on strict medical grounds.

Assisted reproduction is regulated: written informed consent of both partners, age limits, limits on embryo transfer numbers to reduce multiple pregnancy, and rules on anonymous gamete donation.

The Czech health-care system is based on statutory public health insurance with competing insurers; care is financed through insurance, and emergency care must be provided regardless of insurance status.

Patients have the right to access their medical records and to receive a copy; documentation must be kept for statutory periods and handled under GDPR.

Mandatory reporting: selected infectious diseases, suspected child abuse or domestic violence, and certain occupational diseases must be reported to public health authorities.

Cardiopulmonary resuscitation: chest compressions 100–120/min at 5–6 cm depth, ratio 30:2, early defibrillation for shockable rhythms (VF/pVT); adrenaline 1 mg IV every 3–5 min in non-shockable and after the third shock in shockable rhythms.

In pregnancy beyond 20 weeks, perform manual left uterine displacement during CPR and prepare perimortem caesarean within 4–5 minutes if no return of spontaneous circulation.

Anaphylaxis: intramuscular adrenaline 0.5 mg (0.5 mL of 1:1000) into the anterolateral thigh, repeat after 5 minutes; IV fluids, oxygen, remove trigger, antihistamine and corticosteroid as adjuncts.

Ectopic pregnancy: suspect with amenorrhoea, abdominal pain and positive hCG; transvaginal ultrasound shows empty uterus with adnexal mass or free fluid; haemodynamically unstable - urgent laparoscopy/laparotomy; stable - methotrexate if criteria met.

Ovarian torsion: sudden severe unilateral pain with nausea and vomiting; Doppler may be normal; urgent laparoscopy with detorsion and ovarian preservation.

Perioperative care: VTE risk assessment, thromboprophylaxis with low-molecular-weight heparin for major gynaecological surgery, early mobilisation, correction of anaemia, and antibiotic prophylaxis for hysterectomy and caesarean.

Sepsis: take cultures, measure lactate, give broad-spectrum antibiotics within 1 hour, 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L, vasopressors if MAP <65 mmHg.

Massive haemorrhage: activate massive transfusion protocol, give tranexamic acid 1 g IV, balanced transfusion (plasma:red cells:platelets), keep the patient warm and monitor calcium and coagulation.