Obstetrics and Gynecology / Women's Health
This domain covers antenatal care, common obstetric emergencies, contraception and gynaecological problems that present in the family health unit. The Board tests risk stratification, recognition of the dangerous triad of bleeding, hypertension and infection, and safe prescribing in pregnancy.
Core rules
- Antenatal care: WHO recommends eight contacts (first before 12 weeks, then at 20, 26, 30, 34, 36, 38 and 40 weeks). Each contact includes BP, urine protein, weight, fundal height, fetal heart and danger-sign counselling. Give folic acid 400 micrograms preconceptionally and in the first trimester, iron and calcium as per national protocol, and tetanus toxoid.
- Pre-eclampsia: BP 140/90 or more after 20 weeks plus proteinuria or maternal organ dysfunction. Severe features are BP 160/110 or more, symptoms (headache, visual disturbance, epigastric pain), thrombocytopenia, raised liver enzymes or renal impairment. Magnesium sulphate prevents and treats eclampsia; refer urgently.
- Gestational diabetes: screen with a 75 g OGTT at 24 to 28 weeks in women with risk factors or universally as per local policy.
- Postpartum haemorrhage: the four Ts - tone (atony, commonest), trauma, tissue, thrombin. Give oxytocin 10 IU intramuscularly, uterine massage, tranexamic acid 1 g intravenously within three hours, and transfer.
- Contraception: use WHO Medical Eligibility Criteria. Combined pills are unsuitable with migraine with aura, smoking over 35, or hypertension. Progestogen-only methods suit many of these women.
- Cervical screening: start around age 25 to 30 with cytology or HPV testing, repeating per national interval.
Worked example
A 32-year-old at 34 weeks has BP 165/110, headache and 2+ proteinuria. Reasoning: this is severe pre-eclampsia with symptoms, so admission, antihypertensives (labetalol or nifedipine), magnesium sulphate loading, steroids for fetal lung maturity and planned delivery. Do not simply send her home with analgesia.
Traps that cost marks
- Missing pregnancy before prescribing an ACE inhibitor or statin.
- Treating any bleeding in late pregnancy as labour; placenta praevia is a contraindication to vaginal examination.
- Forgetting the four Ts and delaying tranexamic acid in postpartum haemorrhage.