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EFOG-EBCOG Part 1 study materials
EFOG-EBCOG Part 1 study resources

EFOG-EBCOG Part 1: Obstetrics

EFOG-EBCOG Part 1 · Work through your exam, one topic at a time.

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Obstetrics

Domain overview

The Obstetrics domain of EFOG-EBCOG Part 1 tests the application of basic science and guideline-based care to pregnancy, labour, delivery and the puerperium. Questions often combine physiology with a clinical scenario: hypertension, haemorrhage, fetal surveillance, preterm labour and diabetes are recurring themes. Use definitions and thresholds precisely.

Core rules

  • Pre-eclampsia: new hypertension after 20 weeks plus proteinuria or maternal organ dysfunction/uteroplacental dysfunction. Severe features include BP ≥160/110 mmHg, platelets <100 ×10⁹/L, ALT or AST >70 IU/L, creatinine >90 µmol/L, pulmonary oedema, or cerebral/visual symptoms. Antihypertensives: labetalol, nifedipine, hydralazine. Magnesium sulphate for eclampsia or severe pre-eclampsia: 4 g IV loading over 20 min, then 1 g/hour; monitor respiratory rate, reflexes and urine output.
  • Postpartum haemorrhage: ≥500 mL after vaginal birth or ≥1000 mL after caesarean. Causes: tone, trauma, tissue, thrombin. Give oxytocin first-line, tranexamic acid 1 g IV within 3 hours, and escalate to balloon tamponade, uterine artery embolisation or hysterectomy.
  • Preterm labour <37 weeks: antenatal corticosteroids between 24 and 34 weeks (betamethasone 12 mg IM, two doses 24 hours apart); magnesium sulphate for neuroprotection if <32 weeks; tocolysis only to buy time for steroids/transfer.
  • Gestational diabetes: 75-g OGTT at 24–28 weeks; IADPSG/WHO thresholds fasting ≥5.1, 1-hour ≥10.0, 2-hour ≥8.5 mmol/L.

Worked example

A 32-year-old at 34 weeks has BP 165/112 mmHg, 3+ proteinuria, platelets 95 ×10⁹/L and ALT 120 IU/L. The diagnosis is severe pre-eclampsia. She needs admission, IV labetalol to bring BP below 160/110, magnesium sulphate, betamethasone, and delivery after stabilisation because she is ≥34 weeks with severe features. Reasoning: the platelet and ALT values are severe features, so expectant management is not appropriate.

Traps

  • Do not diagnose pre-eclampsia from BP alone without proteinuria or organ/uteroplacental dysfunction; do not withhold magnesium in eclampsia; do not delay delivery for a full steroid course when severe features are present at ≥34 weeks; tranexamic acid after 3 hours is less effective.