UKOM SpOG common mistakes
UKOM SpOG · Understand the traps and how to avoid them.
Choosing the management option that is correct in a non-pregnant adult (e.g., giving an ACE inhibitor for hypertension, warfarin for anticoagulation, or a tetracycline for infection) instead of the pregnancy-compatible alternative.
Candidates revise general medicine and gynecology separately and never build a pregnancy-specific formulary, so under time pressure they retrieve the familiar drug rather than the safe one.
What to do instead
Build a one-page 'drugs to avoid in pregnancy' table (ACE inhibitors/ARBs, warfarin, tetracyclines, fluoroquinolones, valproate, isotretinoin, methotrexate) with the safe substitute beside each, and rehearse it against hypertension, UTI, epilepsy, and VTE vignettes.
Managing pre-eclampsia as a single decision (deliver now) without separating the three parallel tracks: antihypertensive control, magnesium sulfate for seizure prophylaxis in severe disease, and timing of delivery by gestational age.
Pre-eclampsia questions bundle several actions, and candidates latch onto the most dramatic one (delivery) and forget that at 30 weeks the correct answer is usually stabilize, treat, give steroids, and deliver only for maternal or fetal deterioration.
What to do instead
For every pre-eclampsia stem, write three lines before answering: BP target and agent (labetalol/hydralazine/nifedipine), MgSO4 yes/no with criteria (severe features), and delivery timing by gestation and maternal-fetal status.
Interpreting a CTG in isolation from the clinical context, calling a trace 'normal' or 'pathological' without stating baseline rate, variability, accelerations, decelerations, and contraction frequency, and without acting on a pathological feature.
Candidates learn CTG as pattern recognition and skip the structured description, so they miss that a single prolonged deceleration or absent variability with contractions changes management regardless of the rest of the trace.
What to do instead
Practise a fixed reporting sequence (baseline, variability, accelerations, decelerations, contractions, category) on 20 traces, and state the action for each category: continue, conservative measures, fetal scalp stimulation, or expedite delivery.
Treating the second stage of labor as 'wait and push' and failing to recognize when to assist (vacuum/forceps) versus when to proceed to caesarean, and not distinguishing prolonged second stage from obstructed labor.
The definitions of prolonged second stage differ by parity and epidural use, and candidates memorize numbers without linking them to station, position, and fetal status, which actually drive the decision.
What to do instead
Learn the thresholds (nulliparous vs multiparous, with and without epidural) alongside the prerequisites for operative vaginal delivery (full dilatation, engaged head, known position, adequate pelvis, empty bladder, anesthesia, willingness to abandon) and the contraindications.
Missing postpartum hemorrhage as the cause of maternal collapse and instead pursuing pulmonary embolism or sepsis first, or failing to escalate through the uterotonic sequence and balloon/tamponade when bleeding continues.
Collapse vignettes cue 'PE' strongly, and candidates do not apply the simple rule that bleeding is the commonest cause of early postpartum collapse until proven otherwise.
What to do instead
Drill the PPH algorithm as a timed sequence: call for help, assess tone/tissue/trauma/thrombin, bimanual massage, oxytocin, then ergometrine/carboprost/misoprostol, tranexamic acid, balloon tamponade, and hysterectomy, with blood products early.
Staging gynecologic cancers from memory without applying the current FIGO system, and confusing clinical staging (vulva, cervix) with surgical staging (endometrium, ovary).
FIGO staging is revised periodically and candidates mix older editions with new ones, or apply surgical staging principles to cancers still staged clinically.
What to do instead
Maintain a one-page current FIGO table per site (vulva, cervix, endometrium, ovary) and annotate which are clinical versus surgical; re-verify against the latest FIGO publication before the exam.
Investigating anovulatory bleeding or infertility with the wrong first-line test, e.g., ordering an endometrial biopsy or laparoscopy before confirming ovulation, or misreading day-21 progesterone timing.
Candidates conflate the workup sequence for different presentations and forget that confirming ovulation and excluding thyroid/prolactin disorders precede invasive testing.
What to do instead
Learn a fixed infertility workup order (ovulation confirmation, semen analysis, tubal assessment, uterine cavity, then endocrine screen) and the correct timing of mid-luteal progesterone relative to the expected ovulation day.
Classifying urinary incontinence by symptom alone and recommending surgery before conservative therapy, or confusing urgency incontinence with stress incontinence in the urodynamic description.
The words 'leak with cough' and 'leak with urgency' appear in similar stems, and candidates skip the step of confirming diagnosis and trying pelvic floor muscle training and bladder training first.
What to do instead
For each incontinence stem, state the type, the confirmatory test (urodynamics where indicated), and the stepped management: lifestyle, pelvic floor training, bladder training, medication for overactive bladder, then surgery for stress incontinence.
Treating pelvic inflammatory disease or vaginitis with a single agent and omitting partner treatment, or failing to remove an IUD only when indicated rather than routinely.
Candidates memorize one drug name per condition and forget that PID requires broad coverage (e.g., ceftriaxone plus doxycycline plus metronidazole) and that partner notification is part of the answer.
What to do instead
Build a table of gynecologic infections with first-line regimen, pregnancy alternative, partner treatment, and criteria for inpatient therapy or IUD removal, and check each element in the stem.
Ordering or interpreting antenatal fetal surveillance (CTG, biophysical profile, Doppler, amniotic fluid assessment) without linking the result to gestational age, indication, and the next step, or misreading a biophysical profile score.
Surveillance tests are taught as separate skills, so candidates score the test but cannot decide whether to repeat, deliver, or escalate, and they confuse acute with chronic hypoxia markers.
What to do instead
For each surveillance modality, memorize what it detects (acute vs chronic hypoxia), its false-positive behavior, and the management threshold; practise BPP scoring and umbilical artery Doppler interpretation against clinical scenarios.
In an obstetric emergency (shoulder dystocia, cord prolapse, eclampsia, maternal cardiac arrest), listing the correct maneuvers but in the wrong order or omitting the immediately life-saving step.
Candidates recall the set of maneuvers but not the sequence, and under exam pressure they start with a later step such as fundal pressure (contraindicated) or skip calling for help and positioning.
What to do instead
Rehearse each emergency as a numbered drill with the first three actions and the contraindicated actions explicitly, e.g., shoulder dystocia: call, McRoberts, suprapubic pressure, then internal maneuvers, never fundal pressure.