Obstetrics and Gynecology
Obstetrics dominates this domain: hypertensive disorders, hemorrhage, preterm labor, and the acute abdomen in pregnancy. Gynecology adds ectopic pregnancy, contraception, cervical screening and gynecologic oncology.
Core rules
- Postpartum hemorrhage: uterine atony is the commonest cause. Uterine massage, oxytocin, then tranexamic acid, balloon tamponade, and surgery; give blood early.
- Preeclampsia: blood pressure ≥140/90 after 20 weeks plus proteinuria or end-organ dysfunction; severe features include ≥160/110, platelets <100,000, raised transaminases, renal impairment, pulmonary edema, visual or cerebral symptoms.
- Magnesium sulfate prevents and treats eclampsia; delivery is the definitive treatment. Never use ACE inhibitors or ARBs in pregnancy.
- Ectopic pregnancy: any woman of reproductive age with abdominal pain or syncope needs a pregnancy test; a positive result with an empty uterus and free fluid is an ectopic until proven otherwise. Unstable → laparoscopy.
- Gestational diabetes: screen at 24–28 weeks; metformin or insulin.
Worked example
A woman at 34 weeks has a blood pressure of 168/112 mmHg, headache, platelets 88,000, AST 120 U/L and creatinine 1.3 mg/dL. Reasoning: severe preeclampsia with HELLP features. Admit to a monitored bed, start magnesium sulfate for seizure prophylaxis, give intravenous labetalol (or hydralazine/nifedipine) to bring pressure below 160/110, give antenatal corticosteroids, and deliver once stabilized - severe features at 34 weeks justify delivery. The trap is treating the blood pressure alone and omitting magnesium.
Traps that cost marks
- Diagnosing migraine or gastroenteritis in a pregnant woman with headache and hypertension.
- Missing abruption behind a "normal" ultrasound.
- Expectant management beyond stabilization when severe features are present.