Obstetrics and Gynecology / Women's Health
Obstetrics and women’s health in family practice covers antenatal care, common complaints, contraception, abnormal bleeding, menopause and prompt recognition of obstetric emergencies. The exam tests risk stratification and referral, not operative obstetrics.
Core rules
- Start folic acid before conception and in early pregnancy; review medicines for teratogenicity.
- Antenatal visits monitor blood pressure, urine protein, fundal growth, fetal movements and maternal wellbeing.
- Pre-eclampsia is hypertension after 20 weeks plus proteinuria or maternal organ dysfunction; severe features demand urgent referral.
- Contraception counselling compares effectiveness, adherence, contraindications and non-contraceptive benefits.
- Postmenopausal bleeding requires investigation for endometrial pathology.
- Emergency contraception is time-sensitive; a copper intrauterine device is the most effective option when suitable.
- Ectopic pregnancy can present with pain and bleeding before a scan; assess for shock and refer urgently.
Worked example
A 32-year-old at 33 weeks has headache, visual flashes and BP 162/108 mmHg; urine protein is 2+. The reasoning: this is pre-eclampsia with severe features until proven otherwise. Arrange urgent obstetric assessment, monitor blood pressure, check platelet count, liver enzymes, creatinine and fetal status, and avoid isolated antihypertensive treatment without delivery planning. Do not send her home with analgesia alone.
Traps
Dismissing headache in pregnancy as migraine; using ACE inhibitors in pregnancy; assuming all vaginal bleeding is menstruation; and failing to ask about thrombosis risk before combined hormonal contraception.