Iraqi Board OB/GYN cheat sheet

WHO 2016 antenatal model: eight contacts - first before 12 weeks, then at 20, 26, 30, 34, 36, 38 and 40 weeks; NICE schedules 10 appointments for nullipara and 7 for multipara.

Active first stage of labour (WHO 2014): regular painful contractions with progressive cervical dilatation from 5 cm to 10 cm; the latent phase extends to 5 cm and may not progress linearly.

Second-stage duration limits (ACOG): nullipara 3 h without epidural and 4 h with epidural; multipara 2 h without and 3 h with epidural, before diagnosing arrest.

Primary postpartum haemorrhage: at least 500 mL after vaginal birth or 1000 mL after caesarean within 24 h; uterine atony accounts for about 70–80% of cases.

PPH first-line: oxytocin 10 IU IM/IV; tranexamic acid 1 g IV within 3 h of birth, repeated after 30 min if bleeding continues.

Gestational diabetes screening: 75-g OGTT at 24–28 weeks; IADPSG/WHO thresholds fasting at least 5.1, 1-h at least 10.0, 2-h at least 8.5 mmol/L; one abnormal value diagnoses GDM.

Intrapartum group B streptococcus prophylaxis: penicillin G 5 million IU IV loading then 2.5–3 million IU every 4 h; cefazolin 2 g then 1 g every 8 h for non-severe penicillin allergy.

Postpartum thromboprophylaxis: assess VTE risk; LMWH for at least 6 weeks postpartum in women with prior VTE or high-risk thrombophilia, with dose adjusted for weight and renal function.

Preeclampsia with severe features: BP at least 160/110 mmHg, platelets below 100,000/µL, AST/ALT above 2× upper limit, creatinine above 1.1 mg/dL or doubling, pulmonary oedema, or new cerebral/visual symptoms; delivery at 34 weeks or later.

Low-dose aspirin for preeclampsia prevention: 81 mg daily, started at 12–16 weeks (acceptable 12–28 weeks) in high-risk women and continued to delivery unless local protocol specifies stopping at 36 weeks.

Antiphospholipid syndrome obstetric criteria: at least 3 unexplained consecutive pregnancy losses before 10 weeks, at least 1 fetal death at 10 weeks or later, or at least 1 preterm birth before 34 weeks due to preeclampsia, eclampsia or placental insufficiency.

Preterm antenatal corticosteroids: betamethasone 12 mg IM every 24 h for 2 doses or dexamethasone 6 mg IM every 12 h for 4 doses, between 24 0/7 and 33 6/7 weeks; consider from 22 weeks per local policy.

Magnesium sulphate for fetal neuroprotection: 4 g IV loading over 20–30 min then 1 g/h until delivery for anticipated preterm birth before 32 weeks; monitor reflexes, respiration and urine output.

Uncomplicated dichorionic twins: planned delivery at 37 0/7–37 6/7 weeks; monochorionic diamniotic twins at 36 0/7–36 6/7 weeks; monoamniotic twins at 32–34 weeks.

Fetal growth restriction: estimated fetal weight below the 10th centile plus abnormal umbilical artery Doppler or below the 3rd centile; surveillance with Doppler and delivery timing individualized, often 37 weeks if isolated.

Pregestational diabetes targets: HbA1c below 6.5% preconception; fasting below 5.3, 1-h postprandial below 7.8 and 2-h below 6.7 mmol/L during pregnancy; congenital malformation risk rises with periconception HbA1c.

Cervical cancer screening (ACOG): start cytology at 21; age 30–65 co-test every 5 years or cytology every 3 years; stop at 65 after adequate negative screening and no high-risk history.

WHO 2021 cervical screening: HPV DNA primary test from age 30, repeated every 5–10 years; HPV vaccination for girls 9–14 years, with catch-up to 26.

FIGO 2018 cervical cancer: stage IB1 is 2 cm or less, IB2 is more than 2 to 4 cm, and IB3 is more than 4 cm; stage IIA involves the upper two-thirds of the vagina without parametrial involvement.

Endometrial cancer: the most common gynecologic malignancy in high-income countries; type I endometrioid is oestrogen-driven and associated with obesity, diabetes, nulliparity and tamoxifen.

Ovarian cancer first-line chemotherapy: carboplatin AUC 5–6 plus paclitaxel 175 mg/m² every 3 weeks for 6 cycles; PARP maintenance for BRCA-mutated or HRD-positive advanced disease.

Gestational trophoblastic neoplasia: low-risk disease (WHO score 6 or less) is treated with single-agent methotrexate or actinomycin-D; high-risk disease (score 7 or more) with EMA-CO multi-agent chemotherapy.

Vulvar squamous cell carcinoma: sentinel lymph node biopsy is acceptable for unifocal tumours less than 4 cm with clinically negative groins; lichen sclerosus is a risk factor.

Tumour markers: CA-125 for epithelial ovarian cancer; hCG for gestational trophoblastic disease; AFP for yolk sac tumour; inhibin for granulosa cell tumour; CA 19-9 for pancreatic and colorectal cancer.

PCOS Rotterdam criteria: two of three - oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries (at least 12 follicles 2–9 mm or ovarian volume at least 10 mL); exclude other causes.

WHO ovulation disorder groups: Group I hypothalamic-pituitary failure, Group II PCOS, Group III ovarian failure; letrozole is first-line ovulation induction for PCOS.

WHO 2021 semen reference limits: volume at least 1.4 mL, total sperm at least 39 million, concentration at least 16 million/mL, progressive motility at least 30%, total motility at least 42%, normal morphology at least 4%.

Premature ovarian insufficiency: before age 40 with FSH above 25 IU/L on two occasions at least 4 weeks apart and oestrogen deficiency; HRT is continued until at least age 50.

Recurrent pregnancy loss: at least 3 consecutive clinically recognised losses before 10 weeks; investigate antiphospholipid antibodies, parental karyotype and uterine cavity; most remain unexplained.

IVF OHSS prevention: GnRH antagonist protocol with GnRH agonist trigger and freeze-all in high responders; cabergoline 0.5 mg daily for 8 days may be added.

Endometriosis: laparoscopy with histological confirmation is the diagnostic gold standard; medical therapy treats pain but does not improve fertility, so surgery is preferred for infertility.

Male factor infertility: obstructive azoospermia has normal FSH and testicular volume; non-obstructive azoospermia has elevated FSH; ICSI is used for severe oligospermia or azoospermia with retrieved sperm.

POP-Q staging: stage 0 no prolapse; stage 1 leading point above −1 cm; stage 2 −1 to +1 cm; stage 3 more than +1 cm but not within 2 cm of total vaginal length; stage 4 within 2 cm of total vaginal length or complete eversion.

Stress urinary incontinence: involuntary leakage on effort or sneezing/coughing; pelvic floor muscle training for at least 3 months is first-line; midurethral sling is a standard surgical option.

Overactive bladder: urgency, frequency and nocturia with or without urge incontinence; bladder training plus an antimuscarinic or beta-3 agonist such as mirabegron after excluding infection and malignancy.

Urodynamic stress incontinence: leakage during filling cystometry with increased abdominal pressure but no detrusor contraction; detrusor overactivity shows involuntary contractions during filling.

Vaginal pessary: ring or Gellhorn for prolapse; follow-up for expulsion, erosion and voiding dysfunction; topical oestrogen improves comfort in postmenopausal women.

Apical prolapse: sacrocolpopexy has lower recurrence than native tissue vaginal repair but longer operating time; mesh use requires informed consent and specialist training.

Obstetric vesicovaginal fistula: usually caused by prolonged obstructed labour; repair is delayed until tissue is healthy, often 3 months, and may be transvaginal or transabdominal.

Clean intermittent catheterisation is preferred for incomplete bladder emptying; avoid indwelling catheter beyond the required duration to reduce catheter-associated urinary tract infection.

Bacterial vaginosis (Amsel): at least 3 of thin grey discharge, vaginal pH above 4.5, positive whiff test and clue cells; treat with metronidazole 500 mg twice daily for 7 days or 2 g single dose.

Vulvovaginal candidiasis: KOH microscopy shows pseudohyphae; uncomplicated case treated with fluconazole 150 mg single dose or topical imidazole; recurrent disease needs 6-month suppression.

Trichomoniasis: motile flagellates and pH above 4.5; metronidazole 2 g single dose or 500 mg twice daily for 7 days; treat sexual partners and test for other STIs.

PID minimum criteria: lower abdominal pain plus cervical motion, uterine or adnexal tenderness; CDC 2021 outpatient regimen is ceftriaxone 500 mg IM plus doxycycline 100 mg twice daily and metronidazole 500 mg twice daily for 14 days.

Gonorrhoea treatment: ceftriaxone 500 mg IM single dose; chlamydia: doxycycline 100 mg twice daily for 7 days or azithromycin 1 g single dose; test and treat partners.

Early syphilis: benzathine penicillin G 2.4 million IU IM single dose; late latent or unknown duration: 2.4 million IU IM weekly for 3 doses; penicillin allergy needs desensitisation in pregnancy.

Abnormal uterine bleeding: PALM-COEIN classification; endometrial biopsy for postmenopausal bleeding or age over 45 with irregular bleeding; transvaginal endometrial thickness above 4 mm warrants sampling.

Genital herpes: valaciclovir 1 g twice daily for 7 days for primary episode; suppressive valaciclovir 500 mg daily reduces recurrences; caesarean for active genital lesions at term.

Combined oral contraceptive missed pill: if one pill is late, take it when remembered and continue; if two or more are missed, use backup contraception for 7 days and consider emergency contraception if unprotected sex occurred in the first week.

Emergency contraception: levonorgestrel 1.5 mg within 72 h or ulipristal 30 mg within 120 h; copper IUD within 5 days is the most effective and can be used after ulipristal.

LARC durations: etonogestrel implant 3 years; LNG-IUS 5 years (Mirena) or up to 8 years for contraception; copper IUD 10–12 years depending on device.

DMPA: medroxyprogesterone acetate 150 mg IM every 3 months or 104 mg SC; return to fertility may be delayed up to 12 months after the last injection.

UKMEC category 4 contraindications for combined hormonal contraception include migraine with aura, smoking at least 15 cigarettes/day at age 35 or older, breast cancer, and prior VTE.

Postpartum contraception: LARC can be inserted immediately after vaginal or caesarean birth; progestin-only methods are compatible with breastfeeding; combined methods are avoided in the first 6 weeks if VTE risk.

Medical abortion: mifepristone 200 mg orally followed 24–48 h later by misoprostol 800 µg vaginal, buccal or sublingual; approved regimens up to 10 weeks (70 days) gestation.

Tubal sterilisation: failure risk about 1 in 200; ectopic pregnancy must be excluded if pregnancy occurs after sterilisation; vasectomy is safer and cheaper but not immediately effective.

Dating ultrasound: crown-rump length at 7–13+6 weeks is most accurate; if CRL is more than 84 mm, use head circumference/biparietal diameter; dating by CRL is within about ±5–7 days.

First-trimester combined screening: nuchal translucency at 11 0/7–13 6/7 weeks with CRL 45–84 mm; NT of 3.5 mm or more is associated with increased aneuploidy and structural anomaly risk.

Midtrimester anomaly scan: performed at 18–22 weeks; evaluates intracranial, cardiac, abdominal, renal, spinal and limb anatomy, placenta and cervical length.

Amniocentesis is performed from 15 weeks; CVS at 11–14 weeks; procedure-related miscarriage risk is about 0.1–0.5% in experienced centres.

Umbilical artery Doppler: absent or reversed end-diastolic flow indicates severe placental insufficiency and requires urgent specialist assessment and consideration of delivery.

Middle cerebral artery peak systolic velocity above 1.5 multiples of the median suggests fetal anaemia and is used to guide intrauterine transfusion in red-cell alloimmunisation.

Biophysical profile: five components - fetal breathing, movement, tone, amniotic fluid volume and non-stress test; score 4/10 or less or oligohydramnios warrants delivery assessment.

Risk of Malignancy Index: RMI = CA-125 (U/mL) × menopausal status (1 premenopausal, 3 postmenopausal) × ultrasound score (0–3); RMI above 200 indicates referral to gynae-oncology.

Informed consent requires capacity, adequate disclosure of material risks, benefits and alternatives, voluntariness and documentation; it is a process, not a single signature.

Research ethics framework: Declaration of Helsinki, Belmont Report principles (respect for persons, beneficence, justice), IRB/ethics committee approval, and equipoise for RCTs.

Study designs: randomised controlled trial is best for causal inference; cohort for incidence and prognosis; case-control for rare outcomes; cross-sectional for prevalence.

Diagnostic test formulas: sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); PPV = TP/(TP+FP); NPV = TN/(TN+FN); positive likelihood ratio = sensitivity/(1−specificity).

Number needed to treat = 1/absolute risk reduction; NNH = 1/absolute risk increase; ARR = control event rate − intervention event rate.

GRADE assesses certainty of evidence across risk of bias, inconsistency, indirectness, imprecision and publication bias; recommendations are strong or conditional.

P-value is the probability of the observed or a more extreme result if the null hypothesis is true; a 95% CI excluding the null effect corresponds to p<0.05; power is 1−type II error.

Clinical audit measures practice against standards and improves care; research generates new generalisable knowledge and requires ethics approval and consent.