Iraqi Board OB/GYN common mistakes
Iraqi Board OB/GYN · Understand the traps and how to avoid them.
In a postpartum hemorrhage scenario, repeats oxytocin and calls for help but does not start tranexamic acid, bimanual uterine compression, or blood product activation while waiting for a laboratory hemoglobin result.
PPH is memorized as a list of uterotonics; candidates underestimate how quickly hypofibrinogenemia and shock develop and wait for a numerical hemoglobin value before escalating.
What to do instead
Use a timed PPH bundle: quantify blood loss, give IV tranexamic acid within 3 hours of onset, give oxytocin plus adjunct uterotonics, perform bimanual compression, and activate massive transfusion early based on clinical shock, not hemoglobin. Rehearse the sequence aloud in a mock viva.
Withholds magnesium sulfate and delivery because a woman with new severe hypertension has no proteinuria, labelling her 'gestational hypertension' rather than preeclampsia with severe features.
The obsolete triad of hypertension, proteinuria, and edema is overlearned; candidates treat proteinuria as mandatory for severe disease.
What to do instead
Apply current criteria: preeclampsia with severe features is diagnosed by severe-range blood pressure or end-organ features such as thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or new cerebral/visual symptoms, even without proteinuria. Start magnesium sulfate and plan delivery.
Assigns an ovarian cancer stage from CT and CA-125 alone and omits surgical staging; or labels ascites as stage IV without cytology.
Imaging is visually compelling and surgical staging is remembered as a separate topic; candidates conflate clinical and FIGO surgical-pathologic staging.
What to do instead
State that ovarian cancer is staged surgically and pathologically; CT defines resectability, not stage. Ascites alone is not stage IV; pleural effusion requires cytologically positive fluid, and stage IV requires distant metastasis including liver parenchyma.
Starts clomiphene citrate for anovulatory infertility without checking prolactin and TSH and without confirming ovulation; or uses clomiphene in a hypogonadotropic (WHO group I) woman.
Clomiphene is the familiar first-line drug, and the WHO anovulation classification is learned as a table rather than used to select treatment.
What to do instead
Classify anovulation: WHO I needs pulsatile GnRH or gonadotropins, WHO II is the clomiphene/letrozole group, and WHO III needs treatment of hyperprolactinemia. Exclude thyroid disease and hyperprolactinemia first, and document ovulation by mid-luteal progesterone or follicular tracking.
Offers a midurethral sling to every woman who reports leakage, without distinguishing stress from urgency leakage and without a trial of pelvic floor muscle training.
Leakage is treated as a single diagnosis; the history is taken as 'incontinence' rather than mechanism, and conservative therapy is skipped as slow.
What to do instead
Characterize leakage as stress, urgency, or mixed; perform a pelvic examination and cough stress test; and offer supervised pelvic floor muscle training as first-line for stress and mixed incontinence. Reserve surgery for confirmed stress-predominant disease after conservative treatment, with urodynamics when the diagnosis is unclear.
Treats a frothy, malodorous discharge with fluconazole because 'vaginitis' is assumed to be candidiasis, without measuring vaginal pH or performing a wet mount.
Candida is overrepresented in memory, and bedside microscopy is perceived as low-yield or unavailable.
What to do instead
Use pH and wet mount: pH >4.5 with motile trichomonads or clue cells points to trichomoniasis or bacterial vaginosis; treat trichomoniasis with metronidazole including the partner, and bacterial vaginosis with metronidazole or clindamycin. Reserve azoles for confirmed candida.
Prescribes combined oral contraceptives to a 38-year-old smoker or a woman with migraine with aura, missing WHO MEC category 4.
Contraceptive counseling focuses on efficacy and forgets the history that changes eligibility; MEC categories are memorized as numbers without applying them.
What to do instead
Take a structured eligibility history covering age, smoking, migraine type, VTE, hypertension, and breastfeeding/postpartum interval, then apply WHO MEC: category 4 means do not use. Offer progestin-only or intrauterine methods when estrogen is contraindicated.
Re-dates a pregnancy at 28 weeks using biparietal diameter or femur length despite an earlier dating scan, or manages post-term status based on a late scan.
The latest image feels more precise, and the principle that first-trimester dating is most accurate is not applied under time pressure.
What to do instead
Use the earliest ultrasound with crown-rump length or reliable first-trimester dating to establish gestational age; do not revise dates after 14 weeks on the basis of second- or third-trimester biometry. Late scans assess growth and anatomy, not dating.
Reads a trial with p = 0.04 as proof of a large clinical benefit, ignores the confidence interval and absolute risk reduction, and generalizes to a different population.
Statistical significance is taught as the endpoint, and candidates conflate 'significant' with 'important' or 'valid for my patient'.
What to do instead
Appraise effect size with the 95% CI, convert to absolute risk reduction and number needed to treat, check whether the CI excludes clinically trivial effects, and assess directness in terms of population, setting, and intervention. State that p-values do not measure effect magnitude.
In shoulder dystocia, applies fundal pressure and traction on the fetal head rather than calling for help and performing the McRoberts manoeuvre with suprapubic pressure.
Panic drives the instinct to pull, and the sequence of manoeuvres is recalled as a list without the prohibition on fundal pressure.
What to do instead
Announce shoulder dystocia, call for help, stop head traction, and perform McRoberts with suprapubic pressure; then proceed to internal rotational manoeuvres or posterior arm delivery. Fundal pressure is contraindicated because it worsens impaction and causes uterine and infant injury.