General Obstetrics (Antenatal, Intrapartum, Postpartum Care)
What the exam tests
This domain covers routine antenatal scheduling, intrapartum monitoring and dystocia, and postpartum haemorrhage and sepsis. Questions often present a clinical scenario and ask for the next step or the most likely diagnosis.
Core rules
- Dating: crown–rump length at 7–13+6 weeks is the most accurate method; do not redate after 14 weeks using CRL.
- Antenatal care: folic acid 400 micrograms daily; 5 mg for prior neural tube defect, diabetes, obesity, or anticonvulsant use. Give anti-D to unsensitised Rh-negative women at 28 and 34 weeks and within 72 hours of delivery if the baby is Rh-positive.
- Screen for gestational diabetes at 24–28 weeks.
- Active management of the third stage: oxytocin 10 IU IM, controlled cord traction, and uterine massage reduce postpartum haemorrhage.
- PPH is blood loss ≥500 mL after vaginal birth or ≥1000 mL after caesarean birth; uterine atony is the commonest cause. Check tone, tissue, trauma, and thrombin.
- Eclampsia: magnesium sulfate 4 g IV loading then 1 g/hour; recurrent seizures need a further bolus.
Worked example
A 30-year-old G2P1 at 38 weeks delivers a complete placenta, then bleeds 700 mL; the uterus is soft and the bladder is full. First steps are to call for help, assess airway and circulation, catheterise, massage the uterus, give oxytocin, and inspect the genital tract. Tranexamic acid 1 g IV should be given within 3 hours. Atony is the likely cause; ergometrine is avoided if she is hypertensive.
Traps
Confusing latent with active labour; using CRL beyond the first trimester; forgetting anti-D; labelling bleeding as inevitable; and failing to look for retained products or genital tract trauma.