Obstetrics and Gynecology
Obstetrics and Gynecology tests antenatal risk assessment, hypertensive disorders of pregnancy, postpartum hemorrhage, obstructed labor, ectopic pregnancy, and contraception. The exam favors decision points: when to deliver, which drug is contraindicated, and how to stabilize before referral.
Core rules
- Severe pre-eclampsia is BP ≥160/110 with symptoms or severe features; give magnesium sulfate for seizure prophylaxis, treat BP, and deliver after stabilization.
- Postpartum hemorrhage: uterine atony is most common; massage, oxytocin, tranexamic acid, and escalate to balloon or surgery.
- Ectopic pregnancy is a surgical emergency when ruptured; do not delay for serial hCG.
- Never use ACE inhibitors or ARBs in pregnancy; ergometrine is contraindicated in hypertension.
Worked example
A woman at 34 weeks has BP 165/110, 3+ proteinuria, and headache. This is severe pre-eclampsia. Give a magnesium sulfate loading dose (4 g IV over 20 minutes) then maintenance, give labetalol or hydralazine for BP, monitor reflexes and urine output, and plan delivery after maternal stabilization. Do not give diazepam first for eclampsia; magnesium sulfate is superior.
Traps
- Treating hypertension with an ACE inhibitor in pregnancy.
- Giving ergometrine for postpartum hemorrhage in a hypertensive woman.
- Overloading with IV fluids in pre-eclampsia, causing pulmonary edema.
- Missing HELLP syndrome: check platelets, liver enzymes, and hemolysis.