Obstetrics and Gynecology
Obstetrics and Gynecology tests antenatal care, labour, emergency obstetrics, contraception, and common gynaecological presentations. High-yield topics are preeclampsia, postpartum haemorrhage, ectopic pregnancy, miscarriage, and contraception counselling.
Core rules
- Preeclampsia: hypertension after 20 weeks plus proteinuria or maternal organ dysfunction. Severe features include BP ≥160/110, platelets <100 × 10⁹/L, liver enzymes raised, renal impairment, pulmonary oedema, or neurological symptoms.
- Postpartum haemorrhage: assess tone, trauma, tissue, and thrombin; give uterotonics and resuscitate.
- Ectopic pregnancy: consider in any woman of reproductive age with pain, bleeding, or syncope; do pregnancy test and ultrasound.
- Contraception: assess contraindications, especially migraine with aura, smoking over 35, and thrombosis risk.
Worked example
A 34-week pregnant woman has headache, visual flashes, BP 162/108 mmHg, platelets 88 × 10⁹/L, and proteinuria. The reasoning is: preeclampsia with severe features. Admit, give magnesium sulphate for seizure prophylaxis, control BP, and plan delivery. Do not wait for proteinuria if severe hypertension and organ dysfunction are present.
Traps that cost marks
- Using 140/90 as the only threshold and missing severe features.
- Forgetting magnesium toxicity monitoring: reflexes, respiratory rate, urine output.
- Missing ectopic pregnancy with a negative office urine test.
- Underestimating postpartum haemorrhage because blood loss is visually underestimated.
- Prescribing combined oral contraceptives despite migraine with aura.