Obstetrics and Gynecology
This section tests antenatal risk assessment, intrapartum monitoring and recognition of the leading causes of maternal death: haemorrhage, hypertensive disorders, sepsis, obstructed labour and unsafe abortion. Expect questions on the partogram, preeclampsia, postpartum haemorrhage, ectopic pregnancy and gestational diabetes.
Core rules
- Antenatal care: at least eight contacts, with screening for preeclampsia, anaemia, blood group and Rh, HIV, syphilis, hepatitis B and gestational diabetes by 75-g OGTT at 24–28 weeks.
- Postpartum haemorrhage: examine tone, tissue, trauma and thrombin. Uterine massage plus oxytocin 10 IU intramuscularly; tranexamic acid 1 g intravenously within 3 hours; balloon tamponade; hysterectomy as the last step.
- Preeclampsia: BP ≥140/90 after 20 weeks plus proteinuria or evidence of organ dysfunction (thrombocytopenia, renal or liver involvement, neurological or pulmonary signs). Magnesium sulfate for severe features; delivery is the definitive treatment.
- Partogram: crossing the action line means intervene; obstructed labour means caesarean delivery.
- Any woman of reproductive age with abdominal pain and amenorrhoea needs beta-hCG and transvaginal ultrasound before discharge.
Worked example
A woman at 32 weeks has BP 168/112, proteinuria 3+, headache and platelets 92 × 10⁹/L. Reasoning: this is severe preeclampsia with thrombocytopenia and cerebral symptoms. Management is admission, magnesium sulfate 4 g loading then 1 g/hour, a beta-blocker such as labetalol or oral nifedipine for blood pressure, antenatal corticosteroids for fetal lung maturity, and delivery after stabilisation.
Traps
- Excluding preeclampsia because proteinuria is absent - organ dysfunction alone is sufficient.
- Prescribing ACE inhibitors in pregnancy; they are fetotoxic.
- Giving ergometrine to a hypertensive woman.
- Omitting anti-D immunoglobulin in an Rh-negative mother.