PGIM MD ObGyn common mistakes
PGIM MD ObGyn · Understand the traps and how to avoid them.
In a woman at 33+6 weeks with pre-eclampsia, the candidate orders same-day delivery only because the gestational age is close to 34 weeks, without documenting severe features, platelet count, liver enzymes, creatinine, symptoms, or fetal Doppler.
Rote recall of a '34-week delivery' threshold leads candidates to conflate non-severe and severe pre-eclampsia and to skip the severity assessment that determines whether steroids and expectant management are appropriate.
What to do instead
Use a structured severe-feature checklist (BP, platelets, AST/ALT, creatinine, pulmonary oedema, symptoms, fetal growth/Doppler) and state explicitly whether the patient has severe features; then justify delivery versus expectant management with steroids using the documented criteria.
When reviewing a 20-minute CTG showing recurrent late decelerations with reduced baseline variability, the candidate writes 'baseline 140, reactive' and arranges another CTG in 2 hours instead of classifying and acting on the decelerations.
Candidates fixate on the baseline rate and reactivity and do not apply a structured CTG classification system, so abnormal decelerations and reduced variability are missed under time pressure.
What to do instead
Use a reproducible scheme such as DR C BRAVADO or FIGO categories; define late decelerations and reduced variability explicitly, assign a category, and follow the corresponding intrauterine resuscitation and escalation pathway.
After a vaginal delivery, the candidate visually estimates blood loss at 300 mL while the patient has pulse 118/min and systolic BP 95 mmHg, and gives only 10 IU oxytocin IM without escalating.
Visual estimation systematically underestimates postpartum blood loss, and candidates anchor on the low estimate rather than on maternal vital signs and ongoing bleeding.
What to do instead
Quantify loss with a calibrated drape or weighed swabs, treat vital-sign changes as significant, and activate a PPH bundle at 500 mL: uterine massage, oxytocin, tranexamic acid within 3 hours, IV fluids, blood products, and theatre if uncontrolled.
During shoulder dystocia, the candidate applies fundal pressure and strong axial traction on the fetal head when the head retracts and does not deliver with the next contraction.
Panic and lack of rehearsal lead to the two manoeuvres most likely to cause brachial plexus injury and uterine rupture, because they seem to 'push' or 'pull' the baby out quickly.
What to do instead
Run through HELPERR in order: call for help, evaluate for episiotomy, leg manoeuvres, suprapubic pressure, enter manoeuvres, remove posterior arm, roll the patient; never use fundal pressure, and document the time and sequence of manoeuvres.
The candidate diagnoses gestational diabetes using a random plasma glucose of 11.0 mmol/L at 28 weeks without performing or interpreting a 75-g oral glucose tolerance test.
Candidates confuse non-pregnant diabetes diagnostic criteria with gestational diabetes screening and diagnosis, and forget that random glucose alone is not diagnostic in pregnancy unless overt diabetes is suspected.
What to do instead
Apply pregnancy-specific criteria: use a 75-g OGTT with fasting, 1-hour, and 2-hour thresholds (IADPSG/WHO), and reserve random glucose ≥11.1 mmol/L plus symptoms for overt diabetes; document the test used and the thresholds applied.
For a 64-year-old with postmenopausal bleeding and endometrial thickness 3 mm on transvaginal ultrasound, the candidate advises reassurance and does not arrange endometrial sampling.
Candidates over-rely on a thin endometrium as a cancer exclusion rule and forget that postmenopausal bleeding requires tissue diagnosis regardless of a reassuring thickness.
What to do instead
Arrange endometrial sampling (pipelle or hysteroscopy-directed biopsy) for postmenopausal bleeding; use ultrasound thickness as an adjunct, not a substitute for tissue, and document the sampling plan and follow-up.
A haemodynamically stable woman has hCG 1,200 IU/L and an empty uterus on transvaginal ultrasound; the candidate discharges her with analgesia and no serial hCG or follow-up plan.
The candidate misses the discriminatory zone and the possibility of a small ectopic pregnancy, and equates stability with safety.
What to do instead
Check serial hCG and repeat transvaginal ultrasound; if hCG is above the discriminatory zone with no intrauterine pregnancy, manage as ectopic pregnancy; if below, arrange strict follow-up until the diagnosis is resolved.
The candidate requests Doppler ultrasound for suspected ovarian torsion, finds flow present, and cancels urgent laparoscopy.
Normal Doppler flow is falsely treated as excluding torsion, but venous and lymphatic flow can be preserved early and arterial flow may be intermittent.
What to do instead
Treat ovarian torsion as a clinical diagnosis and proceed to urgent laparoscopy regardless of Doppler flow; at surgery, detorse the adnexa and assess viability rather than removing solely because the ovary looks dark.
A 26-year-old with ASC-US on cervical cytology is sent directly for colposcopy without HPV triage.
The candidate applies an older cytology-only algorithm and ignores age-specific HPV-based screening and triage recommendations.
What to do instead
Use age-specific cervical screening guidance: for ASC-US, perform HPV triage; if HPV-negative, repeat screening per interval, and reserve colposcopy for HPV-positive or higher-grade abnormalities.
The candidate prescribes a 6-month course of a GnRH agonist for dysmenorrhoea due to endometriosis without discussing add-back therapy, bone density, or duration limits.
Focus on pain control overshadows the hypo-oestrogenic adverse effects of GnRH agonists and the need for add-back in prolonged use.
What to do instead
Counsel about hypo-oestrogenic effects, prescribe add-back with a progestin, combined oestrogen-progestin, or tibolone where appropriate, limit duration, and arrange review of symptoms and bone health.