Obstetrics and Gynecology
Obstetrics and Gynaecology tests pregnancy complications, labour, contraception, pelvic pain, bleeding, and gynaecological oncology. Safety of mother and fetus governs every decision.
Core rules
- In pregnancy, ABCDE and left lateral tilt after 20 weeks improve venous return.
- Pre-eclampsia is hypertension after 20 weeks plus proteinuria or organ dysfunction; severe features include headache, visual changes, epigastric pain, and thrombocytopenia.
- Ectopic pregnancy must be excluded in any woman of reproductive age with abdominal pain, amenorrhoea, or syncope.
- Postpartum haemorrhage is blood loss ≥500 mL after vaginal birth; uterine atony is commonest, so massage, oxytocin, and resuscitation.
- Contraception counselling considers thrombosis, migraine, breastfeeding, and blood pressure.
Worked example
A 32-year-old at 34 weeks has blood pressure 168/112 mmHg, headache, and 3+ proteinuria. The reasoning: severe pre-eclampsia. Admit, monitor maternal and fetal status, give antihypertensives, magnesium sulphate for seizure prophylaxis, and plan delivery. Fluids should be restricted; ergometrine is avoided because it raises blood pressure.
Traps
Do not treat hypertension in pregnancy with ACE inhibitors; do not attribute first-trimester bleeding to implantation without excluding ectopic; do not forget rhesus status.