Obstetrics and Gynecology
Obstetrics and Gynecology tests antenatal risk assessment, hypertensive disorders, hemorrhage, labor, contraception, and gynecologic emergencies. The exam emphasizes maternal stabilization before delivery decisions.
Core rules
- Antenatal care: confirm gestational age, screen for anemia, hypertension, diabetes, infections, and danger signs.
- Preeclampsia: hypertension after 20 weeks plus proteinuria or organ dysfunction. Severe features include BP at least 160/110, platelets below 100,000, liver enzymes elevated, pulmonary edema, or symptoms.
- Postpartum hemorrhage: uterine atony is most common; massage, oxytocin, then additional uterotonics or surgery.
- Ectopic pregnancy: amenorrhea, pain, bleeding; positive pregnancy test and empty uterus; treat medically or surgically before rupture.
Worked example
A 32-week pregnant woman has headache, BP 165/110, proteinuria, and platelets 85,000. This is severe preeclampsia with thrombocytopenia. Give magnesium sulfate for seizure prophylaxis, control BP with labetalol or nifedipine, and arrange delivery after stabilization. Reasoning: magnesium prevents eclampsia; delivery is definitive, but maternal condition is stabilized first.
Traps
- Using ACE inhibitors or ARBs in pregnancy.
- Giving ergometrine for postpartum hemorrhage in hypertension.
- Overloading with fluids during magnesium therapy.
- Missing HELLP syndrome when platelets and liver enzymes are abnormal.