Obstetrics and Gynecology
What this domain tests
Obstetric items test normal delivery, newborn resuscitation, postpartum hemorrhage, and hypertensive emergencies. Gynecologic items cover ectopic pregnancy, miscarriage, and sexual assault with an emphasis on privacy and evidence preservation.
Core rules
- Stages: dilation, delivery of the infant, delivery of the placenta, and the first postpartum hour.
- Delivery: support the head as it crowns, check for a nuchal cord and slip it over the head, deliver the anterior then posterior shoulder, note the time, dry and warm the newborn, and suction mouth then nose only if needed.
- APGAR at 1 and 5 minutes scores appearance, pulse, grimace, activity, and respiration, each 0–2.
- Newborn with heart rate under 100: positive-pressure ventilation. Heart rate under 60 after 30 seconds of effective ventilation: compressions at a 3:1 ratio.
- Postpartum hemorrhage is most often uterine atony. Massage the fundus, give oxytocin per protocol, and transport.
- Preeclampsia: hypertension after 20 weeks with proteinuria or end-organ signs; eclampsia adds seizures, treated with magnesium sulfate.
- Ectopic pregnancy: missed period, unilateral pain, syncope, shoulder pain.
Worked example
A woman delivers in the ambulance, then continues to bleed heavily with a boggy uterus. Fundal massage and oxytocin address atony; do not pull on the cord or wait for the placenta before transporting.
Traps
Pulling the umbilical cord, routine aggressive suctioning of a vigorous newborn, and assuming abdominal pain in a woman of childbearing age is gastrointestinal.