Obstetrics and Gynaecology
Obstetrics and Gynaecology
This domain tests obstetric emergencies, antenatal risk, labour progress, postpartum care, and gynaecological bleeding. You are expected to use a woman-centred approach, involve the woman in decisions, and recognise when to call for senior obstetric help. New Zealand practice emphasises culturally safe care, including whānau involvement where the woman wishes.
Core rules
- Severe hypertension in pregnancy (≥160/110) is an emergency: repeat, check urine protein, platelets, LFTs, and arrange delivery.
- Postpartum haemorrhage: call for help, assess tone/trauma/tissue/thrombin, rub up a contraction, give oxytocin, tranexamic acid, IV fluids, and blood products.
- Ectopic pregnancy: pregnancy test, transvaginal ultrasound, and discriminatory zone; do not discharge without follow-up.
- CTG: identify baseline, variability, accelerations, decelerations; act on category III.
- Gynaecological bleeding: quantify, check pregnancy test, consider age and menopause.
Worked example
A 34-week primigravida has a severe headache and visual flashes. BP 165/112, urine protein 3+, platelets 90. Reasoning: pre-eclampsia with severe features; give magnesium sulfate loading, antihypertensive (labetalol or nifedipine per protocol), insert catheter, monitor reflexes and urine output, and plan delivery after stabilisation. Explain to the woman and her whānau.
Traps
Treating a headache as migraine, omitting fetal monitoring, giving NSAIDs in pregnancy, and failing to recognise HELLP syndrome.