Women's Health (Obstetrics, Gynaecology and Antenatal Care)
This domain covers antenatal care, common obstetric emergencies, contraception and gynaecological problems in primary care. Items test thresholds and thresholds-under-pressure: blood pressure numbers in pregnancy, preeclampsia features, and postpartum bleeding.
Core rules
- Antenatal care: folic acid 400 micrograms daily preconceptionally (5 mg if previous neural tube defect, diabetes or antiepileptic use). WHO recommends eight antenatal contacts; in Oman, dating ultrasound, 18-22 week anomaly scan and 24-28 week glucose tolerance testing are standard.
- Blood pressure ≥140/90 after 20 weeks with proteinuria or end-organ features defines preeclampsia. Severe features are ≥160/110, platelets <100, rising creatinine or transaminases, headache, visual disturbance or epigastric pain.
- Severe preeclampsia: admit, magnesium sulfate for seizure prophylaxis, antihypertensives (labetalol, nifedipine, hydralazine), corticosteroids for fetal lung maturity before 34 weeks, and plan delivery - delivery is the definitive treatment.
- Anti-D prophylaxis at 28 weeks and within 72 hours of delivery if the baby is Rh-positive and the mother Rh-negative.
- Postpartum haemorrhage: uterine atony is the commonest cause. Uterine massage and oxytocin first, tranexamic acid within 3 hours, then escalate.
- Contraception: follow WHO medical eligibility criteria - combined pills are contraindicated in migraine with aura, smoking over age 35, and previous VTE. Long-acting reversible methods are the most effective.
Worked example
A woman at 34 weeks has BP 158/104, +2 proteinuria, headache and platelets of 95. Reasoning: severe preeclampsia with thrombocytopenia and symptoms. Admit, give magnesium sulfate loading, treat BP, give steroids, involve obstetrics for planned delivery.
Traps that cost marks
Applying non-pregnant BP targets; dismissing headache as tension; prescribing ACE inhibitors or ARBs in pregnancy; forgetting anti-D after delivery.