Reproductive System
The reproductive domain tests pregnancy care, ectopic pregnancy, hypertensive disorders of pregnancy, contraception, menopause, and polycystic ovary syndrome, with emphasis on safety in pregnancy and contraindications.
Core rules
- Ectopic pregnancy: positive hCG with abdominal pain, adnexal mass, or an empty uterus on ultrasound. Check blood type and Rh status. Treat with methotrexate if criteria are met or surgery if unstable.
- Preeclampsia: new hypertension after 20 weeks with proteinuria or end-organ dysfunction. Delivery is definitive; magnesium sulfate prevents seizures.
- Contraception: combined oral contraceptives are contraindicated with migraine with aura, uncontrolled hypertension, smoking over age 35, and prior VTE. Progestin-only methods are safer in many of these situations.
- PCOS: Rotterdam criteria-ovulatory dysfunction, hyperandrogenism, and polycystic ovaries-with two of three required. Treat with lifestyle change, combined contraceptives for cycle control, and metformin for insulin resistance.
Worked example
A 26-year-old has amenorrhea, a positive hCG, right lower quadrant pain, and an empty uterus on transvaginal ultrasound. This is a pregnancy of unknown location suspicious for ectopic. Check serial hCG and blood type. If she is stable and meets criteria, methotrexate is an option; if unstable, proceed to surgery.
Traps
- Missing ectopic pregnancy in early pregnancy with pain.
- Prescribing combined hormonal contraception with migraine with aura.
- Missing preeclampsia because blood pressure was normal at an earlier visit.
- Treating PCOS with metformin alone when contraception is needed.