Obstetrics and Gynecology / Women's Health
Obstetrics and Gynecology / Women's Health covers antenatal care, hypertensive disease of pregnancy, diabetes, contraception, and common gynecologic presentations. The exam tests safe prescribing in pregnancy and recognition of obstetric emergencies.
Core rules
- Folic acid 400 micrograms preconception; 5 mg for previous neural tube defect, diabetes, or antiepileptic use.
- Preeclampsia: BP ≥140/90 after 20 weeks plus proteinuria or maternal organ dysfunction. Severe features include ≥160/110, headache, visual change, epigastric pain, or abnormal liver enzymes. Magnesium sulfate prevents seizures; delivery is definitive.
- Gestational diabetes: 75 g oral glucose tolerance test at 24–28 weeks. Insulin is standard when diet fails; metformin is used in some settings.
- Contraception: combined oral contraceptives are contraindicated with migraine with aura, smoking over age 35, and previous venous thromboembolism. Progestogen-only methods are safer in these groups.
- Ectopic pregnancy: check beta-hCG and ultrasound; methotrexate is never given in a hemodynamically unstable patient.
Worked example
A woman at 33 weeks has BP 165/110 mmHg, 3+ proteinuria, and a severe headache. Reasoning: this is severe preeclampsia. Admit, start magnesium sulfate for seizure prophylaxis and labetalol for BP control, give antenatal corticosteroids, and plan delivery. Do not use ACE inhibitors or ARBs in pregnancy.
Traps
- Attributing headache in pregnancy to migraine.
- Using methotrexate without confirming an intrauterine pregnancy.
- Missing sepsis as a cause of postpartum collapse.
- Advising bed rest for mild preeclampsia instead of monitoring.