Obstetrics and Gynecology
What Obstetrics and Gynecology tests
This domain tests the emergencies and common conditions of pregnancy and gynaecology: hypertensive disorders, postpartum haemorrhage, ectopic pregnancy, gestational diabetes, labour and its complications, and cervical screening. Questions typically describe an obstetric emergency and ask for the immediate drug or the decision about delivery.
Core rules
- Severe preeclampsia: blood pressure 160/110 or above, or hypertension with symptoms or deranged labs. Give magnesium sulfate (4–6 g IV loading, then 1–2 g/h) for seizure prophylaxis, treat blood pressure with labetalol, hydralazine or nifedipine, and deliver at 34 weeks or later after stabilisation; before 34 weeks give corticosteroids and consider expectant management if stable.
- Postpartum haemorrhage: uterine massage, oxytocin, then tranexamic acid 1 g IV within 3 hours, escalate to other uterotonics, balloon tamponade, and surgery. Ergometrine is contraindicated in preeclampsia because it raises blood pressure.
- Ectopic pregnancy: any woman of reproductive age with abdominal pain and a positive pregnancy test needs ultrasound and hCG correlation.
- Shoulder dystocia: call for help, McRoberts manoeuvre, suprapubic pressure, then internal manoeuvres.
Worked example
A woman at 35 weeks has blood pressure 168/112 mmHg, headache, platelets 95, raised AST and proteinuria. Reason: severe preeclampsia. Admit, start magnesium sulfate, lower blood pressure with labetalol, give antenatal corticosteroids for fetal lung maturity, and plan delivery after stabilisation because she is beyond 34 weeks. Fluids are restricted to avoid pulmonary oedema.
Traps
Treating severe hypertension without giving magnesium for seizure prophylaxis; giving ergometrine to a preeclamptic patient; overloading with fluids during magnesium therapy; missing ectopic pregnancy because the patient denies missing a period.