Obstetrics and Gynecology
Core framework
Obstetrics rewards a timeline mindset: date the pregnancy, stage the gestation, then interpret findings against that stage. Master antenatal care and screening, hypertensive disorders of pregnancy, hemorrhage by trimester (ectopic, miscarriage, placenta previa, abruption, postpartum hemorrhage), diabetes in pregnancy, preterm labor, and fetal surveillance. Gynecology requires fluency in abnormal uterine bleeding by age, contraception, pelvic infection, and the common malignancies with their screening pathways.
Concepts you must own
Estimated date of delivery and gestational age calculation. The definitions and thresholds for preeclampsia and its severe features, and the timing of magnesium sulfate. Causes of postpartum hemorrhage in order of frequency (tone, trauma, tissue, thrombin). Cervical screening and management of abnormal results. The difference between pre- and postmenopausal bleeding evaluation.
Traps
- Painless versus painful bleeding in late pregnancy: painless bleeding suggests previa; painful with a rigid uterus suggests abruption. Never perform a digital examination when previa is possible.
- Ectopic pregnancy: a negative or low beta-hCG does not exclude it; the discriminatory zone and trend matter.
- Preeclampsia without proteinuria is still preeclampsia when other organ features are present.
Worked rule of thumb
For any late-pregnancy bleeding stem, decide previa versus abruption first, using pain, uterine tone, and fetal status. Previa: painless, soft uterus, malpresentation. Abruption: painful, tender rigid uterus, fetal distress, maternal shock out of proportion to visible bleeding. That discrimination usually picks the answer before you consider management.