Obstetrics and Gynecology: Antenatal, Intrapartum, and Emergency Care
What this domain tests
The section tests antenatal risk, labour progress, fetal monitoring, postpartum haemorrhage, hypertensive disorders, ectopic pregnancy, contraception, and common gynaecological presentations. Prioritise maternal stabilisation and timely delivery.
Core rules
- Postpartum haemorrhage follows the four Ts: tone, trauma, tissue, thrombin. Uterine atony is commonest.
- Preeclampsia with severe features requires magnesium sulfate for seizure prophylaxis and controlled antihypertensives; delivery is definitive.
- In ectopic pregnancy with haemodynamic instability, resuscitate and operate; do not delay for serial hCG.
- CTG interpretation uses baseline rate, variability, accelerations, and decelerations; late decelerations suggest uteroplacental insufficiency.
- Ergometrine is contraindicated in hypertension and cardiac disease.
Worked example
A woman has 800 mL blood loss after vaginal delivery, tachycardia, and a boggy uterus. Call for help, assess ABC, rub the uterus, empty the bladder, and give oxytocin infusion. Add tranexamic acid and then carboprost or misoprostol according to availability and contraindications. Escalate to balloon tamponade or surgery if bleeding persists. The key reasoning is that atony is the likely cause, but trauma and retained tissue must be excluded.
Traps
Giving ergometrine to a hypertensive woman; delaying blood products in ongoing haemorrhage; diagnosing labour progress from pain alone; missing a scarred uterus in abdominal pain; treating preeclampsia with delivery before maternal stabilisation when eclampsia is imminent.
Exam strategy
In obstetrics, two patients are involved. Stabilise the mother first, then assess fetal status and delivery timing.