High-Yield Obstetrics and Gynaecology for Medical Exams

Obstetrics and gynaecology is a large share of every licensing exam, and it is full of time-critical decisions. Questions test emergencies (bleeding, hypertension, sepsis), antenatal screening, drugs in pregnancy, contraception and gynaecological cancers. This guide is exam revision based on widely used guidelines.

Key definitions

Antenatal care themes

• Booking: blood group and antibodies, full blood count, screening for infections (HIV, hepatitis B, syphilis), haemoglobinopathy screening, blood pressure, urine.
• Supplements: folic acid before conception and in early pregnancy; a higher dose for higher-risk women (previous neural tube defect, antiepileptic drugs, diabetes, high BMI in some guidelines). Vitamin D per national advice.
• Anomaly and aneuploidy screening: combined first-trimester test (nuchal translucency, hCG, PAPP-A) or later serum testing; cell-free DNA where offered.
• Rhesus-negative women: anti-D prophylaxis and after sensitising events.
• Low-dose aspirin: for women at increased risk of pre-eclampsia, from about 12 weeks.

Hypertension in pregnancy

Management themes

• Antihypertensives: labetalol first line in UK guidance, nifedipine or methyldopa alternatives.
• Magnesium sulfate for severe pre-eclampsia and eclampsia; monitor reflexes, respiratory rate and urine output; calcium gluconate reverses toxicity.
• Definitive treatment is delivery; timing balances maternal and fetal risk.
• Avoid ACE inhibitors and ARBs in pregnancy.

Bleeding in early pregnancy

Trap: any woman of reproductive age with abdominal pain or collapse needs a pregnancy test. Shoulder-tip pain with collapse suggests ruptured ectopic with haemoperitoneum.

Pregnancy of unknown location: serial hCG measurements guide decisions; a rise below the expected amount over 48 hours raises concern for ectopic or failing pregnancy.

Bleeding in late pregnancy

Risk factors for abruption: hypertension, smoking, cocaine, trauma, previous abruption.

Postpartum haemorrhage: the four Ts

Prevention: active management of the third stage with a uterotonic is recommended for all births by WHO.

Gestational diabetes

Risk factors: high BMI, previous gestational diabetes, previous large baby, family history, certain ethnic backgrounds. Screening is with an oral glucose tolerance test, typically at 24–28 weeks (earlier if previous gestational diabetes). Management is diet and exercise, then metformin, then insulin per guideline. Postnatally, check glucose because of long-term type 2 diabetes risk.

Labour and delivery

• Stages: first (onset to full dilatation), second (full dilatation to birth), third (birth to delivery of the placenta).
• Cord prolapse: call for help, relieve pressure on the cord (manual elevation, knee-chest or left lateral position), urgent delivery.
• Shoulder dystocia: call for help, McRoberts manoeuvre and suprapubic pressure first, then internal manoeuvres.
• Group B streptococcus: intrapartum antibiotics for colonised women and certain risk factors.
• Fetal heart rate patterns: late decelerations suggest uteroplacental insufficiency.

Drugs in pregnancy (exam favourites)

Contraception

WHO medical eligibility criteria rate each method from category 1 (no restriction) to 4 (unacceptable risk) for each condition.

Gynaecology essentials

• Polycystic ovary syndrome: two of three (oligo- or anovulation, hyperandrogenism, polycystic ovaries on ultrasound) after excluding other causes; weight loss, cycle control, letrozole for ovulation induction in many guidelines.
• Endometriosis: cyclical pain, dysmenorrhoea, dyspareunia, subfertility; laparoscopy confirms.
• Ovarian torsion: sudden unilateral pain, vomiting, adnexal mass; urgent surgery.
• Pelvic inflammatory disease: treat empirically; chlamydia and gonorrhoea; Fitz-Hugh-Curtis syndrome.
• Menopause: HRT relieves vasomotor symptoms; women with a uterus need a progestogen with oestrogen.

Gynaecological cancers

Trap: postmenopausal bleeding needs investigation for endometrial cancer, starting with transvaginal ultrasound for endometrial thickness.

Common exam traps

• Performing a vaginal exam before excluding placenta praevia.
• Forgetting a pregnancy test in a woman with abdominal pain.
• Giving ergometrine to a hypertensive woman or carboprost to an asthmatic.
• Missing magnesium toxicity (loss of reflexes, respiratory depression).
• Forgetting anti-D in a rhesus-negative woman after a sensitising event.
• Prescribing the combined pill to a woman with migraine with aura.

How to revise

O&G rewards algorithm practice: rehearse PPH, eclampsia, cord prolapse and shoulder dystocia drills aloud. MediFlow Exam Prep includes O&G vignettes with explanations. Pair this with high-yield paediatrics.

Summary

• Pre-eclampsia: control blood pressure, magnesium for seizures, deliver.
• PPH: resuscitate and treat the four Ts.
• Early pregnancy bleeding: exclude ectopic.
• Late pregnancy bleeding: placenta praevia before any vaginal exam.
• Know which drugs to avoid and which contraceptives are contraindicated.