Specialist Obstetrics & Gynecology Kuwait

• Low-dose aspirin 75-150 mg from 12 weeks is offered for one high-risk or two moderate risk factors for pre-eclampsia.
• Rh(D) negative women receive anti-D prophylaxis at 28 weeks and after delivery of an Rh positive baby; MCA PSV above 1.5 MoM suggests fetal anaemia.
• Cell-free DNA is a high-sensitivity screening test but a positive result still needs CVS or amniocentesis confirmation.
• IADPSG/WHO gestational diabetes thresholds (75 g OGTT): fasting 5.1, 1 hour 10.0, 2 hours 8.5 mmol/L; one abnormal value suffices.

• Failure of cervical change in the active phase is managed with oxytocin augmentation if contractions are inadequate; caesarean follows arrest despite adequate contractions.
• Shoulder dystocia: McRoberts with suprapubic pressure first, then internal manoeuvres and posterior arm; avoid fundal pressure and strong traction.
• Uterine rupture risk in trial of labour after caesarean is raised by prostaglandins; oxytocin is used with caution.
• Postpartum haemorrhage: four Ts; oxytocin, tranexamic acid, then carboprost or ergometrine as contraindications allow.

• Severe-range hypertension (160/110 mmHg or above) is treated within 30-60 minutes; magnesium sulphate prevents eclampsia and calcium gluconate reverses toxicity.
• Placenta praevia with bleeding: no digital examination; steroids, blood and planned caesarean. Praevia over a scar raises accreta risk.
• Cholestasis of pregnancy: bile acids drive stillbirth risk; ursodeoxycholic acid for symptoms and timing delivery by level.
• Obstetric DIC consumes fibrinogen first, replace with cryoprecipitate or fibrinogen concentrate.

• Uterine atony causes about 70% of postpartum haemorrhage; massage, uterotonics, tranexamic acid and escalation follow a stepwise protocol.
• Give tranexamic acid 1 g IV within 3 hours of birth for any PPH, repeating once after 30 minutes if bleeding continues.
• Endometritis is polymicrobial; clindamycin plus gentamicin is a standard regimen.
• Postpartum blues peak at days 3 to 5; psychosis is an emergency requiring admission.

• Methotrexate for ectopic needs stability, unruptured mass, hCG below about 5,000 IU/L and no fetal cardiac activity.
• Heavy menstrual bleeding without structural cause: LNG-IUS first, tranexamic acid or NSAIDs as alternatives.
• Postmenopausal bleeding with endometrial thickness above 4 mm needs tissue sampling.
• PID is treated empirically with ceftriaxone, doxycycline and metronidazole, and partners are treated.

• Letrozole is first-line for ovulation induction in PCOS; clomifene is second-line.
• Agonist trigger with antagonist protocol and freeze-all minimises OHSS.
• Women aged 35 or more are referred after 6 months of trying; reserve markers include AMH and antral count.
• Hydrosalpinx should be removed or occluded before IVF.

• Stress incontinence: supervised pelvic floor training for at least 3 months first; midurethral sling is the standard operation.
• Overactive bladder: bladder training, then antimuscarinic or beta-3 agonist; botulinum toxin and neuromodulation are third-line.
• Treat prolapse only if symptomatic; pessary is a valid first choice.
• Continuous leakage after surgery or obstructed labour suggests fistula.

• Early endometrial cancer: hysterectomy with BSO and sentinel node assessment; adjuvant therapy is guided by molecular class (POLE, MMRd, p53abn, NSMP).
• Locally advanced cervical cancer (IB3 to IVA) is treated with cisplatin chemoradiation and brachytherapy.
• BRCA1 carriers: risk-reducing BSO at 35 to 40 years after childbearing; PARP inhibitor maintenance after platinum response.
• hCG plateau or rise after a mole defines GTN; low-risk disease is cured with single-agent chemotherapy.

• Combined hormonal contraception is contraindicated (UKMEC 4) in migraine with aura, prior VTE, smoking aged 35 or more with heavy use, and before 6 weeks postpartum if breastfeeding.
• Copper IUD is the most effective emergency contraception, within 5 days.
• Enzyme inducers such as rifampicin reduce efficacy of pills and implants; use an IUD.
• Doxycycline 7 days is first-line for chlamydia.

• Nuchal translucency of 3.5 mm or above warrants diagnostic testing and a detailed scan whatever the calculated risk.
• cfDNA is a screening test; a high-risk result is confirmed by CVS or amniocentesis.
• FGR is managed by Doppler: absent end-diastolic flow prompts delivery planning by 32 to 34 weeks with steroids and magnesium.
• MCA PSV above 1.5 MoM suggests significant fetal anaemia.

• A capacitous pregnant woman may refuse any treatment, including caesarean section; her husband cannot consent for her.
• Competent adolescents can receive confidential contraceptive care; assess for exploitation and safeguarding concerns.
• Duty of candour requires honest disclosure, apology and incident reporting after adverse events.
• In emergencies without capacity, life-saving treatment proceeds in the best interests of the patient with documentation.

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