Master Obstetrics & Gynecology
for DHA

Core Concepts

Obstetrics & Gynecology encompasses female reproductive health across the lifespan, from adolescence through menopause and beyond. Key areas include antenatal, intrapartum, and postpartum care, management of high-risk pregnancies, reproductive endocrinology, contraception, infertility, gynecological oncology, pelvic floor disorders, and preventative health screenings. Emphasize patient safety, evidence-based practice, and cultural sensitivity, particularly within the UAE context which often presents with high rates of gestational diabetes and vitamin D deficiency. Early detection and management of complications are paramount to maternal and fetal well-being.

Clinical Presentation

• **Obstetrics:**
• **Early Pregnancy:** Amenorrhea, nausea/vomiting, breast tenderness. Vaginal bleeding and/or abdominal pain (miscarriage, ectopic pregnancy). Hyperemesis gravidarum.
• **Late Pregnancy:** Reduced fetal movements. Vaginal bleeding (placenta previa, placental abruption, cervical changes). Abdominal pain (preterm labor, abruption). Headache, visual changes, epigastric pain (pre-eclampsia). Leakage of fluid (PPROM).
• **Postpartum:** Perineal pain, lochia changes, fever (endometritis), breast engorgement/pain (mastitis), postpartum hemorrhage (PPH).
• **Gynecology:**
• **Menstrual Disorders:** Abnormal Uterine Bleeding (AUB - menorrhagia, metrorrhagia, post-coital, post-menopausal bleeding), dysmenorrhea, amenorrhea, oligomenorrhea.
• **Pelvic Pain:** Acute (ruptured ovarian cyst, PID, ectopic), chronic (endometriosis, adenomyosis, adhesions). Dyspareunia.
• **Vaginal Symptoms:** Discharge, itching, odor (vaginitis, STIs). Vaginal dryness, atrophy.
• **Pelvic Masses:** Abdominal distension, pressure symptoms, palpable mass (fibroids, ovarian cysts/tumors, uterine prolapse).
• **Infertility:** Inability to conceive after 12 months (or 6 months if >35 years).
• **Urinary Symptoms:** Stress, urge, or mixed incontinence. Recurrent UTIs.
• **Breast Symptoms:** Lumps, pain, nipple discharge, skin changes.

Diagnosis (Gold Standard)

**Obstetrics:** Pregnancy confirmed by urine/serum hCG, then transvaginal ultrasound (TVUS) for viability, dating, and exclusion of ectopic pregnancy. Gestational Diabetes Mellitus (GDM): Oral Glucose Tolerance Test (OGTT) at 24-28 weeks. Pre-eclampsia: New onset hypertension (≥140/90 mmHg) with proteinuria and/or end-organ dysfunction. Ectopic pregnancy: Positive hCG with empty uterus on TVUS, often with adnexal mass/fluid. Placenta previa: TVUS. PPH: Clinical estimation of blood loss (>500mL vaginal, >1000mL C-section).
**Gynecology:** AUB: TVUS for structural causes, endometrial biopsy/hysteroscopy for endometrial pathology (especially post-menopausal bleeding). Pelvic Inflammatory Disease (PID): Clinical diagnosis (pelvic pain, cervical motion tenderness, adnexal tenderness), often supported by elevated inflammatory markers. Ovarian cysts/masses: TVUS, sometimes MRI. Cervical cancer screening: Pap smear (cytology), HPV testing; diagnosis by colposcopy with directed biopsy. Endometrial cancer: Endometrial biopsy. Breast lump: Triple assessment (clinical exam, imaging (mammogram/ultrasound), biopsy). STIs: Nucleic Acid Amplification Tests (NAATs).

Management (First Line)

**Obstetrics:** Antenatal care: Folic acid, iron, vitamin D supplementation, routine screenings. GDM: Diet, exercise, then metformin or insulin. Pre-eclampsia: Delivery is definitive cure, magnesium sulfate for seizure prophylaxis, antihypertensives for BP control. Ectopic pregnancy: Methotrexate (stable, small, unruptured) or laparoscopic salpingectomy. PPH: Uterine massage, oxytocin, other uterotonics (carboprost, misoprostol), surgical exploration if refractory. Preterm labor: Tocolytics (short-term), corticosteroids (fetal lung maturity), magnesium sulfate (neuroprotection <32w). Rh incompatibility: Anti-D immunoglobulin.
**Gynecology:** AUB: Hormonal contraceptives (COCs, LNG-IUS), NSAIDs, tranexamic acid; endometrial ablation or hysterectomy for refractory cases. PID: Broad-spectrum antibiotics (e.g., ceftriaxone + doxycycline + metronidazole). Endometriosis: NSAIDs, hormonal suppression (COCs, GnRH agonists), laparoscopic surgery. Fibroids: Symptomatic management, GnRH agonists, uterine artery embolization, myomectomy, hysterectomy. Cervical cancer: Depends on stage, ranging from LEEP/conization to hysterectomy, radiation, chemotherapy. HPV vaccination for prevention. PCOS: Lifestyle modification, COCs (menstrual regulation, hirsutism), metformin (insulin resistance), clomiphene/letrozole (fertility). Contraception: Wide range including COCs, progestin-only pills, IUDs, implants, barrier methods.