Master Obs & Gyn
for FMGE

What the FMGE Tests in Obs & Gyn

The FMGE Obs & Gyn section tests your ability to manage common obstetric and gynaecological emergencies, interpret antenatal screening results, and apply evidence-based guidelines for labour, postpartum care, and gynaecological oncology. You must demonstrate knowledge of WHO partograph use, Bishop's score, criteria for pre-eclampsia (BP ≥140/90, proteinuria ≥300 mg/24h), gestational diabetes screening (75 g OGTT at 24–28 weeks), and management of ectopic pregnancy (transvaginal ultrasound, serial β-hCG, methotrexate or salpingectomy). In gynaecology, focus on abnormal uterine bleeding (PALM-COEIN classification), cervical cancer screening (HPV co-testing, colposcopy), and emergency contraception (levonorgestrel 1.5 mg, copper IUD). Questions often present a clinical vignette requiring immediate triage—e.g., antepartum haemorrhage, shoulder dystocia, or ruptured ectopic—and expect you to choose the next best diagnostic step or definitive treatment. Drug doses, gestational age cut-offs, and surgical indications are heavily tested.

High-Yield Concepts

• Pre-eclampsia diagnosis and management: Diagnosis: BP ≥140/90 mmHg after 20 weeks with proteinuria (≥300 mg/24h) or end-organ dysfunction. Severe features: BP ≥160/110, platelets <100,000, elevated LFTs, pulmonary oedema. First-line treatment: labetalol 200 mg oral, or IV hydralazine 5 mg; magnesium sulfate 4 g IV loading then 1 g/h for 24 hours for seizure prophylaxis. Delivery recommended at 37 weeks for mild, 34 weeks for severe pre-eclampsia.
• Shoulder dystocia management: Recognise: turtle sign, failure of delivery after head. HELPERR mnemonic: Help (call for assistance), Episiotomy (if needed), Legs (McRoberts' manoeuvre), suprapubic Pressure (not fundal), Enter (internal rotational manoeuvres: Rubin II, Woods' corkscrew), Roll (all-fours position). Avoid fundal pressure. Document time and manoeuvres.
• Ectopic pregnancy diagnosis and treatment: Suspect in first trimester with abdominal pain, adnexal tenderness, and empty uterus on transvaginal ultrasound. β-hCG discriminatory zone: >1500 IU/L with no intrauterine pregnancy suggests ectopic. Treatment: haemodynamically stable, unruptured, mass <3.5 cm, no fetal cardiac activity → methotrexate 50 mg/m² IM (single-dose protocol). Otherwise, laparoscopic salpingectomy.
• Abnormal uterine bleeding (AUB) – PALM-COEIN: Structural causes: Polyp, Adenomyosis, Leiomyoma (submucosal most relevant), Malignancy/hyperplasia. Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified. First-line for ovulatory AUB: tranexamic acid 1 g TID or combined oral contraceptive. Endometrial biopsy indicated if age >45 or risk factors (obesity, PCOS, tamoxifen).
• Cervical cancer screening and management: Screening: HPV co-testing (HPV DNA + cytology) every 5 years ages 30–65; if HPV 16/18 positive, refer for colposcopy. Abnormal cytology (ASC-US with high-risk HPV, LSIL, HSIL) → colposcopy with biopsy. Treatment: CIN2/3 → loop electrosurgical excision procedure (LEEP) or cold knife conisation. Stage IA1: simple hysterectomy if fertility not desired.
• Gestational diabetes mellitus (GDM) screening and management: Screen at 24–28 weeks with 75 g OGTT. Diagnosis: fasting ≥5.1 mmol/L, 1-hour ≥10.0 mmol/L, 2-hour ≥8.5 mmol/L (any one value). First-line management: medical nutrition therapy + self-monitoring blood glucose. If fasting >5.3 mmol/L or postprandial >6.7 mmol/L, start metformin or insulin (insulin preferred in pregnancy). Target: fasting <5.3 mmol/L, 1-hour <7.8 mmol/L.
• Postpartum haemorrhage (PPH) management: Defined as blood loss >500 mL vaginal delivery or >1000 mL caesarean. Most common cause: uterine atony. First-line: uterine massage, oxytocin 10 IU IM/IV (slow push), then ergometrine 0.5 mg IM (contraindicated in hypertension), carboprost 250 mcg IM (asthma contraindication). If ongoing: intrauterine balloon tamponade (Bakri), uterine artery embolisation, or surgical compression sutures (B-Lynch).
• Bishop's score and induction of labour: Bishop's score assesses cervical favourability: 0–3 unfavourable, ≥6 favourable. Components: dilation, effacement, station, consistency, position. Induction methods: favourable cervix → amniotomy + oxytocin; unfavourable → prostaglandin E2 (dinoprostone) 3 mg vaginal pessary or misoprostol 25 mcg vaginally every 4–6 hours. Oxytocin regimen: start at 1–2 mU/min, increase by 1–2 mU/min every 30 min to max 20 mU/min.

Common Traps in Obs & Gyn Questions

• Confusing pre-eclampsia with gestational hypertension: gestational hypertension has BP ≥140/90 but no proteinuria or end-organ damage.
• Using fundal pressure in shoulder dystocia – this can cause uterine rupture or fetal injury; only suprapubic pressure is correct.
• Assuming a positive urine pregnancy test always means intrauterine pregnancy – ectopic or molar pregnancy can also be positive.
• Treating AUB with tranexamic acid before ruling out structural causes – always perform ultrasound first.
• Forgetting that cervical cancer screening is not recommended before age 21, regardless of sexual activity.
• Administering ergometrine to a patient with pre-eclampsia – it is contraindicated due to vasoconstriction and hypertension.

How to Revise Obs & Gyn for the FMGE

Prioritise high-stakes emergencies: PPH, pre-eclampsia, shoulder dystocia, and ectopic rupture. Memorise diagnostic cut-offs (BP, proteinuria, β-hCG, OGTT) and first-line drug doses (oxytocin, MgSO4, methotrexate). Questions are often scenario-based: you must identify the condition from a brief history and then choose the immediate next step (e.g., 'What is the best next step in management?'). Practise interpreting partograph abnormalities (prolonged latent phase, arrest disorders) and Bishop's score components. For gynaecology, focus on AUB classification and cervical cancer staging (FIGO). Use mnemonics (HELPERR, PALM-COEIN) to recall sequences. Review NICE/WHO guidelines for induction and GDM. Spend extra time on surgical indications (e.g., when to do caesarean vs. instrumental delivery) and contraceptive methods (IUD, implant, DMPA).

Practise it: MedLumen has 50 Obs & Gyn questions for the FMGE, each with a full explanation and references.