Master Obs & Gyn
for FMGE

Core Concepts

Obstetrics focuses on pregnancy, childbirth, and the postpartum period. Key areas include Antenatal Care (ANC) – regular check-ups, nutritional advice (folic acid, iron), tetanus toxoid immunization; labor & delivery – three stages, active management of the third stage (oxytocin for PPH prevention); and common complications like Hypertensive Disorders of Pregnancy (PIH, Pre-eclampsia, Eclampsia, HELLP syndrome), Gestational Diabetes Mellitus (GDM), Postpartum Hemorrhage (PPH – uterine atony being the most common cause), Preterm Labor, and fetal surveillance (NST, BPP). Gynecology encompasses female reproductive health, from menarche to menopause. Important topics include menstrual disorders (amenorrhea, abnormal uterine bleeding - AUB, dysmenorrhea), common infections (Pelvic Inflammatory Disease - PID, vaginitis), contraception methods, infertility workup, benign conditions (Uterine Fibroids, Polycystic Ovarian Syndrome - PCOS, Endometriosis, Ovarian Cysts), and gynecological malignancies (Cervical, Endometrial, Ovarian Cancer).

Clinical Presentation

• **Pregnancy:** Amenorrhea, nausea/vomiting, breast tenderness, fatigue, quickening.
• **Labor:** Regular, painful uterine contractions, cervical effacement & dilation, "show," rupture of membranes.
• **PPH:** Excessive vaginal bleeding (>500mL vaginal, >1000mL C-section) within 24 hours of delivery.
• **Pre-eclampsia:** New-onset hypertension after 20 weeks gestation, proteinuria, often with edema; severe features include headache, visual changes, epigastric pain.
• **Ectopic Pregnancy:** Amenorrhea, sudden onset lower abdominal pain (often unilateral), vaginal spotting, signs of shock if ruptured.
• **PID:** Lower abdominal pain, fever, chills, purulent vaginal discharge, dyspareunia, cervical motion tenderness.
• **AUB:** Irregular, heavy, prolonged, or frequent uterine bleeding not related to pregnancy.
• **Uterine Fibroids:** Heavy menstrual bleeding (menorrhagia), pelvic pressure/pain, dysmenorrhea, infertility, recurrent pregnancy loss.
• **PCOS:** Oligo/amenorrhea, hirsutism, acne, obesity, infertility due to anovulation.
• **Endometriosis:** Chronic pelvic pain, severe dysmenorrhea, dyspareunia, deep sacral pain, infertility.
• **Cervical Cancer:** Often asymptomatic early; late symptoms include post-coital bleeding, abnormal vaginal discharge, pelvic pain.
• **Ovarian Cancer:** Vague symptoms like abdominal bloating, early satiety, pelvic discomfort, changes in bowel habits (often presents late).

Diagnosis (Gold Standard)

**Pregnancy:** Serum/urine hCG (qualitative/quantitative), Transvaginal Ultrasound (TVUS) for viability and dating. **Ectopic Pregnancy:** TVUS (empty uterus, adnexal mass), serial hCG (rises slower than normal IUP). **Pre-eclampsia:** Blood pressure measurement, 24-hour urine protein collection (or spot protein/creatinine ratio), LFTs, RFTs, CBC. **GDM:** Oral Glucose Tolerance Test (OGTT) at 24-28 weeks. **PPH:** Clinical diagnosis based on estimated blood loss. **Fibroids:** Pelvic Ultrasound (TVUS/TAS). **PCOS:** Rotterdam criteria (2 of 3: oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovaries on USG). **Endometriosis:** Laparoscopy with biopsy. **Cervical Cancer:** Pap smear (screening), Colposcopy with directed biopsy (diagnosis). **Endometrial Cancer:** Endometrial Biopsy. **Ovarian Cancer:** Ultrasound, CT scan, CA-125 (tumor marker, useful for monitoring), surgical staging. **PID:** Clinical triad (lower abdominal pain, cervical motion tenderness, adnexal tenderness), with supportive labs (ESR, CRP, leucocytosis).

Management (First Line)

• **ANC:** Folic acid, iron supplementation, TT immunization, regular visits for fetal growth and maternal well-being.
• **Active Management of 3rd Stage Labor:** Oxytocin 10 IU IM/IV after delivery of anterior shoulder.
• **PPH:** Uterine massage, Oxytocin; if unresponsive, Ergometrine, Misoprostol, Tranexamic Acid.
• **Pre-eclampsia (severe):** Labetalol/Nifedipine/Hydralazine for BP control, Magnesium Sulfate for seizure prophylaxis.
• **Eclampsia:** Magnesium Sulfate (loading dose + maintenance).
• **GDM:** Medical Nutrition Therapy, exercise; if uncontrolled, Insulin.
• **Ectopic Pregnancy:** Methotrexate (stable, small, unruptured) or Laparoscopic Salpingectomy.
• **PID:** Broad-spectrum antibiotics (e.g., Ceftriaxone + Doxycycline + Metronidazole).
• **AUB:** NSAIDs, Tranexamic acid, Hormonal therapy (OCPs, progestins); surgical options include endometrial ablation or hysterectomy.
• **Fibroids:** Expectant management, GnRH analogues, Myomectomy (fertility-sparing), Hysterectomy.
• **PCOS:** Lifestyle modification, OCPs (menstrual regulation, hirsutism), Clomiphene Citrate (for infertility).
• **Endometriosis:** NSAIDs, OCPs, GnRH analogues; laparoscopic excision of implants.
• **Cervical Cancer:** HPV vaccination for prevention; treatment depends on stage (LEEP, conization, hysterectomy, chemoradiation).
• **Contraception:** Oral Contraceptive Pills (OCPs), Injectables, Intrauterine Devices (IUDs – Cu-T, LNG-IUD), Barrier methods, Surgical sterilization.

Exam Red Flags