Master Obs & Gyn
for PMDC NLE Step 1

Core Concepts

Obstetrics: Covers pregnancy, childbirth, and postpartum. Key maternal adaptations: increased blood volume (40-50%), cardiac output, and hypercoagulability. Gestational age is typically calculated from the first day of the last menstrual period (LMP) or early ultrasound.

• Gravidity: Total number of pregnancies. Parity: Number of births beyond 20 weeks gestation.
• Term Pregnancy: 37-41 weeks. Preterm: <37 weeks. Post-term: >42 weeks.
• Antenatal Care: Routine monitoring. Includes dating scan (early TVUS), anomaly scan (18-22 wks), vaccinations (Tdap, Flu), folic acid, iron.

Gynecology: Focuses on the female reproductive system. Menstrual cycle governed by GnRH, FSH, LH, Estrogen, Progesterone.

• Menstrual Cycle: Follicular (estrogen dominant), Ovulation (LH surge), Luteal (progesterone dominant).
• Amenorrhea: Primary (no menarche by 15 with secondary sexual characteristics, or 13 without) vs. Secondary (absence of menses for 3+ cycles).

Clinical Presentation

• Ectopic Pregnancy: Amenorrhea, unilateral lower abdominal pain, vaginal spotting. Rupture: hypovolemic shock.
• Miscarriage: Vaginal bleeding, lower abdominal cramping in early pregnancy.
• Pre-eclampsia: New HTN (>140/90 mmHg) and proteinuria (>0.3g/24h) after 20 weeks. Severe: BP >160/110, headache, visual changes, RUQ pain, thrombocytopenia.
• Gestational Diabetes Mellitus (GDM): Often asymptomatic; diagnosed by screening. Risks: fetal macrosomia, neonatal hypoglycemia.
• Placenta Previa: Painless bright red vaginal bleeding in late second/third trimester.
• Abruptio Placentae: Painful vaginal bleeding, sudden severe abdominal pain, uterine tenderness, fetal distress.
• Pelvic Inflammatory Disease (PID): Lower abdominal pain, fever, vaginal discharge, cervical motion tenderness.
• Uterine Fibroids: Menorrhagia, pelvic pressure/pain, urinary frequency. Often asymptomatic.
• Endometriosis: Chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, infertility.
• Polycystic Ovary Syndrome (PCOS): Oligo/anovulation (irregular menses), hyperandrogenism (hirsutism, acne), polycystic ovaries on US.

Diagnosis (Gold Standard)

• Pregnancy: Serum/urine hCG.
• Ectopic Pregnancy: Transvaginal Ultrasound (TVUS) showing empty uterus + positive hCG; or adnexal mass/free fluid.
• Pre-eclampsia: BP measurement + 24-hour urine collection for proteinuria.
• Gestational Diabetes: Oral Glucose Tolerance Test (OGTT) at 24-28 weeks.
• Placenta Previa/Abruptio: Transabdominal Ultrasound (for previa), clinical findings (for abruptio).
• PID: Clinical diagnosis based on minimum criteria; laparoscopy is definitive but rarely needed.
• Endometriosis: Laparoscopy with biopsy.
• Cervical Cancer: Cervical biopsy (after abnormal Pap smear).
• Endometrial Cancer: Endometrial biopsy.

Management (First Line)

• Ectopic Pregnancy: Methotrexate (stable, unruptured) or Surgical (laparoscopic salpingectomy/salpingostomy).
• Miscarriage: Expectant, Medical (misoprostol), or Surgical (D&C).
• Pre-eclampsia: Delivery (definitive); Antihypertensives (Labetalol, Nifedipine); Magnesium Sulfate for seizure prophylaxis.
• Gestational Diabetes: Diet/exercise, then Insulin if targets not met.
• Placenta Previa: Strict rest, avoid vaginal exams, C-section for delivery if persists near term.
• Abruptio Placentae: Emergency C-section (if unstable or fetal distress), aggressive fluid resuscitation.
• Pelvic Inflammatory Disease: Broad-spectrum antibiotics (e.g., Ceftriaxone + Doxycycline + Metronidazole).
• Uterine Fibroids: NSAIDs/hormonal therapy (OCPs); Surgical: Myomectomy (fertility desired) or Hysterectomy.
• Endometriosis: NSAIDs, hormonal contraceptives (OCPs), GnRH agonists. Surgical excision.
• PCOS: Lifestyle modification, OCPs for menstrual regulation/hirsutism, Metformin for insulin resistance, Clomiphene for infertility.
• Postpartum Hemorrhage (PPH): Uterine massage, Oxytocin.