Master Obstetrics and Gynecology
for SMLE

Core Concepts

Obstetrics and Gynecology (ObGyn) encompasses female reproductive health, pregnancy, childbirth, and puerperium. It combines medical and surgical management. Key principles include understanding normal physiological changes (menstrual cycle, pregnancy), early detection and management of complications, and preventative care (e.g., vaccination, screening). Emphasis is placed on maternal and fetal well-being, contraception, fertility, and management of gynecological pathologies across all ages.

Clinical Presentation

• Abnormal Vaginal Bleeding:
  • Antepartum: Painless (Placenta Previa), Painful (Abruptio Placentae).
  • Postpartum: Heavy bleeding after delivery (Postpartum Hemorrhage - PPH).
  • Non-gravid: Menorrhagia, metrorrhagia, post-coital, post-menopausal (e.g., endometrial pathology, fibroids, polyps, cervical cancer).
• Pelvic Pain: Acute (e.g., Ectopic pregnancy, PID, ovarian torsion, ruptured cyst) or Chronic (e.g., Endometriosis, Adenomyosis, adhesions).
• Vaginal Discharge: Itchiness, odor, dysuria (e.g., Infections like Candidiasis, Bacterial Vaginosis, STIs).
• Pregnancy-related Symptoms: Nausea/vomiting, hypertension (e.g., Pre-eclampsia), reduced fetal movement, preterm contractions, symptoms of DVT/PE.
• Infertility: Inability to conceive after 12 months (or 6 months if >35 years) of unprotected intercourse.
• Urinary Symptoms: Frequency, urgency, incontinence (e.g., UTI, pelvic organ prolapse).

Diagnosis (Gold Standard)

• Pregnancy Confirmation: Serum/urine hCG.
• Ectopic Pregnancy: Transvaginal Ultrasound (TVS) showing extrauterine gestational sac + hCG levels not doubling appropriately.
• Gestational Diabetes Mellitus (GDM): Oral Glucose Tolerance Test (OGTT) at 24-28 weeks.
• Pre-eclampsia: New-onset hypertension (>140/90 mmHg after 20 weeks) with proteinuria or end-organ dysfunction.
• Placenta Previa/Abruptio Placentae: Transabdominal Ultrasound (for previa), clinical presentation (for abruption).
• Cervical Cancer Screening: Pap smear (cytology) followed by colposcopy with biopsy for abnormal results.
• Endometrial Cancer: Endometrial biopsy.
• Ovarian Mass: Pelvic Ultrasound; CA-125 for suspicion of malignancy.
• Pelvic Inflammatory Disease (PID): Clinical diagnosis (pelvic pain, cervical motion tenderness, adnexal tenderness, fever, discharge); definitive with laparoscopy.
• Infertility: Comprehensive workup including semen analysis, ovulation assessment (progesterone), tubal patency (HSG), ovarian reserve (AMH, FSH).

Management (First Line)

• Antenatal Care: Regular visits, screening (blood group, infections, GDM), nutritional advice, folic acid.
• Pre-eclampsia: Delivery is definitive management; Magnesium Sulfate for seizure prophylaxis/eclampsia treatment; Antihypertensives (Labetalol, Nifedipine, Hydralazine).
• Postpartum Hemorrhage (PPH): Uterine massage, Oxytocin; explore causes (tone, trauma, tissue, thrombin).
• Ectopic Pregnancy:
  • Stable: Methotrexate (IM).
  • Unstable/Contraindication to MTX: Surgical (laparoscopic salpingectomy).
• Gestational Diabetes: Dietary modifications, exercise; Insulin if diet/exercise fail.
• Preterm Labor: Tocolytics (Nifedipine, Indomethacin), Betamethasone (fetal lung maturity), antibiotics for PROM.
• Cervical Intraepithelial Neoplasia (CIN): LEEP (Loop Electrosurgical Excision Procedure) or cryotherapy.
• Pelvic Inflammatory Disease (PID): Broad-spectrum antibiotics (e.g., Ceftriaxone + Doxycycline + Metronidazole).
• Menorrhagia (Heavy Menstrual Bleeding): Tranexamic acid, NSAIDs, hormonal contraceptives (COCs), Mirena IUD.
• Contraception: Discuss options based on patient needs/contraindications (COCs, Progestin-only, IUD, implant, barrier methods).

Exam Red Flags