Obstetrics and Gynecology High-Yield Notes
1. Antepartum Hemorrhage (APH)
● Placenta previa: Painless recurrent bleeding, maternal blood loss.
● Placental abruption: Painful, fetus loses blood.
● CTG:
○ Start from bottom: maternal contractions (none in antepartum), fetal movements,
fetal HR.
○ Baseline HR ~140, variability and reactivity present = reassuring.
○ Late decelerations → fetal scalp pH sample to assess for acidosis.
2. Brachial Plexus Injury
● Birth-related; may result from shoulder dystocia.
● Erb’s palsy: C5-C6.
● Klumpke’s palsy: C8-T1.
3. Gestational Diabetes
● Diagnosed via OGTT.
● Risk factors: obesity, age, PCOS, macrosomia.
● Management: diet ± metformin ± insulin.
4. Preeclampsia
● BP ≥140/90 after 20 weeks + proteinuria/end-organ damage.
● Risk to mother and fetus; monitor and deliver if severe.
5. Large for Dates
● Causes: GDM, polyhydramnios, incorrect dating, macrosomia.
6. Incontinence & Urodynamics
● Urge: Detrusor overactivity.
● Stress: Leak with ↑ pressure (cough/sneeze).
○ Rule out detrusor instability first (urodynamics).
○ Surgical: Burch colposuspension.
● Mixed: Combination.
● True incontinence: Constant leak (e.g., fistula).
● Mobility-related: Functional limitation.
● Medical:
○ Oxybutynin, Mirabegron.
7. Gynecological Oncology
● Ovarian cancer: Risk originates in fallopian tubes.
○ Treatment: Chemotherapy.
● Cervical cancer:
○ Treatment: Radiotherapy.
● Uterine cancer:
○ Follow-up: Vaginal vault smear.
○ Radiotherapy if recurrence or spread.
● Vulval cancer:
○ Excision ± radiotherapy.
8. Molar Pregnancy & Choriocarcinoma
● Molar pregnancy:
○ High β-hCG, snowstorm on US.
○ Suction + evacuation.
○ Avoid pregnancy for 12 months; follow β-hCG levels.
● Choriocarcinoma:
○ Curable.
○ Methotrexate + multi-agent chemo.
9. Myoma Nascens
● Expelling fibroid; may require surgical removal if symptomatic.
10. PCOS
● LH:FSH ~3:1.
● First: Weight loss (~1 kg/month)
● Then: Metformin (4–6 months) → Clomifene.
● Rapid weight loss → hypo-GnRH amenorrhea.
11. Male Factor Infertility
● Semen analysis (~30% of cases).
● Assess volume, motility, morphology, count.
12. Tubal Factor Infertility
● Check tubal patency.
● Hydrosalpinx → may require salpingectomy pre-IVF.
13. IVF Protocol
● FSH to stimulate follicles.
● When follicle ~2 cm → LH/hCG trigger (day 11–12).
● Then: Timed intercourse, IUI (permit required), or IVF.
14. Contraceptives
● COCP:
○ 21 active + 7 placebo (gold standard)
○ Natural vs synthetic estrogen
● POP (progestogen-only pill):
○ Thickens cervical mucus
○ Desogestrel variant also inhibits ovulation
○ Good for breastfeeding (no estrogen)
● IUS (e.g., Mirena):
○ Thickens mucus, reduces bleeding
○ Only IUS indicated for heavy periods
● Copper coil:
○ Prevents intrauterine pregnancy
○ No hormone effect
● Acne:
○ Mirena/implant → worsen acne
○ Preferred: COCP or copper IUD
○ Cyproterone acetate (anti-androgenic)
15. Menopause Management
● Estrogen maintains ligament flexibility, uterine compliance
○ ↓ Estrogen → tougher uterus, ↑ prolapse
● If estrogen contraindicated:
○ Bisphosphonates:
■ Oral (monthly) or IV (yearly)
○ SERMs:
■ Risk: Endometrial hyperplasia, HTN, DVT
○ PTH analogs: Stimulate bone growth