Topic library

≥500 ml after birth; major >1000 ml or any signs of shock.

Fit in pregnancy or after birth — treat as eclampsia until proven otherwise.

Head born, shoulders stuck. Note the time of head delivery.

Cord below the presenting part after membranes rupture.

Unresponsive pregnant or recently delivered woman.

Suspected infection + red flags — Sepsis Six within 1 hour.

Early pregnancy with pain, collapse or shoulder-tip pain.

Bleeding from 24+0 weeks until birth.

Shock with a mass in the vagina after birth.

Usually a scarred uterus in labour.

Sudden collapse in labour or just after birth.

Baby not breathing well at birth.

New global guidance: act early, give everything together.

Uterotonics and tranexamic acid in the order you reach for them.

Labetalol first, nifedipine second, methyldopa third; target ≤135/85.

Steroids, neuroprotection, tocolysis and PPROM antibiotics.

Prostaglandins, oxytocin and tocolysis for hyperstimulation.

GBS, caesarean, instrumental birth, sepsis, PID, endometritis.

RhD-negative women and LMWH doses.

Ectopic, miscarriage, emergency contraception, heavy bleeding.

Antiemetic ladder, thiamine and fluids.

Anaphylaxis, arrest, hypoglycaemia, local anaesthetic.

Glucose targets and breastfeeding-safe pain relief.

Misoprostol-only regimens by indication and weeks.

Positive test + bleeding ± pain.

Praevia vs abruption vs vasa praevia.

Obstetric vs non-obstetric causes.

Always do a pregnancy test first.

In pregnancy think pre-eclampsia first.

Pulmonary embolism until proven otherwise.

Look for the source; screen for sepsis.

Confirm rupture of membranes.

Cholestasis vs skin conditions.

Hyperemesis is a diagnosis of exclusion.

Common infections at a glance.

Postnatal red flags.

Structure, gravida/para notation and GTPAL.

Inspection, palpation, auscultation — in order.

Four grips to find lie, presentation, position and engagement.

Rough gestation by where the fundus lies.

Everything to feel and record.

Cusco and Sims technique and swabs.

Size, position and tenderness of uterus and adnexa.

What the sign is and what it points to.

Classic signs and when they appear.

Is she really in labour?

The sums you need on the ward — each has a calculator.

Physiology changes the reference ranges.

AFI and deepest vertical pocket.

Quick reference values.

For audits, exams and teaching.

The four words that describe the baby in the uterus.

Which point names the position for each presentation.

How far the head has descended.

Frank, complete, footling.

Deflexed presentations and what they mean for birth.

Landmarks felt on vaginal examination.

Which diameter presents depends on flexion.

Grading on VE — a clue to disproportion.

Inlet, midcavity and outlet.

Shape predicts the mechanism of labour.

The cardinal movements.

Malpositions that slow labour.

Definitions and expected duration.

When to suspect, confirm and act.

What to check and how often.

White / amber / red features and overall category.

Replaces the old partograph alert/action lines.

Method depends on the Bishop score.

Active vs physiological management.

Classification — if unsure, choose the higher grade.

Newborn condition at 1 and 5 min.

Standard way to compare caesarean rates.

Normal birth of the head, shoulders and body.

Forceps or vacuum — prerequisites and when to stop.

Which instrument for which situation.

Urgency and decision-to-birth time.

Counselling numbers.

Selection and conduct.

Timing and mode of birth.

HELPERR — move on quickly; go to internal manoeuvres early.

Hands off the breech until scapulae are visible.

Turning a breech baby to cephalic through the abdomen.

Second twin, or transverse lie at full dilatation.

Controlled birth of the head.

Active management of the third stage.

Rotate the occiput anterior at full dilatation.

Buy time in atonic PPH.

Johnson’s manoeuvre and O’Sullivan hydrostatic method.

Keep the presenting part off the cord until birth.

Booking, visits, scans and bloods.

Who needs 5 mg folic acid.

Aspirin 75–150 mg nightly from 12 weeks to birth.

Definitions, admission and timing of birth.

GDM screening, diagnosis, targets and timing of birth.

Thresholds and iron treatment.

Score at booking, on admission and after birth.

Diagnosis, steroids, magnesium, tocolysis.

Itch without rash + raised bile acids.

Definitions and when to deliver.

Who gets intrapartum antibiotics.

Doses and sensitising events.

Diagnosis and timing of birth.

Common medical conditions in pregnancy.

Diagnosis, birth, investigations and support.

When to refer an antibody-positive mother.

Oligohydramnios and polyhydramnios.

TTTS, growth discordance and one twin dying.

Secondary PPH, puerperal sepsis, mastitis and engorgement.

Transvaginal scan criteria before calling a pregnancy non-viable.

Expectant, medical or surgical — the woman chooses.

Scan diagnosis and choosing expectant, methotrexate or surgery.

Positive test, no pregnancy seen on TVS.

Three or more first-trimester losses (investigate after 2 if a cause is suspected).

Complete vs partial mole, evacuation and hCG follow-up.

Severe nausea and vomiting with dehydration and ketosis.

Mifepristone then misoprostol regimens by gestation.

PALM-COEIN, investigation and the treatment ladder.

Location decides symptoms and the operation.

Pain, dysmenorrhoea, dyspareunia, subfertility.

2 of 3 Rotterdam criteria after excluding other causes.

Primary vs secondary and a stepwise work-up.

Diagnosis, POI and HRT safety.

Exclude endometrial cancer.

Benign or suspicious? RMI and IOTA rules.

Surgical emergency — save the ovary.

Clinical diagnosis — treat at a low threshold.

POP-Q staging and first-line treatment.

No conception after 12 months of regular sex.

Ovarian hyperstimulation after fertility treatment.

Too early, too late, and Tanner staging.

Labial adhesions, vulvovaginitis and congenital conditions.

Admit, IV antibiotics, drain if no response.

Lichen sclerosus, vulvodynia and ectropion.

Six months or more — a symptom, not a diagnosis.

Diary first, then a stepped plan.

Exclude a tumour first.

Adhesions inside the uterus after curettage or infection.

Bladder training first, then drugs.

Mostly from obstructed labour in Pakistan — prevent with a catheter.

2 in 6 months or 3 in 12 months.

What to give and when to refer.

Always test the man.

Pakistan law: Anti-Rape Act 2021 and Rules 2022.

Ask every woman, alone, in a safe place.

Is this method safe for her?

Cu-IUD is the most effective.

What to do depends on how many and which week.

Timings after birth and failure rates.

HPV primary screening and results.

FIGO 2018 staging.

FIGO 2023 — histology and molecular type now change the stage.

FIGO 2014 staging.

FIGO 2021 staging.

FIGO 2000 anatomical stage + WHO prognostic score (e.g. “III:4”).

Surgery for early disease, chemoradiation for advanced.

Surgery plus molecular class guides everything.

Complete removal of all visible disease matters most.

Often in young women — fertility-sparing surgery.

Wide excision plus groin assessment.

Which marker points where.

Fetal compromise, failure to progress, malpresentation, praevia, ≥2 previous CS, maternal request.

Vertical upper-segment incision when the lower segment can’t be used.

Last-resort control of haemorrhage.

Fibroids, refractory bleeding, adenomyosis/endometriosis, cancer, chronic pain.

Uterovaginal prolapse or benign bleeding with a mobile, modest-sized uterus.

Symptomatic fibroids in a woman wishing to keep her uterus.

Persistent or symptomatic benign cyst (dermoid, endometrioma) with low malignancy risk.

Tubal ectopic unsuitable for medical treatment.

Pain, endometriosis, subfertility (dye test), ectopic, adnexal mass.

Atonic PPH where bimanual compression stops the bleeding.

Surgical control of pelvic haemorrhage.

Suture to support the cervix in women at risk of mid-trimester loss.

Symptomatic anterior or posterior vaginal wall prolapse.

Vault prolapse, or uterine prolapse (hysteropexy).

Obstetric anal sphincter injury.

Endometrial sampling — now largely replaced by hysteroscopy + biopsy.

Suction evacuation for incomplete or missed miscarriage.

Outpatient uterine evacuation under local anaesthetic, up to ~12 weeks.

PMB, abnormal bleeding, polyps, fibroids, lost coil, subfertility.

Abnormal bleeding ≥45 or risk factors; PMB with endometrium ≥4 mm.

Contraception, heavy bleeding (LNG-IUS), HRT endometrial protection, emergency contraception (Cu-IUD).

Large loop excision of the transformation zone for CIN2+ / high-grade changes.

Abnormal area seen at colposcopy.

Symptomatic or visible cervical polyp.

Word catheter or marsupialisation — similar recurrence.

Induction with favourable cervix, or slow progress in established labour.

Mechanical induction with an unfavourable cervix.

Retained placenta or PPH with placenta in situ.

Bleeding cervical laceration after birth.

Fetal compromise, instrumental birth, or to prevent a severe tear.

Atonic PPH not controlled by uterotonics — the “tamponade test”.

Suspected complete or partial mole.

Continuous FHR when the external trace is poor.

Epidural with inability to void, retention, before CS or instrumental birth.

How risky pregnancy is for each heart condition.

Common in Pakistan. Tachycardia and fluid kill.

New heart failure late in pregnancy or up to 6 months after.

Can occur with near-normal glucose. Treat the mother to save the baby.

New ATA guideline (May 2026).

Uncontrolled asthma is the bigger risk.

Keep the disease quiet and prevent clots.

Pregnancy creatinine is normally 45–60 µmol/L.

Two liver emergencies of late pregnancy.

Thalassaemia trait is common in Pakistan — test the partner.

Ask every woman, at booking and after birth.

Most drugs are safe. These are not.

Screen every woman. Stop it reaching the baby.

Pakistan has one of the world’s highest rates.

Viral load at 36 weeks decides the mode of birth.

Treat early — it is completely preventable in the baby.

UK advice changed in 2024: oral antivirals replace VZIG.

Classic congenital infections.

Treat even asymptomatic bacteriuria in pregnancy.

Vivax is commonest in Pakistan; falciparum is the killer.

Seasonal outbreaks in Karachi, Lahore, Rawalpindi and Peshawar.

Extensively drug-resistant typhoid in Sindh since 2016.

First-line drugs are safe.

Treat early in pregnancy.

A structured call to a senior or a shift handover.

What to write when you admit a pregnant woman.

For caesarean section and other surgery.

What the next doctor needs to know.

Capacity, information and free choice.

Before any gynae operation.

Sign in, time out, sign out.

Faster recovery after gynae surgery.

Fever, ileus and organ injury.

Daily needs, thresholds and major haemorrhage.

Assault, burns, poisoning, criminal abortion, unexplained injury.

Greet, ask permission, and take a history.

Short instructions during labour and birth.

Caesarean, blood, breastfeeding, spacing and danger signs.

Four years: IMM (years 1–2), then post-IMM (years 3–4).

Basic sciences entry exam, four sittings a year.

Intermediate Module at the end of year 2.

Theory, then clinical 3–4 weeks later.

Two-year membership diploma.

Finish them in years 1–2.

Dissertations ended in January 2025.

Daily entries, quarterly Mini-CEX and DOPS.

January and July, stipendiary posts only.

Four-year degree with a thesis.

UK membership — CPSP answers follow RCOG too.

Theory dates; clinicals follow 2–4 weeks later.

Major units across Pakistan and their universities.

Numbers for your synopsis, viva and teaching.

Pakistani guidelines worth knowing for vivas.

What you will find in the labour ward cupboard.

What your patients may be covered by.

No notes, no scans, no blood group. A common situation.

Sending a woman to a tertiary unit safely.