OBGYN Essentials: High-Yield Review

Hypertensive Disorders of Pregnancy

Preeclampsia is a multisystem disorder characterized by new-onset hypertension (≥140/90) and proteinuria or end-organ dysfunction after 20 weeks gestation. Understanding the management of severe features is a critical exam objective.

Early Pregnancy Complications

The MCCQE frequently tests the management of vaginal bleeding in the first trimester. Ectopic pregnancy must always be ruled out in any reproductive-age woman with abdominal pain and bleeding.

• Ectopic Pregnancy: Look for a history of PID or tubal surgery. Diagnosis involves serial β-hCG levels and transvaginal ultrasound. Management can be medical (Methotrexate) or surgical depending on stability and β-hCG levels.
• Spontaneous Abortion: Distinguishing between threatened, inevitable, incomplete, and missed abortion is key for determining management (expectant vs. medical vs. surgical).

Labor and Delivery Management

Candidates must be proficient in interpreting fetal heart rate (FHR) tracings and identifying signs of fetal distress. Early decelerations are usually benign (head compression), while late and variable decelerations require immediate evaluation and potentially urgent delivery.

Postpartum Hemorrhage (PPH)

PPH is a leading cause of maternal mortality. The "4 Ts" (Tone, Tissue, Trauma, Thrombin) are the framework for identifying the cause. Uterine atony (Tone) is the most common cause, managed initially with fundal massage and uterotonics (Oxytocin).