MBBS Obstetrics & Gynecology Syllabus

Obstetrics & Gynecology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Obstetrics & Gynecology in MBBS, not a summary of it.

1. 1

   Anatomy and Physiology

   2 topics

   • Anatomy of the female reproductive system
     • External genitalia
     • Internal genitalia (uterus, fallopian tubes, ovaries)
     • Pelvic floor muscles
   • Physiology of the menstrual cycle
     • Hormonal regulation (FSH, LH, estrogen, progesterone)
     • Follicular development
     • Ovulation
     • Endometrial changes
2. 2

   Normal Pregnancy

   3 topics

   • Antenatal care
     • Initial assessment
     • Risk assessment
     • Screening tests (ultrasound, biochemical markers)
     • Prenatal counseling
   • Physiological changes in pregnancy
     • Cardiovascular changes
     • Respiratory changes
     • Gastrointestinal changes
     • Renal changes
     • Endocrine changes
   • Fetal development and monitoring
     • Fetal growth and development
     • Fetal movements
     • Fetal heart rate monitoring (cardiotocography, Doppler ultrasound)
3. 3

   Obstetric Disorders

   4 topics

   • Hypertensive disorders of pregnancy
     • Gestational hypertension
     • Preeclampsia
     • Eclampsia
     • HELLP syndrome
   • Gestational diabetes mellitus
     • Diagnosis
     • Monitoring
     • Management (dietary modification, insulin therapy)
   • Preterm labor
     • Risk factors
     • Diagnosis
     • Prevention (progesterone supplementation)
     • Management (tocolysis, antenatal corticosteroids)
   • Multiple pregnancy
     • Diagnosis
     • Complications (preterm birth, twin-to-twin transfusion syndrome)
     • Management
4. 4

   Labor and Delivery

   4 topics

   • Normal labor
     • Stages of labor (first stage, second stage, third stage)
     • Mechanisms of labor
     • Assessment of progress
   • Intrapartum monitoring
     • Fetal heart rate monitoring (cardiotocography)
     • Assessment of fetal well-being
     • Partogram
   • Management of labor
     • Induction of labor
     • Augmentation of labor
     • Pain relief methods (analgesia, anesthesia)
     • Instrumental delivery (forceps, vacuum extraction)
   • Cesarean section
     • Indications
     • Preoperative preparation
     • Surgical techniques
     • Postoperative care
5. 5

   Postpartum Care

   3 topics

   • Physiological changes in the postpartum period
     • Uterine involution
     • Lochia
     • Breastfeeding
     • Maternal bonding
   • Postpartum complications
     • Postpartum hemorrhage
     • Puerperal sepsis
     • Postpartum blues
     • Postpartum depression
   • Contraception
     • Counseling on contraceptive methods (oral contraceptives, intrauterine devices, implants, sterilization)
     • Initiation of contraception in the postpartum period
6. 6

   Gynecological Disorders

   4 topics

   • Menstrual disorders
     • Dysmenorrhea
     • Menorrhagia
     • Oligomenorrhea
     • Amenorrhea
   • Benign gynecological conditions
     • Fibroids (leiomyomas)
     • Ovarian cysts
     • Endometriosis
     • Pelvic inflammatory disease (PID)
   • Gynecological cancers
     • Cervical cancer
     • Endometrial cancer
     • Ovarian cancer
     • Vulvar cancer
   • Reproductive endocrinology
     • Polycystic ovary syndrome (PCOS)
     • Premature ovarian insufficiency (POI)
     • Hyperprolactinemia
7. 7

   Reproductive Endocrinology and Infertility

   4 topics

   • Evaluation of Infertility
     • History taking
     • Physical examination
     • Investigations (hormonal assays, imaging studies)
     • Male factor evaluation
   • Assisted Reproductive Technologies (ART)
     • Intrauterine insemination (IUI)
     • In vitro fertilization (IVF)
     • Intracytoplasmic sperm injection (ICSI)
     • Gamete donation
   • Endocrine Disorders Causing Infertility
     • Hypothalamic-pituitary dysfunction
     • Thyroid disorders
     • Hyperprolactinemia
   • Ovulation Induction
     • Clomiphene citrate
     • Gonadotropins
     • Aromatase inhibitors for ovulation induction in women with anovulatory infertility
8. 8

   Urogynecology and Pelvic Floor Disorders

   3 topics

   • Urinary incontinence
     • Stress urinary incontinence
     • Urge urinary incontinence
     • Mixed urinary incontinence
     • Overflow incontinence
   • Pelvic organ prolapse
     • Anterior compartment prolapse (cystocele)
     • Posterior compartment prolapse (rectocele)
     • Uterine prolapse
   • Pelvic floor dysfunction
     • Pelvic floor muscle exercises (Kegel exercises)
     • Biofeedback therapy
     • Surgical management of pelvic organ prolapse
9. 9

   Sexual and Reproductive Health

   4 topics

   • Sexual health and contraception
     • Sexual history taking
     • Counseling on sexual health
     • Contraceptive counseling
   • Sexually transmitted infections (STIs)
     • Chlamydia
     • Gonorrhea
     • Syphilis
     • Genital herpes
     • Human papillomavirus (HPV)
     • HIV/AIDS
   • Menopause
     • Symptoms of menopause
     • Hormone replacement therapy (HRT)
     • Management of menopausal symptoms (hot flashes, vaginal dryness)
   • Sexual dysfunction
     • Female sexual dysfunction (hypoactive sexual desire disorder, dyspareunia, vaginismus)
     • Male sexual dysfunction (erectile dysfunction, premature ejaculation)
10. 10

    Gynecological Oncology

    4 topics

    • Cervical cancer
      • Screening (Pap smear, HPV testing)
      • Diagnosis
      • Staging
      • Management
    • Endometrial cancer
      • Clinical features
      • Diagnosis (endometrial biopsy)
      • Staging
      • Management
    • Ovarian cancer
      • Clinical features
      • Diagnosis (CA-125, imaging studies)
      • Staging
      • Management
    • Gestational trophoblastic disease
      • Hydatidiform mole
      • Invasive mole
      • Choriocarcinoma
      • Placental site trophoblastic tumor

Obstetrics & Gynecology flashcards for MBBS

24 of 64 cards from the Obstetrics & Gynecology deck — real questions with worked answers.

1. What is the typical blood supply to the uterus, and from which major vessel does the uterine artery arise?

   The uterus is supplied mainly by the uterine artery, a branch of the anterior division of the internal iliac (hypogastric) artery. It anastomoses with the ovarian artery (a direct branch of the abdominal aorta). The uterine artery crosses over the ureter ("water under the bridge").

2. Name the four anatomical parts of the fallopian tube from the uterus outward, and state where fertilization usually occurs.

   From uterus outward: interstitial (intramural), isthmus, ampulla, infundibulum (with fimbriae). Fertilization normally occurs in the ampulla.

3. What are the three layers of the uterine wall?

   From inside out: endometrium (mucosal lining), myometrium (thick smooth muscle), and perimetrium (serosa/peritoneal covering).

4. Which ligament carries the ovarian vessels, and which ligament connects the ovary to the lateral pelvic wall?

   The suspensory ligament of the ovary (infundibulopelvic ligament) carries the ovarian artery and vein. The ovary is connected to the lateral pelvic wall by this same suspensory ligament; the ovarian ligament connects the ovary to the uterus.

5. What is the normal anatomical position of the uterus in most women?

   Anteverted and anteflexed. Anteversion is the angle between the cervix/vagina axis; anteflexion is the angle between the cervix and uterine body.

6. List the four phases of the menstrual cycle in terms of the ovarian and uterine cycles.

   Ovarian cycle: follicular phase and luteal phase (separated by ovulation). Uterine cycle: menstrual phase, proliferative phase, and secretory phase.

7. Which hormone surge triggers ovulation, and approximately when does ovulation occur in a 28-day cycle?

   The luteinizing hormone (LH) surge triggers ovulation, occurring around day 14 (approximately 36 hours after LH surge onset, ~10–12 hours after the LH peak).

8. Which hormone dominates the proliferative (follicular) phase, and which dominates the secretory (luteal) phase of the menstrual cycle?

   Estrogen (from the developing follicle) dominates the proliferative phase. Progesterone (from the corpus luteum) dominates the secretory phase.

9. What maintains the corpus luteum if pregnancy occurs, and what happens to it if it does not?

   If pregnancy occurs, human chorionic gonadotropin ($\beta$-hCG) from the trophoblast maintains the corpus luteum. If no pregnancy, the corpus luteum regresses into the corpus albicans (~day 24–26), progesterone falls, and menstruation follows.

10. What is Naegele's rule for calculating the estimated date of delivery (EDD)?

    EDD = first day of last menstrual period (LMP) $-$ 3 months $+$ 7 days $+$ 1 year. (Assumes a regular 28-day cycle.)

11. What is the recommended schedule of routine antenatal visits in an uncomplicated pregnancy (traditional model)?

    Every 4 weeks until 28 weeks, every 2 weeks from 28–36 weeks, then weekly from 36 weeks until delivery.

12. What are the recommended daily folic acid doses for low-risk versus high-risk women preconception, and why?

    Low-risk: $400\ \mu g/day$. High-risk (e.g., previous neural tube defect, diabetes, antiepileptics): $5\ mg/day$. Folic acid reduces the risk of fetal neural tube defects and should start before conception through the first trimester.

13. What is the definition of gravidity versus parity?

    Gravidity = total number of pregnancies, regardless of outcome. Parity = number of pregnancies carried to a viable gestational age (usually $\geq 24$ weeks / $\geq 20$ weeks depending on convention), whether live or stillborn.

14. What cardiovascular changes occur in normal pregnancy regarding cardiac output, plasma volume, and blood pressure?

    Cardiac output rises ~30–50%. Plasma volume rises ~40–50% (greater than red cell mass, causing physiological/dilutional anemia). Blood pressure falls in the second trimester (lowest mid-pregnancy) due to reduced systemic vascular resistance, then returns to baseline by term.

15. Why does physiological (dilutional) anemia of pregnancy occur?

    Plasma volume increases by ~40–50% while red cell mass increases only ~20–30%, so hemoglobin concentration falls despite an absolute rise in red cell mass. WHO defines anemia in pregnancy as $Hb < 11\ g/dL$.

16. Describe the respiratory changes in pregnancy regarding tidal volume, minute ventilation, and arterial $\text{CO}_2$.

    Tidal volume increases ~30–40% and minute ventilation rises, producing a compensated respiratory alkalosis with reduced $P_a\text{CO}_2$ (~28–32 mmHg). Respiratory rate stays roughly unchanged; functional residual capacity decreases.

17. What happens to the glomerular filtration rate (GFR) and renal blood flow in pregnancy, and how does this affect serum creatinine?

    GFR and renal plasma flow increase ~50%, so serum creatinine and urea fall. A "normal" non-pregnant creatinine may actually indicate renal impairment in pregnancy.

18. What is the normal rate of fetal heart development, and when can the fetal heartbeat first be detected on transvaginal ultrasound?

    The fetal heart begins beating around day 22 of embryonic development. Cardiac activity is usually detectable on transvaginal ultrasound by ~6 weeks gestation (when crown-rump length is ~5–7 mm).

19. What are the normal limits of the baseline fetal heart rate, and what defines fetal bradycardia and tachycardia?

    Normal baseline FHR is $110\text{–}160\ \text{bpm}$. Bradycardia is $< 110\ \text{bpm}$ and tachycardia is $> 160\ \text{bpm}$ (sustained $> 10$ minutes).

20. On a CTG, what is a reactive non-stress test (NST) and what does it indicate?

    A reactive NST shows at least 2 accelerations of $\geq 15\ \text{bpm}$ above baseline lasting $\geq 15$ seconds within a 20-minute window. It indicates a well-oxygenated, non-acidotic fetus (good fetal wellbeing).

21. Distinguish early, variable, and late decelerations on CTG and their associations.

    Early decelerations mirror contractions (nadir with peak) — benign, due to head compression. Variable decelerations are abrupt, V-shaped, variable timing — due to cord compression. Late decelerations begin after the contraction peak and recover after it ends — associated with uteroplacental insufficiency/fetal hypoxia.

22. What are the five components of the biophysical profile (BPP) and the maximum score?

    Fetal breathing movements, gross body movements, fetal tone, amniotic fluid volume, and the non-stress test (reactive FHR). Each scores 0 or 2, for a maximum of 10.

23. Define pre-eclampsia using the classic diagnostic criteria.

    New-onset hypertension ($\geq 140/90\ \text{mmHg}$ on two occasions) after 20 weeks gestation, plus proteinuria ($\geq 300\ mg/24h$ or protein:creatinine ratio $\geq 30\ mg/mmol$) OR new-onset end-organ dysfunction (renal, hepatic, neurological, hematological, or uteroplacental).

24. What distinguishes gestational hypertension, pre-eclampsia, and eclampsia?

    Gestational hypertension: new hypertension after 20 weeks without proteinuria or end-organ involvement. Pre-eclampsia: hypertension + proteinuria/end-organ dysfunction. Eclampsia: pre-eclampsia with new-onset generalized tonic-clonic seizures.

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