NEET PG Obstetrics & Gynecology Syllabus

What is the role of antenatal corticosteroids in preterm labor, and the window of gestational age?

Antenatal corticosteroids (betamethasone or dexamethasone) accelerate fetal lung maturity (surfactant) to reduce respiratory distress syndrome. Given between 24 and 34 weeks (up to 37 in selected cases) when preterm birth is anticipated within 7 days.

What is the purpose of magnesium sulfate when given before preterm birth before 32 weeks?

Fetal neuroprotection - it reduces the risk of cerebral palsy in the preterm infant.

In dichorionic vs monochorionic twins, what does chorionicity determine and what is the 'lambda/twin-peak sign'?

Chorionicity determines whether twins share a placenta and affects risk (monochorionic twins risk twin-to-twin transfusion syndrome). The lambda (twin-peak) sign indicates dichorionic; the T-sign indicates monochorionic-diamniotic.

What are the three stages of labor and what defines each?

First stage: onset of true labor to full (10 cm) cervical dilatation. Second stage: full dilatation to delivery of the baby. Third stage: delivery of the baby to delivery of the placenta.

What are the cardinal movements of labor in order?

Engagement, descent, flexion, internal rotation, extension, external rotation (restitution), and expulsion.

What defines the latent and active phases of the first stage of labor?

Latent phase: from onset to ~6 cm dilatation (slow). Active phase: from ~6 cm to full dilatation, with more rapid, progressive cervical change (~1 cm/hr or more).

What are the components of the Bishop score and what does it predict?

Cervical dilatation, effacement, consistency, position, and fetal station. It predicts the likelihood of successful labor induction; a score >8 suggests a favorable cervix.

What is the WHO partograph and what is the alert line used for?

The partograph graphically monitors labor progress (cervical dilatation, descent, FHR, contractions). Crossing the alert line indicates slow progress requiring closer observation/intervention; the action line prompts active intervention.

What is the drug of choice for active management of the third stage of labor to prevent postpartum hemorrhage?

Oxytocin (10 IU IM) given with delivery of the anterior shoulder/baby is the recommended uterotonic for active management of the third stage.

Differentiate elective (planned) from emergency cesarean section indications - give two examples each.

Elective: placenta previa, breech presentation, previous classical CS. Emergency: fetal distress, cord prolapse, failure to progress, abruptio placentae.

What is the most common type of uterine incision for cesarean section and why is it preferred?

The lower uterine segment transverse (Kerr) incision - preferred for less blood loss, easier repair, lower rupture risk in future pregnancy, allowing trial of labor after cesarean (TOLAC).

What hormonal changes drive lactation in the postpartum period?

After placental delivery, the fall in estrogen/progesterone removes inhibition, allowing prolactin to stimulate milk production; suckling triggers oxytocin release causing milk ejection (let-down reflex).

What is involution of the uterus and the normal progression of lochia?

Involution is the return of the uterus to pre-pregnant size (~6 weeks). Lochia progresses from lochia rubra (red, days 1-3) to lochia serosa (pinkish-brown, days 4-10) to lochia alba (whitish, up to ~6 weeks).

Define primary postpartum hemorrhage and list the '4 Ts' of its causes.

Primary PPH is blood loss ≥500 mL (vaginal) or ≥1000 mL (CS) within 24 hours of delivery. Causes: Tone (uterine atony - most common), Trauma, Tissue (retained products), and Thrombin (coagulopathy).

What is the most common cause of postpartum hemorrhage and its first-line management?

Uterine atony is the most common cause. First-line management: uterine massage and uterotonics (oxytocin first-line; then ergometrine, carboprost, or misoprostol).

Compare the mechanism of combined oral contraceptive pills versus progestin-only pills.

COCs (estrogen + progestin) primarily inhibit ovulation by suppressing FSH/LH. Progestin-only pills mainly thicken cervical mucus and thin the endometrium, with variable ovulation suppression.

Which contraceptive method is the most effective long-acting reversible method, and how does the copper IUD work?

Long-acting reversible contraceptives (IUDs and implants) are most effective. The copper IUD is spermicidal/spermotoxic and creates a sterile inflammatory reaction (foreign-body effect) preventing fertilization and implantation.

Define menorrhagia, metrorrhagia, and oligomenorrhea.

Menorrhagia: heavy/prolonged menstrual bleeding at regular intervals. Metrorrhagia: irregular bleeding between periods. Oligomenorrhea: infrequent menstruation (cycle >35 days).

What is the PALM-COEIN classification used for, and what do the two groups represent?

PALM-COEIN classifies causes of abnormal uterine bleeding. PALM = structural causes (Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia); COEIN = non-structural (Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified).

What is the most common benign tumor of the uterus, and its hormone dependence?

Uterine leiomyoma (fibroid) - the most common benign uterine tumor. It is estrogen- and progesterone-dependent, growing during reproductive years and regressing after menopause.

Distinguish endometriosis from adenomyosis.

Endometriosis is endometrial tissue outside the uterus (e.g., ovary, peritoneum), causing dysmenorrhea/infertility. Adenomyosis is endometrial tissue within the myometrium, causing a diffusely enlarged, tender uterus with heavy painful periods.

What is the most common gynecological cancer worldwide vs in India, and the leading risk factor for cervical cancer?

Cervical cancer is the most common gynecological cancer in India (endometrial cancer is most common in developed countries). The leading risk factor for cervical cancer is persistent infection with high-risk HPV (types 16 and 18).

What is the most common histological type of cervical cancer and the main screening tests?

Squamous cell carcinoma is the most common type. Screening is by Pap smear (cervical cytology), HPV DNA testing, and VIA (visual inspection with acetic acid) in low-resource settings.

What is the most common type of endometrial carcinoma and its classic risk factor?

Endometrioid adenocarcinoma (Type I) is the most common type. The classic risk factor is unopposed estrogen exposure (obesity, nulliparity, late menopause, PCOS, tamoxifen, estrogen-only HRT).

What is the most common type of ovarian cancer and the tumor marker used to monitor it?

Epithelial ovarian carcinoma (serous type) is the most common. CA-125 is the tumor marker used for monitoring epithelial ovarian cancer.

What is the classic definition of PCOS by the Rotterdam criteria?

PCOS is diagnosed when at least 2 of 3 are present: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound (≥12 follicles or ovarian volume >10 mL), after excluding other causes.

How is infertility defined and what is the most common cause of ovulatory infertility?

Infertility is failure to conceive after 12 months of regular unprotected intercourse (6 months if woman >35). PCOS is the most common cause of anovulatory infertility.

What is the first-line ovulation induction agent for PCOS, and an alternative?

Letrozole (aromatase inhibitor) is now first-line for ovulation induction in PCOS; clomiphene citrate (a SERM) is the traditional alternative. Both stimulate FSH release to induce follicle development.

Differentiate IUI, IVF, and ICSI.

IUI (intrauterine insemination) places washed sperm into the uterus. IVF (in-vitro fertilization) fertilizes eggs with sperm in the lab and transfers embryos. ICSI (intracytoplasmic sperm injection) injects a single sperm directly into the oocyte, used for severe male factor infertility.

Name the endocrine disorders (other than PCOS) that cause anovulatory infertility.

Hyperprolactinemia, thyroid dysfunction (hypothyroidism), hypothalamic amenorrhea (low GnRH), and premature ovarian insufficiency (high FSH, low estrogen).

Differentiate stress, urge, and overflow urinary incontinence.

Stress incontinence: leakage on increased intra-abdominal pressure (cough, sneeze) due to urethral sphincter weakness. Urge incontinence: sudden urge with leakage from detrusor overactivity. Overflow: leakage from an over-distended, poorly emptying bladder.

What grading system is used for pelvic organ prolapse and what does first-line conservative management include?

The POP-Q (Pelvic Organ Prolapse Quantification) system stages prolapse 0-IV. Conservative management includes pelvic floor muscle (Kegel) exercises and vaginal pessaries.

What are the major postmenopausal hormonal changes and the diagnostic FSH level?

Menopause: ovarian estrogen production falls, FSH and LH rise (FSH typically >40 IU/L), causing amenorrhea for 12 months. Symptoms include hot flushes, vaginal atrophy, and accelerated bone loss/osteoporosis.

Match the classic STIs to their organisms: gonorrhea, syphilis, chancroid, and chlamydia.

Gonorrhea - Neisseria gonorrhoeae; syphilis - Treponema pallidum; chancroid - Haemophilus ducreyi; chlamydia - Chlamydia trachomatis.

How do you distinguish a painless versus painful genital ulcer in STIs?

Painless ulcer (chancre) suggests primary syphilis (Treponema pallidum). Painful ulcer suggests chancroid (Haemophilus ducreyi) or genital herpes (HSV - usually multiple vesicular/painful ulcers).

What is the most common cause of gestational trophoblastic disease and the classic ultrasound finding of a complete hydatidiform mole?

Hydatidiform mole is the most common GTD. A complete mole shows a 'snowstorm' or 'cluster of grapes' appearance on ultrasound with markedly elevated beta-hCG, and no fetal tissue (46,XX, entirely paternal).

Differentiate complete from partial hydatidiform mole by karyotype and fetal tissue.

Complete mole: usually 46,XX (all paternal), no fetal tissue, higher malignant potential. Partial mole: usually triploid 69,XXY (two paternal sets + one maternal), with some fetal/embryonic tissue, lower malignant potential.

What is choriocarcinoma and which tumor marker is used to monitor GTD?

Choriocarcinoma is a malignant form of gestational trophoblastic neoplasia that can follow a molar pregnancy, miscarriage, or normal pregnancy and metastasizes (commonly to lungs). Beta-hCG is the tumor marker used to monitor disease and response to treatment.

What does the WHO define as a normal semen analysis (lower reference limits) for volume, concentration, and motility?

WHO 2021 lower reference limits: semen volume ≥1.4 mL, sperm concentration ≥16 million/mL, total motility ≥42%, and normal morphology ≥4%.