NExT Obstetrics and Gynecology Syllabus

Obstetrics and 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 and Gynecology in NExT, not a summary of it.

1. 1

   Basic Obstetrics and Antenatal Care

   5 topics

   • Physiology of Pregnancy
     • Maternal physiological changes, placental function
   • Diagnosis of Pregnancy and Antenatal Care
     • ANC visits, immunization, nutrition under RCH
   • Normal Labor and Mechanism
     • Stages of labor, partograph
   • Puerperium and Lactation
   • Antenatal Diagnosis and Genetic Screening
2. 2

   High-Risk Pregnancy and Obstetric Complications

   5 topics

   • Hypertensive Disorders of Pregnancy
     • Pre-eclampsia, eclampsia, HELLP syndrome
   • Antepartum Hemorrhage
     • Placenta previa, abruptio placentae
   • Medical Disorders in Pregnancy
     • Gestational diabetes, anemia, heart disease
   • Multiple Pregnancy and Malpresentations
   • Rh Isoimmunization and IUGR
3. 3

   Intrapartum and Postpartum Care

   4 topics

   • Abnormal Labor and Dystocia
     • Cephalopelvic disproportion, obstructed labor
   • Operative Obstetrics
     • Cesarean section, instrumental delivery
   • Postpartum Hemorrhage
     • Atonic and traumatic PPH, management protocols
   • Maternal Mortality and Near-Miss Audit
4. 4

   General Gynecology

   5 topics

   • Menstrual Disorders
     • AUB, amenorrhea, dysmenorrhea
   • Pelvic Infections and STIs
     • PID, vaginal discharge syndromes
   • Benign Pelvic Tumors
     • Fibroid uterus, ovarian cysts
   • Endometriosis and Adenomyosis
   • Genital Prolapse and Urogynecology
5. 5

   Gynecological Oncology and Endocrinology

   5 topics

   • Cervical Cancer and Screening
     • HPV, Pap smear, VIA, staging
   • Endometrial and Ovarian Cancer
   • Gestational Trophoblastic Disease
   • Infertility and Assisted Reproduction
     • Male and female factors, ovulation induction, IVF
   • PCOS and Menopause
6. 6

   Contraception and Reproductive Health Programs

   3 topics

   • Contraceptive Methods
     • Barrier, hormonal, IUCD, sterilization
   • Medical Termination of Pregnancy
     • MTP Act provisions and methods
   • National Family Welfare and RMNCH+A Programs

Obstetrics and Gynecology flashcards for NExT

24 of 61 cards from the Obstetrics and Gynecology deck — real questions with worked answers.

1. In normal pregnancy, by how much does maternal blood volume, plasma volume, and red cell mass increase, and what does this produce?

   Blood volume rises ~40-50%, plasma volume ~50%, and red cell mass only ~20-30%. The disproportionate plasma rise causes the physiological (dilutional) anemia of pregnancy.

2. What are the typical cardiovascular changes in pregnancy regarding cardiac output, heart rate, and blood pressure?

   Cardiac output rises 30-50% (peaks ~mid-pregnancy), heart rate increases ~10-20 bpm, and blood pressure falls in the second trimester (mainly diastolic, due to reduced systemic vascular resistance) then returns to baseline near term.

3. What respiratory change defines normal pregnancy and what acid-base picture results?

   Tidal volume rises ~40% causing hyperventilation; PaCO2 falls (~30 mmHg) producing a compensated respiratory alkalosis (with renal bicarbonate excretion).

4. Which hormone maintains the corpus luteum in early pregnancy and is the basis of pregnancy tests, and when does the placenta take over progesterone production?

   Beta-hCG maintains the corpus luteum; the luteoplacental shift occurs around 7-9 weeks when the placenta takes over progesterone production.

5. List the presumptive, probable, and positive signs of pregnancy with one example each.

   Presumptive (subjective: amenorrhea, nausea), Probable (objective examiner signs: Hegar's sign, positive hCG, Goodell's sign), Positive (fetal: fetal heart sounds, fetal movements felt by examiner, ultrasound visualization of fetus).

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

   EDD = first day of last menstrual period (LMP) minus 3 months plus 7 days (plus 1 year), assuming a regular 28-day cycle.

7. What is the recommended schedule of antenatal visits and minimum visits per WHO 2016 and Government of India guidelines?

   WHO 2016 recommends a minimum of 8 contacts; India's earlier model and PMSMA emphasize at least 4 ANC visits (first in 1st trimester, second 14-26 wk, third 28-34 wk, fourth 36 wk-term).

8. What doses of folic acid and iron are recommended in routine Indian antenatal care?

   Folic acid 400 mcg (5 mg in high-risk such as prior neural tube defect) preconceptionally and in early pregnancy; iron-folic acid (100 mg elemental iron + 500 mcg folic acid) daily for at least 180 days during pregnancy and 180 days postpartum.

9. What are the three stages of labor and their definitions?

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

10. List the cardinal movements (mechanism) of labor in a vertex presentation in order.

    Engagement, Descent, Flexion, Internal rotation, Extension, External rotation (restitution), and Expulsion.

11. What are the signs of placental separation in the third stage of labor?

    Lengthening of the umbilical cord, a gush of blood, the uterus becoming globular/firm and rising in the abdomen (calkin's), and suprapubic bulging.

12. What changes occur during the puerperium regarding uterine involution and lochia stages?

    The uterus involutes from ~1000 g to ~50-60 g by 6 weeks. Lochia progresses: rubra (red, days 1-4), serosa (pinkish, days 5-9), and alba (whitish, after ~day 10 up to 3-6 weeks).

13. Which hormones drive lactogenesis and the milk ejection (let-down) reflex?

    Prolactin (from anterior pituitary) drives milk synthesis; oxytocin (from posterior pituitary) causes myoepithelial contraction for milk ejection/let-down.

14. What is the composition advantage of colostrum and how long is exclusive breastfeeding recommended?

    Colostrum is rich in protein, secretory IgA, and antibodies with low fat/lactose. Exclusive breastfeeding is recommended for the first 6 months of life.

15. What are the standard maternal serum markers in the second-trimester quadruple screen and the pattern in Down syndrome?

    AFP, hCG, unconjugated estriol (uE3), and inhibin A. In trisomy 21: low AFP, low uE3, high hCG, high inhibin A.

16. What is non-invasive prenatal testing (NIPT) based on, and what is the gold-standard confirmatory diagnostic test?

    NIPT analyzes cell-free fetal DNA in maternal blood (a screening test). Confirmation requires invasive karyotyping via chorionic villus sampling (11-13 wk) or amniocentesis (after 15 wk).

17. How is the diagnosis of gestational hypertension distinguished from preeclampsia?

    Gestational hypertension: BP >=140/90 after 20 weeks without proteinuria/end-organ involvement. Preeclampsia: new hypertension after 20 weeks WITH proteinuria (>=300 mg/24h) OR end-organ dysfunction (thrombocytopenia, renal/liver involvement, neurologic/visual symptoms, pulmonary edema).

18. What are the features of severe preeclampsia and the first-line drug for eclampsia prophylaxis/treatment?

    Severe features: BP >=160/110, platelets <100,000, elevated transaminases, serum creatinine >1.1, pulmonary edema, headache/visual disturbance. Magnesium sulfate is first-line for seizure prophylaxis and treatment of eclampsia.

19. What does HELLP syndrome stand for?

    Hemolysis, Elevated Liver enzymes, and Low Platelets - a severe variant of preeclampsia.

20. Differentiate placenta previa from abruptio placentae in antepartum hemorrhage.

    Placenta previa: painless, causeless, recurrent bright-red bleeding with a soft, non-tender uterus and normal fetal condition. Abruptio placentae: painful bleeding (often concealed) with a tense/tender (woody) uterus, often with fetal distress and signs of shock disproportionate to visible loss.

21. What are the four grades (types) of placenta previa?

    Type I (low-lying, encroaches lower segment), Type II (marginal, reaches but does not cover internal os), Type III (incomplete/partial central, partially covers os), Type IV (complete/central, completely covers internal os).

22. What are the diagnostic glucose thresholds for gestational diabetes by the DIPSI (India) single-step 75 g test?

    DIPSI: 75 g oral glucose given irrespective of fasting status, with a 2-hour plasma glucose >=140 mg/dL diagnosing GDM.

23. What is the most common medical disorder complicating pregnancy in India and its impact threshold?

    Anemia (Hb <11 g/dL); it is a leading indirect cause of maternal mortality and is associated with preterm birth, low birth weight, and increased postpartum hemorrhage risk.

24. What are the types of twin pregnancy by chorionicity/amnionicity and which carries the highest risk?

    Dichorionic-diamniotic, monochorionic-diamniotic, and monochorionic-monoamniotic. Monochorionic-monoamniotic (and conjoined) carry the highest risk; monochorionic twins risk twin-to-twin transfusion syndrome.

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