NExT Obstetrics and Gynecology Syllabus

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).

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.

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.

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.

What is the most common malpresentation, and what are the types of breech presentation?

Breech is the most common malpresentation. Types: frank (hips flexed, knees extended), complete (hips and knees flexed), and footling/incomplete (one or both feet presenting).

What is the pathophysiology of Rh isoimmunization and the standard prophylaxis?

An Rh-negative mother sensitized by Rh-positive fetal cells forms anti-D IgG that crosses the placenta in subsequent pregnancies causing hemolytic disease of the fetus/newborn. Prophylaxis: anti-D immunoglobulin (300 mcg) at 28 weeks and within 72 hours postpartum (and after any sensitizing event).

How is intrauterine growth restriction (IUGR) defined and what distinguishes symmetrical from asymmetrical IUGR?

IUGR = estimated fetal weight below the 10th percentile for gestational age. Symmetrical (early, whole body proportionately small - chromosomal/infective causes); asymmetrical (late, head sparing with reduced abdominal circumference - placental insufficiency).

What are the three Ps that determine abnormal labor and define arrest of labor in the active phase?

The three Ps: Power (uterine contractions), Passage (pelvis), Passenger (fetus). Active-phase arrest: no cervical change for >=4 hours with adequate contractions or >=6 hours with inadequate contractions at >=6 cm dilatation.

What is shoulder dystocia and the first-line maneuver to manage it?

Shoulder dystocia is impaction of the anterior fetal shoulder behind the maternal pubic symphysis after delivery of the head. First-line: McRoberts maneuver (hyperflexion of maternal thighs onto abdomen) with suprapubic pressure.

What are the prerequisites for a forceps or vacuum (instrumental vaginal) delivery?

Fully dilated cervix, ruptured membranes, engaged head with known position, adequate pelvis, empty bladder, vertex presentation, adequate analgesia, and consent (mnemonic considerations of position, station, presentation).

What are the absolute indications for cesarean section (a few key examples)?

Central placenta previa, cephalopelvic disproportion (absolute), transverse lie, cord prolapse with a live fetus not deliverable vaginally, vasa previa, and prior classical cesarean scar.

What are the four Ts that classify the causes of postpartum hemorrhage?

Tone (uterine atony - most common), Trauma (lacerations, rupture), Tissue (retained placenta/products), and Thrombin (coagulopathy).

How is primary postpartum hemorrhage defined and what is the first-line uterotonic?

Primary PPH: blood loss >=500 mL after vaginal delivery (>=1000 mL after cesarean) within 24 hours. First-line uterotonic is oxytocin; second-line agents include ergometrine, carboprost (avoid in asthma), and misoprostol.

What is the active management of the third stage of labor (AMTSL) to prevent PPH?

Administration of a uterotonic (oxytocin) within 1 minute of birth, controlled cord traction with counter-pressure on the uterus, and uterine massage after placental delivery.

Define the Maternal Mortality Ratio (MMR) and India's current target.

MMR = number of maternal deaths per 100,000 live births. India's SDG/National Health Policy target is to reduce MMR below 70 per 100,000 live births by 2030 (and below 100 nationally earlier).

What is a maternal near-miss and why is near-miss audit valuable?

A maternal near-miss is a woman who nearly died but survived a life-threatening complication during pregnancy, childbirth, or within 42 days of termination. Auditing near-misses (more frequent than deaths) identifies system gaps in care to prevent future maternal deaths.

Define menorrhagia, metrorrhagia, polymenorrhea, and oligomenorrhea.

Menorrhagia: heavy and/or prolonged menstrual bleeding at regular intervals. Metrorrhagia: irregular bleeding between periods. Polymenorrhea: cycles shorter than 21 days. Oligomenorrhea: cycles longer than 35 days.

What is the PALM-COEIN classification used for and what do the categories represent?

It classifies abnormal uterine bleeding. PALM (structural: Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia) and COEIN (non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified).

What organisms most commonly cause pelvic inflammatory disease and what is a classic late complication?

Neisseria gonorrhoeae and Chlamydia trachomatis (often polymicrobial). Complications include tubo-ovarian abscess, infertility, ectopic pregnancy, and chronic pelvic pain; Fitz-Hugh-Curtis syndrome is perihepatitis.

What is the syndromic approach used in the Indian RTI/STI program for vaginal discharge and genital ulcers?

It treats based on symptom syndromes without lab confirmation: e.g., vaginal/cervical discharge and genital ulcer disease are managed with standardized colour-coded kits (e.g., Kit 1 for urethral/cervical discharge, kits for genital ulcers) to enable point-of-care treatment.

What is the most common benign uterine tumor, and what degeneration is specific to pregnancy?

Uterine leiomyoma (fibroid) is the most common benign uterine tumor. Red (carneous) degeneration is characteristic during pregnancy.

What is the most common benign ovarian tumor in young women and its classic content?

Mature cystic teratoma (dermoid cyst); it contains ectodermal tissue such as hair, sebaceous material, and teeth (tissues from all three germ layers).

Define endometriosis and adenomyosis and contrast them.

Endometriosis: endometrial-like tissue outside the uterus (e.g., ovaries forming chocolate cysts). Adenomyosis: endometrial glands within the myometrium causing a diffusely bulky, tender uterus (classically in multiparous women) with menorrhagia and dysmenorrhea.

What is the most common site of endometriosis and a typical clinical triad?

The ovary is the most common site. Classic triad: dysmenorrhea, dyspareunia, and infertility (often with cyclical/chronic pelvic pain).

What is the POP-Q based staging concept and the classification of uterine prolapse degrees?

POP-Q quantifies prolapse relative to the hymen. Uterine descent: 1st degree (cervix in vagina), 2nd degree (cervix to introitus), 3rd degree/procidentia (entire uterus outside the introitus). Compartment defects include cystocele, rectocele, and enterocele.

What is stress urinary incontinence and its first-line conservative management?

Involuntary leakage of urine on increased intra-abdominal pressure (coughing, sneezing) due to urethral hypermobility/sphincter weakness. First-line: pelvic floor (Kegel) exercises; surgical option is mid-urethral sling.

What are the screening methods for cervical cancer and the causative agent?

Pap smear (cytology), VIA (visual inspection with acetic acid - used in India for low-resource screening), and HPV DNA testing. Cause: persistent high-risk HPV infection (types 16 and 18 most common).

What is the most common histological type of cervical cancer and its FIGO staging principle?

Squamous cell carcinoma is most common. Cervical cancer is staged clinically (FIGO), with stage based on tumor extent: confined to cervix (I), beyond uterus but not lower third vagina/pelvic wall (II), to pelvic wall/lower vagina/hydronephrosis (III), and beyond pelvis or bladder/rectum (IV).

What is the most common gynecological cancer in developed countries, its commonest type, and the cardinal symptom?

Endometrial carcinoma; the commonest type is endometrioid adenocarcinoma. Cardinal symptom: postmenopausal bleeding. Unlike cervical cancer, it is surgically staged (FIGO).

What is the most common type of ovarian cancer, the classic tumor marker, and why is it usually detected late?

Epithelial ovarian carcinoma (serous type) is most common; CA-125 is the classic marker. It presents late because of vague symptoms and absence of effective screening, earning the name 'silent killer.'

What is the spectrum of gestational trophoblastic disease and the key tumor marker for monitoring?

Hydatidiform mole (complete and partial), invasive mole, choriocarcinoma, and placental site trophoblastic tumor. Beta-hCG is the marker used for diagnosis, monitoring response, and follow-up after evacuation.

Contrast complete and partial hydatidiform mole in karyotype and fetal parts.

Complete mole: usually 46,XX of paternal origin (empty ovum fertilized), no fetal parts, very high hCG, higher malignant potential. Partial mole: triploid (69,XXY) with some fetal parts and focal villous changes.

How is infertility defined and what is the first-line ovulation induction agent in PCOS-related anovulation?

Infertility: failure to conceive after 12 months of regular unprotected intercourse. Letrozole (aromatase inhibitor) is now first-line for ovulation induction in PCOS (previously clomiphene citrate).

What is the Rotterdam criteria for diagnosing PCOS?

At least 2 of 3: (1) oligo/anovulation, (2) clinical or biochemical hyperandrogenism, (3) polycystic ovaries on ultrasound (>=12 follicles 2-9 mm or ovarian volume >10 mL), after excluding other causes.

What defines menopause and what hormonal change confirms it?

Menopause is permanent cessation of menstruation, diagnosed retrospectively after 12 consecutive months of amenorrhea (average age ~51). It is confirmed by elevated FSH (>40 IU/L) with low estradiol.

Classify contraceptive methods and give the most effective reversible (LARC) options.

Categories: barrier (condom, diaphragm), hormonal (OCPs, progestin injectables/implants), intrauterine devices (copper-T, LNG-IUS), natural/fertility-awareness, and permanent (tubal ligation, vasectomy). The most effective reversible (LARC) options are implants and IUDs.

What is the mechanism and timing window of common emergency contraception methods?

Levonorgestrel pill (1.5 mg) within 72 hours (mainly inhibits/delays ovulation); ulipristal acetate up to 120 hours; and the copper IUD within 5 days, which is the most effective (prevents fertilization/implantation).

Under the amended MTP Act (2021) in India, up to what gestational age can pregnancy be terminated and with how many providers' opinions?

Up to 20 weeks on one registered medical practitioner's opinion; from 20 to 24 weeks (for specified categories of women) on two practitioners' opinions; beyond 24 weeks only for substantial fetal abnormalities as approved by a State Medical Board.

What is the standard medical abortion regimen for early pregnancy?

Mifepristone (antiprogesterone) 200 mg orally followed 24-48 hours later by misoprostol (prostaglandin) - effective up to 9-10 weeks (63 days) of gestation.

What does RMNCH+A stand for and what is its key strategic addition over earlier programs?

Reproductive, Maternal, Newborn, Child, and Adolescent Health. Its key addition is the explicit inclusion of the Adolescent age group, adopting a continuum-of-care/life-cycle approach across the reproductive years.

Name key components/schemes under India's National Family Welfare and maternal health programs.

Janani Suraksha Yojana (JSY - cash incentive for institutional delivery), Janani Shishu Suraksha Karyakram (JSSK - free care for mother/newborn), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA - free ANC on the 9th of each month), and the ASHA worker scheme.