UK Medical Licensing Assessment (UKMLA) Reproductive, Sexual and Women's Health Syllabus

Reproductive, Sexual and Women's Health syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Reproductive, Sexual and Women's Health in UK Medical Licensing Assessment (UKMLA), not a summary of it.

1. 1

   Obstetrics: Antenatal and Intrapartum Care

   5 topics

   • Normal pregnancy and antenatal care
     • Antenatal screening and booking
     • Physiological changes in pregnancy
     • Fetal growth monitoring
   • Medical disorders in pregnancy
     • Hypertensive disorders and pre-eclampsia
     • Gestational diabetes
     • Venous thromboembolism in pregnancy
   • Antenatal complications
     • Antepartum haemorrhage (placenta praevia and abruption)
     • Preterm labour and rupture of membranes
     • Rhesus disease and isoimmunisation
   • Labour and delivery
     • Stages of labour and monitoring
     • Failure to progress and instrumental delivery
     • Caesarean section indications
   • Obstetric emergencies
     • Postpartum haemorrhage
     • Shoulder dystocia and cord prolapse
     • Eclampsia and amniotic fluid embolism
2. 2

   Obstetrics: Early Pregnancy and Postnatal Care

   4 topics

   • Early pregnancy complications
     • Miscarriage
     • Ectopic pregnancy
     • Gestational trophoblastic disease
     • Hyperemesis gravidarum
   • Postnatal care and complications
     • Postnatal infection and sepsis
     • Perinatal mental health
   • Termination of pregnancy
   • Maternal and perinatal mortality
3. 3

   Gynaecology

   5 topics

   • Menstrual disorders
     • Heavy menstrual bleeding
     • Amenorrhoea and oligomenorrhoea
     • Dysmenorrhoea and premenstrual syndrome
   • Benign gynaecological conditions
     • Fibroids
     • Endometriosis and adenomyosis
     • Polycystic ovary syndrome
     • Ovarian cysts
   • Pelvic pain and infection
     • Pelvic inflammatory disease
     • Chronic pelvic pain
   • Urogynaecology
     • Urinary incontinence
     • Pelvic organ prolapse
   • Menopause and its management
4. 4

   Gynaecological Oncology

   4 topics

   • Cervical disease and screening
     • Cervical screening programme and HPV
     • Cervical cancer
   • Endometrial and uterine cancer
   • Ovarian cancer
   • Vulval and vaginal disease
5. 5

   Contraception, Sexual and Reproductive Health

   4 topics

   • Contraception
     • Hormonal contraception
     • Long-acting reversible contraception
     • Emergency contraception
     • UK Medical Eligibility Criteria
   • Sexually transmitted infections
     • Chlamydia and gonorrhoea
     • Syphilis
     • Genital herpes and warts
     • Partner notification
   • Subfertility
     • Investigation of the infertile couple
     • Assisted reproduction principles
   • Sexual health consultation and risk assessment

Reproductive, Sexual and Women's Health flashcards for UK Medical Licensing Assessment (UKMLA)

22 of 61 cards from the Reproductive, Sexual and Women's Health deck — real questions with worked answers.

1. During routine antenatal care in the UK, at what gestations are the two standard ultrasound scans offered?

   The dating/booking scan at $11^{+2}$ to $14^{+1}$ weeks (also used for combined Down's screening), and the anomaly (fetal anatomy) scan at $18^{+0}$ to $20^{+6}$ weeks.

2. What is the recommended daily dose of folic acid before conception and in the first trimester, and the higher dose for high-risk women?

   $400\ \mu g$ daily for low-risk women until 12 weeks; $5\ mg$ daily for high-risk women (e.g. previous neural tube defect, diabetes, BMI $\geq 30$, antiepileptic drugs, sickle cell disease).

3. What is the combined test for Down's syndrome screening, what does it measure, and when is it performed?

   Performed at 11–14 weeks: nuchal translucency on ultrasound plus serum $\beta$-hCG (raised) and PAPP-A (low). A risk $\geq 1\text{ in }150$ is screen-positive and prompts offer of diagnostic testing.

4. What are the diagnostic tests for fetal chromosomal/genetic abnormalities, and at what gestations are they done?

   Chorionic villus sampling (CVS) from 11 weeks and amniocentesis from 15 weeks. CVS carries a slightly higher miscarriage risk (~$1\text{–}2\%$) than amniocentesis (~$0.5\text{–}1\%$).

5. Define pre-eclampsia and state its diagnostic blood pressure and proteinuria thresholds.

   New-onset hypertension ($\geq 140/90\ \text{mmHg}$) after 20 weeks plus proteinuria (urine protein:creatinine ratio $\geq 30\ \text{mg/mmol}$) and/or maternal organ dysfunction. Severe: BP $\geq 160/110\ \text{mmHg}$.

6. Which drug is given for seizure prophylaxis and treatment in severe pre-eclampsia/eclampsia, and what is monitored for toxicity?

   Magnesium sulfate ($\ce{MgSO4}$). Monitor respiratory rate, reflexes (loss of patellar reflex is early sign), and urine output; toxicity is reversed with calcium gluconate.

7. What is the first-line oral antihypertensive for hypertension in pregnancy, and which common agents are contraindicated?

   First-line: labetalol (alternatives nifedipine, methyldopa). ACE inhibitors, ARBs and thiazide diuretics are contraindicated (teratogenic/fetotoxic).

8. How and when is gestational diabetes screened for and diagnosed in the UK?

   75 g oral glucose tolerance test at 24–28 weeks in at-risk women (earlier if previous GDM). Diagnostic thresholds: fasting glucose $\geq 5.6\ \text{mmol/L}$ or 2-hour glucose $\geq 7.8\ \text{mmol/L}$.

9. What is the first-line management of gestational diabetes when fasting glucose is below $7\ \text{mmol/L}$ at diagnosis?

   A 1–2 week trial of diet and exercise; if targets not met, add metformin, then insulin if needed. If fasting glucose is $\geq 7\ \text{mmol/L}$ at diagnosis, start insulin immediately.

10. What defines placenta praevia and how does it classically present?

    Placenta lying wholly or partly in the lower uterine segment (over/near the internal os). Presents with painless bright-red vaginal bleeding; the uterus is soft and non-tender. Vaginal examination is avoided.

11. What defines placental abruption and its classic clinical features?

    Premature separation of a normally sited placenta. Presents with painful vaginal bleeding (may be concealed), a tense/'woody' hard tender uterus, and signs of fetal distress; bleeding may be out of proportion to maternal shock.

12. State the four criteria of the Bishop score and what a high score indicates.

    Cervical dilatation, effacement (length/consistency), station of presenting part, and cervical position/consistency. A higher score (typically $\geq 7$) predicts a favourable cervix likely to respond to induction.

13. What are the three stages of labour?

    First stage: onset of regular contractions to full dilatation ($10\ cm$), divided into latent ($<4\ cm$) and active phases. Second stage: full dilatation to delivery of the baby. Third stage: delivery of the baby to delivery of the placenta and membranes.

14. Define the cardinal movements (mechanism) of normal labour in order.

    Engagement and descent, flexion, internal rotation, extension (delivery of head), restitution/external rotation, then expulsion (delivery of shoulders and body).

15. What is the immediate stepwise management sequence (mnemonic HELPERR) for shoulder dystocia?

    Call for Help, Evaluate for Episiotomy, Legs (McRoberts manoeuvre), suprapubic Pressure, Enter manoeuvres (internal rotation), Remove the posterior arm, Roll the patient onto all fours. McRoberts plus suprapubic pressure resolves most cases.

16. Define primary postpartum haemorrhage and give the volume thresholds.

    Blood loss $\geq 500\ mL$ from the genital tract within 24 hours of delivery. Minor PPH: $500\text{–}1000\ mL$; major PPH: $>1000\ mL$. Secondary PPH occurs from 24 hours to 12 weeks postpartum.

17. List the '4 Ts' causes of primary postpartum haemorrhage in order of frequency.

    Tone (uterine atony — most common, ~70%), Trauma (lacerations), Tissue (retained products), and Thrombin (coagulopathy).

18. What is the first-line uterotonic for postpartum haemorrhage due to uterine atony, and what mechanical measures accompany it?

    IV/IM oxytocin (after bimanual uterine compression and rubbing up a contraction). Subsequent agents: ergometrine (avoid in hypertension), carboprost (avoid in asthma), and misoprostol.

19. What is amniotic fluid embolism and its classic clinical triad?

    Amniotic fluid/fetal cells entering the maternal circulation, causing the triad of acute hypoxia (dyspnoea/cyanosis), cardiovascular collapse (hypotension), and coagulopathy (DIC), often around delivery. Management is supportive/resuscitative.

20. What is uterine rupture, its key risk factor and presentation?

    Full-thickness disruption of the uterine wall. Main risk factor is a previous caesarean/uterine scar, especially during labour. Presents with sudden severe abdominal pain, cessation of contractions, fetal distress, vaginal bleeding and loss of station of the presenting part.

21. What is the definition of recurrent miscarriage and one key investigation?

    Three or more consecutive pregnancy losses before 24 weeks. Investigations include antiphospholipid antibody screen (lupus anticoagulant, anticardiolipin), parental karyotyping and pelvic ultrasound for uterine anomalies.

22. What is the typical hCG pattern, ultrasound finding and first-line management of an ectopic pregnancy?

    Serum hCG that fails to rise appropriately (suboptimal rise, often $<63\%$ in 48 h) with an empty uterus; an adnexal mass may be seen. Management options: expectant, medical (IM methotrexate) or surgical (salpingectomy/salpingotomy) depending on size, hCG and stability.

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