UPSC CMSE Gynecology and Obstetrics Syllabus

What distinguishes eclampsia from pre-eclampsia?

Eclampsia is the occurrence of new-onset generalized tonic-clonic seizures in a woman with pre-eclampsia, not attributable to other causes.

What is the drug of choice for preventing and treating eclamptic seizures?

Magnesium sulfate (MgSO4).

What are the clinical signs of magnesium sulfate toxicity and the antidote?

Loss of deep tendon reflexes, respiratory depression, and reduced urine output; antidote is intravenous calcium gluconate.

What does the HELLP syndrome acronym stand for?

Hemolysis, Elevated Liver enzymes, and Low Platelets — a severe variant of pre-eclampsia.

What is the only definitive treatment (cure) for pre-eclampsia and eclampsia?

Delivery of the fetus and placenta.

Which antihypertensives are commonly used and which are contraindicated in pregnancy?

Used: labetalol, methyldopa, nifedipine, hydralazine. Contraindicated: ACE inhibitors and ARBs (fetal renal damage/teratogenicity).

What are the diagnostic criteria for gestational diabetes using the 75 g OGTT (IADPSG/WHO)?

Fasting glucose greater than or equal to 92 mg/dL, 1-hour greater than or equal to 180 mg/dL, or 2-hour greater than or equal to 153 mg/dL — any one value confirms GDM.

At what gestational age is screening for gestational diabetes routinely performed?

Between 24 and 28 weeks of gestation.

What is the first-line management of gestational diabetes, and the preferred pharmacologic agent if needed?

First-line is medical nutrition therapy and exercise; insulin is the preferred drug when pharmacotherapy is required.

Name two major fetal complications of poorly controlled gestational diabetes.

Macrosomia (with shoulder dystocia risk) and neonatal hypoglycemia; also polyhydramnios and respiratory distress syndrome.

Define menorrhagia and metrorrhagia.

Menorrhagia is excessive or prolonged menstrual bleeding at regular intervals; metrorrhagia is irregular bleeding between expected menstrual periods.

What does the PALM-COEIN classification categorize, and what do the two groups represent?

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

Define primary versus secondary dysmenorrhea.

Primary dysmenorrhea is painful menstruation without underlying pelvic pathology (due to prostaglandins); secondary dysmenorrhea is caused by pelvic pathology such as endometriosis or fibroids.

What is pelvic inflammatory disease and its two most common causative organisms?

PID is infection of the upper female genital tract (uterus, tubes, ovaries); most commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis.

What is the classic clinical triad/findings on examination suggesting PID?

Lower abdominal/pelvic pain with cervical motion tenderness, adnexal tenderness, and uterine tenderness, often with fever and abnormal discharge.

What is Fitz-Hugh-Curtis syndrome?

Perihepatitis (inflammation of the liver capsule) causing right upper quadrant pain as a complication of PID.

Name two major long-term sequelae of untreated pelvic inflammatory disease.

Tubal factor infertility and increased risk of ectopic pregnancy; also chronic pelvic pain.

What is endometriosis?

The presence of functional endometrial-like tissue (glands and stroma) outside the uterine cavity, commonly on ovaries, peritoneum, and uterosacral ligaments.

What is the classic symptom triad of endometriosis?

Dysmenorrhea, dyspareunia, and infertility (often with chronic pelvic pain).

What is an endometrioma and how does it appear?

An ovarian cyst filled with old/altered blood from endometriosis, known as a 'chocolate cyst' because of its thick brown contents.

What is the gold-standard method for definitive diagnosis of endometriosis?

Laparoscopy with direct visualization and histological confirmation of lesions.

What are uterine fibroids (leiomyomas) and on what hormone are they dependent?

Benign smooth muscle tumors of the myometrium; they are estrogen (and progesterone) dependent and typically regress after menopause.

Name the three main location-based types of uterine fibroids.

Submucosal (beneath endometrium), intramural (within the myometrial wall), and subserosal (beneath the serosa, projecting outward).

Which type of uterine fibroid most commonly causes heavy menstrual bleeding and infertility?

Submucosal fibroids, because they distort the endometrial cavity.

What is the most common type of physiologic ovarian cyst, and what is its typical course?

Functional cysts — follicular and corpus luteum cysts; they are usually benign and resolve spontaneously within a few menstrual cycles.

What is the gravest acute complication of an ovarian cyst and its hallmark symptom?

Ovarian torsion — sudden severe unilateral lower abdominal pain (a surgical emergency); rupture causing hemoperitoneum is another acute complication.

What is the most common gynecologic cancer, and which is the most lethal, in many populations?

Endometrial (uterine) cancer is the most common gynecologic malignancy; ovarian cancer is the most lethal due to late detection.

Which virus causes most cervical cancers, and what is the key screening test?

Human papillomavirus (HPV), especially types 16 and 18; the Pap smear (cervical cytology) with HPV testing is the key screening tool.

What tumor marker is commonly elevated in epithelial ovarian cancer?

CA-125.

How is infertility clinically defined?

Failure to conceive after 12 months of regular unprotected intercourse (6 months if the woman is 35 years or older).

What is the most common cause of anovulatory infertility in women of reproductive age?

Polycystic ovary syndrome (PCOS).

What are the Rotterdam criteria for diagnosing PCOS?

At least 2 of 3: oligo-/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound (12 or more follicles or ovarian volume greater than 10 mL), after excluding other causes.

What is the first-line ovulation induction agent in PCOS-related infertility?

Letrozole (an aromatase inhibitor) is now first-line; clomiphene citrate is an alternative.

How is menopause clinically defined?

The permanent cessation of menstruation confirmed after 12 consecutive months of amenorrhea (average age around 51 years).

What hormonal changes characterize menopause?

Markedly decreased estrogen with elevated FSH and LH due to loss of negative feedback from ovarian follicular depletion.

Name three common symptoms of menopause.

Vasomotor symptoms (hot flashes/night sweats), vaginal dryness/atrophy, and mood or sleep disturbances; long-term effects include osteoporosis.

When is combined (estrogen plus progestogen) HRT used rather than estrogen-only, and why?

Combined HRT is used in women with an intact uterus; the progestogen protects the endometrium from estrogen-induced hyperplasia and cancer. Estrogen-only HRT is used after hysterectomy.

Name two major risks associated with hormone replacement therapy.

Increased risk of venous thromboembolism and breast cancer (with combined HRT); estrogen-only HRT raises endometrial cancer risk if the uterus is present.

Which contraceptive method is the most effective reversible method available?

Long-acting reversible contraceptives (LARCs) — intrauterine devices and the subdermal implant (failure rates under 1%).

What is the primary mechanism of action of combined oral contraceptive pills?

Suppression of ovulation by inhibiting the LH surge and FSH (via negative feedback), plus thickening cervical mucus and thinning the endometrium.

Name two absolute contraindications to combined oral contraceptive pills.

History of venous thromboembolism and migraine with aura; others include active breast cancer, uncontrolled hypertension, and smoking over age 35.

What is the mechanism of action of the levonorgestrel and the copper intrauterine devices?

Copper IUD: copper is spermicidal and prevents fertilization/implantation; levonorgestrel IUD: thickens cervical mucus, thins endometrium, and partially suppresses ovulation.

Within what time frames are the levonorgestrel pill and the copper IUD effective as emergency contraception?

Levonorgestrel emergency pill within 72 hours (up to 120 with reduced efficacy); copper IUD within 5 days and is the most effective emergency method.

What is in vitro fertilization (IVF) and its basic sequence of steps?

An assisted reproductive technique where eggs are retrieved after controlled ovarian stimulation, fertilized with sperm in the laboratory, and the resulting embryo(s) transferred into the uterus.

What is the difference between IUI and IVF?

IUI (intrauterine insemination) places washed sperm directly into the uterus around ovulation for in vivo fertilization; IVF fertilizes the egg outside the body in the lab before embryo transfer.

What is ICSI and when is it primarily indicated?

Intracytoplasmic sperm injection — a single sperm is injected directly into an oocyte; primarily indicated for severe male-factor infertility.

What is the most significant complication of controlled ovarian stimulation in ART?

Ovarian hyperstimulation syndrome (OHSS), characterized by enlarged ovaries, fluid shifts, ascites, and risk of thromboembolism.