Obstetrics and Gynaecology for PRES Level 2: Pregnancy to Screening

Two patients in one stem

Obstetric questions ask you to protect a mother and a baby at once, and most wrong answers help one at the expense of the other. Gynaecology questions are different: they are about screening, bleeding, pain and fertility in a woman who is not pregnant, and they lean on programmes and law that vary by country. At 12 in every 100, this domain is large enough to cost you the exam if it is your weak point, and candidates trained in other specialties are often most exposed here.

What is tested

• Antenatal. Antenatal care and screening, gestational diabetes and medical disorders in pregnancy, hypertensive disorders including pre-eclampsia and eclampsia, venous thromboembolism and pulmonary embolism in pregnancy.
• Bleeding in pregnancy. Antepartum haemorrhage (abruption and praevia), miscarriage and ectopic pregnancy.
• Labour and after. Labour, induction and obstetric emergencies, postpartum haemorrhage and puerperal complications.
• Gynaecology. Menstrual disorders and amenorrhoea, polycystic ovary syndrome and infertility, endometriosis, pelvic inflammatory disease and pelvic pain.
• Screening and cancer. Cervical screening, HPV and colposcopy, ovarian and endometrial cancer.
• Hormones and contraception. Contraception, including with fibroids, menopause and hormone replacement therapy.
• Infection and law. Sexually transmitted infections, and termination of pregnancy law and counselling.
• Prescribing. Drugs in pregnancy and breastfeeding.

Local guideline points

• Cervical screening. CervicalCheck uses HPV primary screening for ages 25 to 65. The interval is every three years at 25 to 29 and every five years at 30 to 65. After a total hysterectomy the GP decides whether screening is still needed, and after a subtotal hysterectomy screening may need to continue.
• NCEC maternity guidance. National clinical guidelines cover the maternity early warning system, hypertensive disease in pregnancy and venous thromboembolism in pregnancy. Learn the action each guideline prompts.
• Termination of pregnancy. The Health (Regulation of Termination of Pregnancy) Act 2018 sets the lawful circumstances, the doctor's role and a waiting period. Take the gestational limits and timings from the Act, not from memory.
• Sexual offences and young patients. The Criminal Law (Sexual Offences) Act 2017 matters when a young patient attends for contraception or a sexually transmitted infection. See professionalism, ethics, law and prescribing.
• Prescribing. Drugs in pregnancy and breastfeeding follow HPRA and formulary advice.

How the questions are framed

Obstetric stems give the gestation first. Gestation decides the differential, so find it before anything else. Bleeding stems add pain and uterine tone to separate abruption from praevia. Hypertension stems give a blood pressure, protein and symptoms and ask whether the picture is pre-eclampsia, and what to give. Gynaecology stems often hang on a single result, such as a positive pregnancy test with pain, or an abnormal screening result, and ask for the next step.

Three typical traps

1. Doing a vaginal examination in antepartum bleeding. Placenta praevia must be excluded by imaging first. A stem that tempts you to examine is testing this.
2. Using a contraindicated drug in pregnancy or breastfeeding. Read the patient's status first, then the option list.
3. Quoting the wrong screening interval. UK and Irish programmes differ. Use the HSE ages and intervals.

How to revise it

1. Write each obstetric emergency as a short pathway: abruption, praevia, eclampsia, postpartum haemorrhage, cord prolapse, shoulder dystocia.
2. Make a first-trimester pain and bleeding table comparing miscarriage types and ectopic pregnancy.
3. Learn the HPV screening pathway from invitation to colposcopy.
4. Build a contraception grid with who each method suits, contraindications and interactions.
5. List drugs to avoid in pregnancy and their safer alternatives.

Pair this domain with cardiovascular and respiratory for thromboembolism, with endocrine and renal for diabetes in pregnancy, and with psychiatry for perinatal mental health.

Subtopic notes: the decision behind each topic

• Antenatal care and screening. What is offered, when, and how to counsel about results.
• Hypertensive disorders. Distinguish chronic hypertension, gestational hypertension and pre-eclampsia, then treat severe disease and prevent eclampsia.
• Antepartum haemorrhage. Abruption versus praevia: pain, tone, imaging and the immediate resuscitation.
• Gestational diabetes and medical disorders. Screening, targets and drug choice in pregnancy.
• Thromboembolism in pregnancy. Why the test sequence differs and which anticoagulant is used.
• Labour and obstetric emergencies. Induction, failure to progress, cord prolapse, shoulder dystocia and the first actions.
• Postpartum haemorrhage. The four causes, the stepwise response and the drugs.
• Early pregnancy. Miscarriage types, ectopic pregnancy and how a positive test with pain is managed.
• Contraception. Choosing by medical history, including with fibroids, and counselling on failure and emergency methods.
• Menstrual disorders. Amenorrhoea work-up, heavy bleeding and polycystic ovary syndrome.
• Screening and colposcopy. HPV primary screening results and the actions that follow.
• Gynaecological cancers. Presentations and urgent referral for ovarian and endometrial cancer.
• Menopause. Benefits and risks of hormone therapy and who it suits.
• Pelvic pain and infection. Endometriosis, pelvic inflammatory disease and sexually transmitted infections.
• Termination of pregnancy. The legal framework, counselling and the doctor's duties.

Revising across two weeks

Use the first week for pregnancy, from antenatal care to labour and the postpartum period, and the second for gynaecology, screening, contraception and law. Draw each obstetric emergency as a flow chart and test yourself by redrawing it from memory. Add the HPV screening pathway and the Irish programme ages to your local sheet. Practise reading the gestation in every stem before anything else. In the last days, mix obstetric questions with cardiology, endocrine and psychiatry questions so you can handle stems that cross systems.