Refer these topics and give viva questions and answers like above files that can ask in my viva as well .. from all the topics
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antenatal care mechanism of labour postpartum care induction of labour VBAC caesarean delivery viva questions
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miscarriage ectopic pregnancy primary amenorrhoea puberty abnormal uterine bleeding fibroids endometriosis viva questions
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Great, I can do that.
I can see all the topics in your screenshot (Obstetrics + Gynaecology), and I will generate viva-style questions with crisp model answers from all topics.
Because this is a very large syllabus (46 topics), I will give you a high-yield complete viva bank in a compact format first. If you want, next I can expand each topic into a long-answer viva version with examiner follow-up questions.
Obstetrics Viva Q&A (High-yield)
1) Antenatal care
Q: What are the aims of antenatal care?
A: Ensure maternal-fetal wellbeing, detect/treat complications early, provide supplements/vaccination, birth preparedness, and counselling.
A: Ensure maternal-fetal wellbeing, detect/treat complications early, provide supplements/vaccination, birth preparedness, and counselling.
Q: What is the minimum ANC contact model by WHO?
A: 8 contacts for improved outcomes.
A: 8 contacts for improved outcomes.
2) Mechanism of labour and labour care
Q: Cardinal movements of labour?
A: Engagement, descent, flexion, internal rotation, extension, restitution, external rotation, expulsion.
A: Engagement, descent, flexion, internal rotation, extension, restitution, external rotation, expulsion.
Q: Define active labour.
A: Regular painful contractions with progressive cervical dilatation, usually from about 4 to 6 cm onward depending protocol.
A: Regular painful contractions with progressive cervical dilatation, usually from about 4 to 6 cm onward depending protocol.
3) Postpartum care
Q: Define puerperium.
A: 6 weeks after delivery during which reproductive organs return to non-pregnant state.
A: 6 weeks after delivery during which reproductive organs return to non-pregnant state.
Q: Common immediate postpartum danger signs?
A: Heavy bleeding, fever, severe abdominal pain, severe headache/visual symptoms, breathlessness.
A: Heavy bleeding, fever, severe abdominal pain, severe headache/visual symptoms, breathlessness.
4) Induction of labour
Q: Two common indications for induction?
A: Post-dates pregnancy, hypertensive disorders, diabetes, IUGR, PROM (as indicated).
A: Post-dates pregnancy, hypertensive disorders, diabetes, IUGR, PROM (as indicated).
Q: What score assesses cervical favorability?
A: Bishop score.
A: Bishop score.
5) VBAC and caesarean delivery
Q: One absolute contraindication to VBAC?
A: Previous classical (vertical upper segment) uterine scar.
A: Previous classical (vertical upper segment) uterine scar.
Q: Most feared complication in TOLAC?
A: Uterine rupture.
A: Uterine rupture.
6) PROM/PPROM
Q: Define PROM and PPROM.
A: PROM: rupture before labour onset; PPROM: rupture before labour and before 37 weeks.
A: PROM: rupture before labour onset; PPROM: rupture before labour and before 37 weeks.
Q: Major risk of prolonged rupture?
A: Ascending infection (chorioamnionitis).
A: Ascending infection (chorioamnionitis).
7) Preterm labour and cerclage
Q: Define preterm labour.
A: Labour before 37 completed weeks with cervical change.
A: Labour before 37 completed weeks with cervical change.
Q: Main indication for cerclage?
A: Cervical insufficiency with suggestive history and/or short cervix criteria.
A: Cervical insufficiency with suggestive history and/or short cervix criteria.
8) Diabetes in pregnancy
Q: Maternal complications?
A: Preeclampsia, polyhydramnios, operative delivery, infections.
A: Preeclampsia, polyhydramnios, operative delivery, infections.
Q: Fetal complications?
A: Macrosomia, shoulder dystocia, neonatal hypoglycaemia, stillbirth risk.
A: Macrosomia, shoulder dystocia, neonatal hypoglycaemia, stillbirth risk.
9) Hypertension in pregnancy
Q: Diagnostic BP threshold?
A: ≥140/90 mmHg on two readings.
A: ≥140/90 mmHg on two readings.
Q: Severe features of preeclampsia?
A: Severe hypertension, thrombocytopenia, elevated liver enzymes, renal dysfunction, pulmonary edema, cerebral/visual symptoms.
A: Severe hypertension, thrombocytopenia, elevated liver enzymes, renal dysfunction, pulmonary edema, cerebral/visual symptoms.
10) Intrauterine fetal death (IUFD)
Q: Define IUFD.
A: Fetal death in utero after age of viability (cutoff varies by guideline).
A: Fetal death in utero after age of viability (cutoff varies by guideline).
Q: Two important maternal evaluations after IUFD?
A: Coagulation profile (if prolonged retention), cause workup (infection, hypertension, diabetes, thrombophilia, placental pathology).
A: Coagulation profile (if prolonged retention), cause workup (infection, hypertension, diabetes, thrombophilia, placental pathology).
11) Fetal growth restriction (FGR)
Q: Differentiate SGA and FGR.
A: SGA is size <10th centile; FGR implies pathological growth failure with Doppler/clinical evidence.
A: SGA is size <10th centile; FGR implies pathological growth failure with Doppler/clinical evidence.
Q: Key surveillance tool?
A: Umbilical artery Doppler.
A: Umbilical artery Doppler.
12) Anaemia in pregnancy
Q: Most common cause?
A: Iron deficiency.
A: Iron deficiency.
Q: Why treat aggressively?
A: Reduces maternal morbidity, heart failure risk, PPH impact, adverse perinatal outcomes.
A: Reduces maternal morbidity, heart failure risk, PPH impact, adverse perinatal outcomes.
13) Rh isoimmunisation
Q: Who needs anti-D prophylaxis?
A: Rh-negative unsensitised women after sensitising events and routinely antenatally/postpartum as per protocol.
A: Rh-negative unsensitised women after sensitising events and routinely antenatally/postpartum as per protocol.
Q: Severe fetal complication?
A: Hydrops fetalis due to hemolytic disease.
A: Hydrops fetalis due to hemolytic disease.
14) Multiple pregnancy
Q: Main maternal risks?
A: Anemia, preeclampsia, GDM, PPH, operative delivery.
A: Anemia, preeclampsia, GDM, PPH, operative delivery.
Q: Main fetal risks?
A: Preterm birth, growth restriction, TTTS in monochorionic twins.
A: Preterm birth, growth restriction, TTTS in monochorionic twins.
15) Epilepsy in pregnancy
Q: Why is preconception care essential?
A: Optimize anti-seizure therapy, minimize teratogenic risk, folic acid planning.
A: Optimize anti-seizure therapy, minimize teratogenic risk, folic acid planning.
Q: Drug commonly linked with higher congenital malformation risk?
A: Valproate.
A: Valproate.
16) Antenatal screening
Q: First trimester aneuploidy screening components?
A: Nuchal translucency + serum markers (as per local protocol).
A: Nuchal translucency + serum markers (as per local protocol).
Q: Screening vs diagnostic test?
A: Screening estimates risk; diagnostic confirms disease (e.g., CVS/amniocentesis).
A: Screening estimates risk; diagnostic confirms disease (e.g., CVS/amniocentesis).
17) Heart disease in pregnancy
Q: Most dangerous period for decompensation?
A: Late pregnancy, labour, and early postpartum due to hemodynamic shifts.
A: Late pregnancy, labour, and early postpartum due to hemodynamic shifts.
Q: NYHA class meaning?
A: Functional limitation due to cardiac symptoms.
A: Functional limitation due to cardiac symptoms.
18) Antepartum haemorrhage
Q: Two major causes after 28 weeks?
A: Placenta previa and placental abruption.
A: Placenta previa and placental abruption.
Q: First step in management?
A: Maternal stabilization (ABC), then fetal assessment.
A: Maternal stabilization (ABC), then fetal assessment.
19) Liver disease in pregnancy
Q: Pregnancy-specific liver disorders?
A: Intrahepatic cholestasis, acute fatty liver of pregnancy, HELLP.
A: Intrahepatic cholestasis, acute fatty liver of pregnancy, HELLP.
Q: Key symptom in intrahepatic cholestasis?
A: Pruritus (often palms/soles), usually without rash.
A: Pruritus (often palms/soles), usually without rash.
20) Obstetric psychiatry
Q: Postpartum blues vs depression?
A: Blues is mild, transient (few days); depression is persistent, function-impairing.
A: Blues is mild, transient (few days); depression is persistent, function-impairing.
Q: Psychiatric emergency postpartum?
A: Postpartum psychosis.
A: Postpartum psychosis.
21) CTG and partogram
Q: Components of CTG interpretation?
A: Baseline rate, variability, accelerations, decelerations, contractions.
A: Baseline rate, variability, accelerations, decelerations, contractions.
Q: Use of partogram?
A: Track labour progress and detect delay/obstructed labour early.
A: Track labour progress and detect delay/obstructed labour early.
22) Thyroid disorders in pregnancy
Q: Why uncontrolled hypothyroidism matters?
A: Miscarriage, preeclampsia, preterm birth, neurodevelopmental impact.
A: Miscarriage, preeclampsia, preterm birth, neurodevelopmental impact.
Q: Preferred treatment for hypothyroidism?
A: Levothyroxine.
A: Levothyroxine.
23) DVT in pregnancy
Q: Why risk is increased?
A: Hypercoagulable state + venous stasis + endothelial factors.
A: Hypercoagulable state + venous stasis + endothelial factors.
Q: Drug of choice for treatment in pregnancy?
A: Low molecular weight heparin.
A: Low molecular weight heparin.
Gynaecology Viva Q&A (High-yield)
1) Miscarriage
Q: Types of miscarriage?
A: Threatened, inevitable, incomplete, complete, missed, septic, recurrent.
A: Threatened, inevitable, incomplete, complete, missed, septic, recurrent.
Q: Management options in early pregnancy loss?
A: Expectant, medical, surgical.
A: Expectant, medical, surgical.
2) Ectopic pregnancy
Q: Commonest site?
A: Fallopian tube (ampulla most common).
A: Fallopian tube (ampulla most common).
Q: Life-threatening complication?
A: Rupture causing intra-abdominal hemorrhage.
A: Rupture causing intra-abdominal hemorrhage.
3) Primary amenorrhoea and puberty
Q: Define primary amenorrhoea.
A: No menarche by expected age cutoff per guideline, especially with absent secondary sexual characteristics.
A: No menarche by expected age cutoff per guideline, especially with absent secondary sexual characteristics.
Q: First evaluation steps?
A: Pregnancy exclusion (if relevant), history, exam, pelvic US, hormonal profile.
A: Pregnancy exclusion (if relevant), history, exam, pelvic US, hormonal profile.
4) Symptom analysis bleeding
Q: Key bleeding history points?
A: Pattern, amount, duration, intermenstrual/postcoital bleeding, pain, pregnancy possibility, medications.
A: Pattern, amount, duration, intermenstrual/postcoital bleeding, pain, pregnancy possibility, medications.
Q: Why ask age?
A: Differential diagnosis changes with age and guides cancer risk assessment.
A: Differential diagnosis changes with age and guides cancer risk assessment.
5) Symptom analysis pain
Q: Causes of acute pelvic pain?
A: Ectopic pregnancy, torsion, PID, ruptured cyst, appendicitis.
A: Ectopic pregnancy, torsion, PID, ruptured cyst, appendicitis.
Q: Red flags?
A: Hemodynamic instability, fever/sepsis, peritonism, positive pregnancy test with pain.
A: Hemodynamic instability, fever/sepsis, peritonism, positive pregnancy test with pain.
6) Menstruation physiology & HPO-axis drugs
Q: Normal cycle control axis?
A: Hypothalamus (GnRH) → pituitary (FSH/LH) → ovary (estrogen/progesterone).
A: Hypothalamus (GnRH) → pituitary (FSH/LH) → ovary (estrogen/progesterone).
Q: Drug class that suppresses ovulation?
A: Combined hormonal contraception / GnRH analogues (context dependent).
A: Combined hormonal contraception / GnRH analogues (context dependent).
7) Abnormal uterine bleeding (AUB)
Q: PALM-COEIN classification meaning?
A: Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia; Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified.
A: Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia; Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified.
Q: First-line test in reproductive age with AUB?
A: Pregnancy test.
A: Pregnancy test.
8) Fibroids and adenomyosis
Q: Typical fibroid symptoms?
A: Heavy bleeding, pressure symptoms, infertility/subfertility, pain.
A: Heavy bleeding, pressure symptoms, infertility/subfertility, pain.
Q: Definitive treatment for symptomatic fibroids with completed family?
A: Hysterectomy.
A: Hysterectomy.
9) Endometriosis
Q: Classic symptom triad?
A: Dysmenorrhoea, dyspareunia, subfertility/chronic pelvic pain.
A: Dysmenorrhoea, dyspareunia, subfertility/chronic pelvic pain.
Q: Gold standard diagnosis?
A: Laparoscopy with histologic confirmation.
A: Laparoscopy with histologic confirmation.
10) Molar pregnancy
Q: Hallmark lab finding?
A: Markedly elevated beta-hCG.
A: Markedly elevated beta-hCG.
Q: Essential follow-up?
A: Serial beta-hCG monitoring to detect persistent trophoblastic disease.
A: Serial beta-hCG monitoring to detect persistent trophoblastic disease.
11) PCOS and secondary amenorrhoea
Q: Rotterdam criteria (any two)?
A: Oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovarian morphology.
A: Oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovarian morphology.
Q: Long-term risks in PCOS?
A: Insulin resistance, type 2 diabetes, endometrial hyperplasia/cancer risk.
A: Insulin resistance, type 2 diabetes, endometrial hyperplasia/cancer risk.
12) Subfertility
Q: Definition?
A: Failure to conceive after 12 months of regular unprotected intercourse (earlier evaluation in selected cases).
A: Failure to conceive after 12 months of regular unprotected intercourse (earlier evaluation in selected cases).
Q: Basic couple evaluation?
A: Ovulation assessment, tubal patency/uterine cavity assessment, semen analysis.
A: Ovulation assessment, tubal patency/uterine cavity assessment, semen analysis.
13) Infections in gynaecology
Q: Common organisms in PID?
A: N. gonorrhoeae, C. trachomatis, mixed anaerobic flora.
A: N. gonorrhoeae, C. trachomatis, mixed anaerobic flora.
Q: Long-term sequelae of PID?
A: Infertility, chronic pelvic pain, ectopic risk.
A: Infertility, chronic pelvic pain, ectopic risk.
14) Contraception
Q: Most effective reversible method?
A: LARC (IUD/IUS, implant).
A: LARC (IUD/IUS, implant).
Q: Emergency contraception options?
A: Levonorgestrel, ulipristal acetate, copper IUD.
A: Levonorgestrel, ulipristal acetate, copper IUD.
15) Menopause and HRT
Q: Definition of menopause?
A: 12 months of amenorrhoea due to ovarian follicular depletion.
A: 12 months of amenorrhoea due to ovarian follicular depletion.
Q: Main benefit of HRT?
A: Relief of vasomotor symptoms and prevention of bone loss in appropriate candidates.
A: Relief of vasomotor symptoms and prevention of bone loss in appropriate candidates.
16) Postmenopausal bleeding
Q: Why is PMB important?
A: Must exclude endometrial carcinoma.
A: Must exclude endometrial carcinoma.
Q: First-line investigation?
A: Transvaginal ultrasound (endometrial thickness assessment), then biopsy if indicated.
A: Transvaginal ultrasound (endometrial thickness assessment), then biopsy if indicated.
17) Urinary incontinence
Q: Types?
A: Stress, urge, mixed, overflow, functional.
A: Stress, urge, mixed, overflow, functional.
Q: First-line treatment for stress incontinence?
A: Pelvic floor muscle training.
A: Pelvic floor muscle training.
18) Pelvic organ prolapse
Q: Risk factors?
A: Multiparity, aging, menopause, obesity, chronic raised intra-abdominal pressure.
A: Multiparity, aging, menopause, obesity, chronic raised intra-abdominal pressure.
Q: Non-surgical management?
A: Pelvic floor exercises, pessary.
A: Pelvic floor exercises, pessary.
19) Recurrent miscarriage
Q: Define recurrent pregnancy loss (common definition)?
A: Two or more consecutive losses (definition varies by guideline).
A: Two or more consecutive losses (definition varies by guideline).
Q: Important causes to screen?
A: APS, uterine anomalies, parental karyotype issues, endocrine factors.
A: APS, uterine anomalies, parental karyotype issues, endocrine factors.
20) Ovarian neoplasms (benign/malignant)
Q: Features suspicious for malignancy?
A: Solid areas, papillary projections, ascites, bilateral complex masses, raised risk markers.
A: Solid areas, papillary projections, ascites, bilateral complex masses, raised risk markers.
Q: Tumor marker commonly used in epithelial ovarian cancer?
A: CA-125 (not a standalone screening test).
A: CA-125 (not a standalone screening test).
21) Cervical cancer and screening
Q: Main etiological factor?
A: Persistent high-risk HPV infection.
A: Persistent high-risk HPV infection.
Q: Screening methods?
A: HPV testing and/or cytology per national program.
A: HPV testing and/or cytology per national program.
22) Endometrial hyperplasia and cancer
Q: Key risk factor?
A: Unopposed estrogen exposure.
A: Unopposed estrogen exposure.
Q: Definitive diagnosis?
A: Endometrial sampling/histopathology.
A: Endometrial sampling/histopathology.
23) Premenstrual syndrome
Q: PMS vs PMDD?
A: PMDD is severe, function-impairing form with marked mood symptoms.
A: PMDD is severe, function-impairing form with marked mood symptoms.
Q: Initial management?
A: Lifestyle measures, symptom charting, then pharmacologic options if needed.
A: Lifestyle measures, symptom charting, then pharmacologic options if needed.
If you want, I can now give:
- Top 10 most commonly asked examiner traps from these topics
- One-line rapid-fire viva answers (for last-minute revision)
- OSCE-style case viva station questions for each topic.
Just refer this file and make questions like this on these topics
Pre prof viva - Gyn & Obs (7-10 mins)
Group X - Mock set (from all listed topics)
Group X - Mock set (from all listed topics)
Student 1
Rukshan sir (gyn)
• What is miscarriage?
• Types of miscarriage?
• How do you differentiate threatened and inevitable miscarriage clinically?
• What is septic miscarriage?
• How do you manage septic miscarriage?
Rukshan sir (gyn)
• What is miscarriage?
• Types of miscarriage?
• How do you differentiate threatened and inevitable miscarriage clinically?
• What is septic miscarriage?
• How do you manage septic miscarriage?
Hunukumbura sir (obs)
• Define antenatal care.
• What are the objectives of antenatal care?
• What are routine booking investigations at first visit?
• How do you calculate EDD from LMP?
• What is the formula name?
• Which is more accurate for dating: LMP or first trimester scan?
• Define antenatal care.
• What are the objectives of antenatal care?
• What are routine booking investigations at first visit?
• How do you calculate EDD from LMP?
• What is the formula name?
• Which is more accurate for dating: LMP or first trimester scan?
Student 2
Rukshan sir (gyn)
• Define ectopic pregnancy.
• Commonest site of ectopic pregnancy?
• Risk factors for ectopic pregnancy?
• Other ectopic sites?
• Management options of ectopic pregnancy?
• Indications for medical management with methotrexate?
Rukshan sir (gyn)
• Define ectopic pregnancy.
• Commonest site of ectopic pregnancy?
• Risk factors for ectopic pregnancy?
• Other ectopic sites?
• Management options of ectopic pregnancy?
• Indications for medical management with methotrexate?
Madura sir (obs)
• Define mechanism of labour.
• What are cardinal movements?
• What is favourable fetal position for vaginal delivery?
• How do you assess fetal position clinically?
• What are common malpositions?
• Complications of persistent OP position?
• Define mechanism of labour.
• What are cardinal movements?
• What is favourable fetal position for vaginal delivery?
• How do you assess fetal position clinically?
• What are common malpositions?
• Complications of persistent OP position?
Student 3
Rukshan sir (gyn)
• Define primary amenorrhoea.
• Causes of primary amenorrhoea with absent secondary sexual characters?
• Causes with normal secondary sexual characters?
• How do you evaluate a girl with primary amenorrhoea?
• Role of pelvic ultrasound?
• Role of FSH/LH/prolactin/TSH?
Rukshan sir (gyn)
• Define primary amenorrhoea.
• Causes of primary amenorrhoea with absent secondary sexual characters?
• Causes with normal secondary sexual characters?
• How do you evaluate a girl with primary amenorrhoea?
• Role of pelvic ultrasound?
• Role of FSH/LH/prolactin/TSH?
Madura sir (obs)
• Define postpartum period.
• Immediate postpartum monitoring parameters?
• What are danger signs in puerperium?
• Causes of postpartum fever?
• Postpartum contraception counselling points?
• Define postpartum period.
• Immediate postpartum monitoring parameters?
• What are danger signs in puerperium?
• Causes of postpartum fever?
• Postpartum contraception counselling points?
Student 4
Rukshan sir (gyn)
• How do you approach a patient with bleeding per vaginum?
• Differential diagnoses of heavy menstrual bleeding?
• What is FIGO PALM-COEIN classification?
• What does FIGO stand for?
• Which structural causes are common for HMB?
• Initial investigations in AUB?
Rukshan sir (gyn)
• How do you approach a patient with bleeding per vaginum?
• Differential diagnoses of heavy menstrual bleeding?
• What is FIGO PALM-COEIN classification?
• What does FIGO stand for?
• Which structural causes are common for HMB?
• Initial investigations in AUB?
Hunukumbura sir (obs)
• Define induction of labour.
• Indications for induction?
• Contraindications for induction?
• What is Bishop score?
• Methods of induction?
• Complications of induction?
• Define induction of labour.
• Indications for induction?
• Contraindications for induction?
• What is Bishop score?
• Methods of induction?
• Complications of induction?
Student 5
Rukshan sir (gyn)
• How do you analyze pelvic pain in gyn history?
• Differentials for acute pelvic pain?
• Differentials for chronic pelvic pain?
• Red flag features in pelvic pain?
• Role of bimanual examination?
Rukshan sir (gyn)
• How do you analyze pelvic pain in gyn history?
• Differentials for acute pelvic pain?
• Differentials for chronic pelvic pain?
• Red flag features in pelvic pain?
• Role of bimanual examination?
Madura sir (obs)
• What is VBAC?
• Who is a good candidate for VBAC?
• Contraindications to VBAC?
• Risks of TOLAC?
• How do you counsel for VBAC vs repeat CS?
• What is VBAC?
• Who is a good candidate for VBAC?
• Contraindications to VBAC?
• Risks of TOLAC?
• How do you counsel for VBAC vs repeat CS?
Student 6
Rukshan sir (gyn)
• Explain normal menstrual physiology (HPO axis).
• Hormonal events in follicular and luteal phases?
• Drugs that affect HPO axis?
• How does COCP suppress ovulation?
• How do GnRH analogues work?
Rukshan sir (gyn)
• Explain normal menstrual physiology (HPO axis).
• Hormonal events in follicular and luteal phases?
• Drugs that affect HPO axis?
• How does COCP suppress ovulation?
• How do GnRH analogues work?
Madura sir (obs)
• Define PROM and PPROM.
• Complications of PPROM?
• How do you diagnose rupture of membranes?
• Management of term PROM?
• Management principles in PPROM at 34 weeks vs <34 weeks?
• Define PROM and PPROM.
• Complications of PPROM?
• How do you diagnose rupture of membranes?
• Management of term PROM?
• Management principles in PPROM at 34 weeks vs <34 weeks?
Student 7
Rukshan sir (gyn)
• Define AUB.
• PALM-COEIN classification again with examples?
• When do you do endometrial sampling?
• Medical options for HMB?
• Surgical options for refractory AUB?
Rukshan sir (gyn)
• Define AUB.
• PALM-COEIN classification again with examples?
• When do you do endometrial sampling?
• Medical options for HMB?
• Surgical options for refractory AUB?
Hunukumbura sir (obs)
• Define preterm labour.
• Risk factors for preterm labour?
• What is role of tocolysis?
• Antenatal corticosteroid indications?
• What is cervical cerclage and indications?
• Types of cerclage?
• Define preterm labour.
• Risk factors for preterm labour?
• What is role of tocolysis?
• Antenatal corticosteroid indications?
• What is cervical cerclage and indications?
• Types of cerclage?
Student 8
Rukshan sir (gyn)
• Types of fibroids by location?
• FIGO classification of fibroids?
• Which fibroid type causes HMB commonly?
• Symptoms of submucosal fibroid?
• Management options for fibroids?
• What is adenomyosis?
Rukshan sir (gyn)
• Types of fibroids by location?
• FIGO classification of fibroids?
• Which fibroid type causes HMB commonly?
• Symptoms of submucosal fibroid?
• Management options for fibroids?
• What is adenomyosis?
Madura sir (obs)
• Define GDM.
• Screening strategy for GDM?
• Complications of GDM to mother and fetus?
• Why neonatal hypoglycaemia occurs?
• Intrapartum glucose control targets?
• Define GDM.
• Screening strategy for GDM?
• Complications of GDM to mother and fetus?
• Why neonatal hypoglycaemia occurs?
• Intrapartum glucose control targets?
Student 9
Rukshan sir (gyn)
• Define endometriosis.
• Common symptoms?
• Sites of endometriosis?
• Diagnosis of endometriosis?
• Medical and surgical management?
• Why does endometriosis cause subfertility?
Rukshan sir (gyn)
• Define endometriosis.
• Common symptoms?
• Sites of endometriosis?
• Diagnosis of endometriosis?
• Medical and surgical management?
• Why does endometriosis cause subfertility?
Madura sir (obs)
• Classify hypertensive disorders in pregnancy.
• Diagnostic criteria of preeclampsia?
• Severe features?
• How do you manage severe preeclampsia?
• Indications for delivery?
• Classify hypertensive disorders in pregnancy.
• Diagnostic criteria of preeclampsia?
• Severe features?
• How do you manage severe preeclampsia?
• Indications for delivery?
Student 10
Rukshan sir (gyn)
• What is molar pregnancy?
• Types of mole?
• Clinical features?
• Ultrasound findings?
• Initial management?
• Follow-up with beta hCG?
• Malignancy risk after mole?
Rukshan sir (gyn)
• What is molar pregnancy?
• Types of mole?
• Clinical features?
• Ultrasound findings?
• Initial management?
• Follow-up with beta hCG?
• Malignancy risk after mole?
Madura sir (obs)
• Define IUFD.
• Causes of IUFD?
• How to confirm IUFD?
• Principles of management and induction?
• Investigations to find cause and recurrence prevention?
• Define IUFD.
• Causes of IUFD?
• How to confirm IUFD?
• Principles of management and induction?
• Investigations to find cause and recurrence prevention?
Student 11
Rukshan sir (gyn)
• Define PCOS.
• Rotterdam criteria?
• Differential diagnosis of secondary amenorrhoea?
• Evaluation of secondary amenorrhoea?
• Long-term complications of PCOS?
• Management in a woman seeking pregnancy?
Rukshan sir (gyn)
• Define PCOS.
• Rotterdam criteria?
• Differential diagnosis of secondary amenorrhoea?
• Evaluation of secondary amenorrhoea?
• Long-term complications of PCOS?
• Management in a woman seeking pregnancy?
Madura sir (obs)
• Define FGR.
• Difference between SGA and FGR?
• Causes of FGR?
• Surveillance methods in FGR?
• Doppler changes in placental insufficiency?
• Timing of delivery in FGR?
• Define FGR.
• Difference between SGA and FGR?
• Causes of FGR?
• Surveillance methods in FGR?
• Doppler changes in placental insufficiency?
• Timing of delivery in FGR?
Student 12
Rukshan sir (gyn)
• Define subfertility.
• Initial evaluation of couple?
• Ovulatory factor assessment?
• Tubal factor assessment?
• Male factor assessment?
• Basic management pathway?
Rukshan sir (gyn)
• Define subfertility.
• Initial evaluation of couple?
• Ovulatory factor assessment?
• Tubal factor assessment?
• Male factor assessment?
• Basic management pathway?
Madura sir (obs)
• Define anaemia in pregnancy.
• Causes of anaemia in pregnancy?
• Workup of microcytic anaemia?
• Oral vs IV iron indications?
• Indications for blood transfusion?
• Define anaemia in pregnancy.
• Causes of anaemia in pregnancy?
• Workup of microcytic anaemia?
• Oral vs IV iron indications?
• Indications for blood transfusion?
Student 13
Rukshan sir (gyn)
• Common gyn infections in OPD/ward?
• PID causes and risk factors?
• Diagnostic criteria for PID?
• Complications of PID?
• Syndromic management and partner treatment?
Rukshan sir (gyn)
• Common gyn infections in OPD/ward?
• PID causes and risk factors?
• Diagnostic criteria for PID?
• Complications of PID?
• Syndromic management and partner treatment?
Madura sir (obs)
• What is Rh isoimmunisation?
• Who should receive anti-D prophylaxis?
• Sensitising events?
• How do you monitor sensitized pregnancy?
• Fetal complications and management?
• What is Rh isoimmunisation?
• Who should receive anti-D prophylaxis?
• Sensitising events?
• How do you monitor sensitized pregnancy?
• Fetal complications and management?
Student 14
Rukshan sir (gyn)
• Enumerate contraceptive methods.
• What is COCP and composition?
• How to start COCP?
• Missed pill advice?
• Contraindications to estrogen methods?
• Emergency contraception options?
Rukshan sir (gyn)
• Enumerate contraceptive methods.
• What is COCP and composition?
• How to start COCP?
• Missed pill advice?
• Contraindications to estrogen methods?
• Emergency contraception options?
Hunukumbura sir (obs)
• Types of twin pregnancy by chorionicity and amnionicity?
• Complications of multiple pregnancy?
• How and when determine chorionicity?
• Surveillance in twin pregnancy?
• Mode of delivery decisions in twins?
• Types of twin pregnancy by chorionicity and amnionicity?
• Complications of multiple pregnancy?
• How and when determine chorionicity?
• Surveillance in twin pregnancy?
• Mode of delivery decisions in twins?
Student 15
Rukshan sir (gyn)
• Define menopause.
• Common menopausal symptoms?
• Indications and contraindications for HRT?
• Risks and benefits of HRT?
• Non-hormonal options?
Rukshan sir (gyn)
• Define menopause.
• Common menopausal symptoms?
• Indications and contraindications for HRT?
• Risks and benefits of HRT?
• Non-hormonal options?
Madura sir (obs)
• Epilepsy in pregnancy: key preconception advice?
• Anti-epileptic drug concerns?
• Folic acid dose?
• Intrapartum seizure management?
• Breastfeeding and AEDs?
• Epilepsy in pregnancy: key preconception advice?
• Anti-epileptic drug concerns?
• Folic acid dose?
• Intrapartum seizure management?
• Breastfeeding and AEDs?
Student 16
Rukshan sir (gyn)
• Define postmenopausal bleeding.
• Differential diagnoses of PMB?
• Initial investigations?
• Normal endometrial thickness cutoff on TVS?
• When is endometrial biopsy needed?
Rukshan sir (gyn)
• Define postmenopausal bleeding.
• Differential diagnoses of PMB?
• Initial investigations?
• Normal endometrial thickness cutoff on TVS?
• When is endometrial biopsy needed?
Madura sir (obs)
• What is antenatal screening?
• First trimester screening tests?
• Second trimester anomaly scan purpose?
• Screening vs diagnostic tests?
• NIPT role and limitations?
• What is antenatal screening?
• First trimester screening tests?
• Second trimester anomaly scan purpose?
• Screening vs diagnostic tests?
• NIPT role and limitations?
Student 17
Rukshan sir (gyn)
• Types of urinary incontinence?
• How to differentiate stress and urge incontinence?
• Initial management of stress incontinence?
• Pharmacologic options for urge incontinence?
• When do you refer for surgery?
Rukshan sir (gyn)
• Types of urinary incontinence?
• How to differentiate stress and urge incontinence?
• Initial management of stress incontinence?
• Pharmacologic options for urge incontinence?
• When do you refer for surgery?
Madura sir (obs)
• Heart disease in pregnancy: why high risk?
• NYHA class significance?
• Which lesions poorly tolerated in pregnancy?
• Antenatal and intrapartum management principles?
• Infective endocarditis prophylaxis indications?
• Heart disease in pregnancy: why high risk?
• NYHA class significance?
• Which lesions poorly tolerated in pregnancy?
• Antenatal and intrapartum management principles?
• Infective endocarditis prophylaxis indications?
Student 18
Rukshan sir (gyn)
• Have you seen uterovaginal prolapse?
• Staging system for prolapse?
• Risk factors for prolapse?
• Role of menopause in prolapse?
• Conservative vs surgical treatment?
Rukshan sir (gyn)
• Have you seen uterovaginal prolapse?
• Staging system for prolapse?
• Risk factors for prolapse?
• Role of menopause in prolapse?
• Conservative vs surgical treatment?
Madura sir (obs)
• Define APH.
• Causes of APH?
• Differentiate placenta previa and abruption clinically?
• Can abruption be concealed?
• Initial management of APH?
• Mode of delivery in placenta previa?
• Define APH.
• Causes of APH?
• Differentiate placenta previa and abruption clinically?
• Can abruption be concealed?
• Initial management of APH?
• Mode of delivery in placenta previa?
Student 19
Rukshan sir (gyn)
• Define recurrent miscarriage.
• Causes of recurrent miscarriage?
• Evaluation protocol?
• Role of APS testing?
• Management in next pregnancy?
Rukshan sir (gyn)
• Define recurrent miscarriage.
• Causes of recurrent miscarriage?
• Evaluation protocol?
• Role of APS testing?
• Management in next pregnancy?
Madura sir (obs)
• Liver disorders specific to pregnancy?
• Features of intrahepatic cholestasis?
• Features of acute fatty liver?
• How to differentiate HELLP from other liver disease?
• Obstetric management principles?
• Liver disorders specific to pregnancy?
• Features of intrahepatic cholestasis?
• Features of acute fatty liver?
• How to differentiate HELLP from other liver disease?
• Obstetric management principles?
Student 20
Rukshan sir (gyn)
• Approach to adnexal mass.
• Benign vs malignant ovarian mass features on US?
• Tumor markers and their limitations?
• Management of benign ovarian cyst?
• Basic principles of ovarian cancer staging?
Rukshan sir (gyn)
• Approach to adnexal mass.
• Benign vs malignant ovarian mass features on US?
• Tumor markers and their limitations?
• Management of benign ovarian cyst?
• Basic principles of ovarian cancer staging?
Madura sir (obs)
• Postpartum psychiatric disorders?
• Baby blues vs postpartum depression vs psychosis?
• Risk assessment for self-harm/infanticide?
• Initial management and referral pathway?
• Postpartum psychiatric disorders?
• Baby blues vs postpartum depression vs psychosis?
• Risk assessment for self-harm/infanticide?
• Initial management and referral pathway?
Student 21
Rukshan sir (gyn)
• Why cervical cancer screening is important?
• Causative organism?
• Screening methods available?
• HPV DNA test role?
• What to do with visible cervical lesion?
• Role of colposcopy and biopsy?
Rukshan sir (gyn)
• Why cervical cancer screening is important?
• Causative organism?
• Screening methods available?
• HPV DNA test role?
• What to do with visible cervical lesion?
• Role of colposcopy and biopsy?
Madura sir (obs)
• What is CTG?
• Components of CTG interpretation?
• Define reassuring/non-reassuring/pathological traces?
• What is partogram?
• Features indicating poor progress in labour?
• What is CTG?
• Components of CTG interpretation?
• Define reassuring/non-reassuring/pathological traces?
• What is partogram?
• Features indicating poor progress in labour?
Student 22
Rukshan sir (gyn)
• Define endometrial hyperplasia.
• Classification with/without atypia?
• Risk factors for endometrial cancer?
• PMB workup?
• How is endometrial carcinoma diagnosed and staged?
Rukshan sir (gyn)
• Define endometrial hyperplasia.
• Classification with/without atypia?
• Risk factors for endometrial cancer?
• PMB workup?
• How is endometrial carcinoma diagnosed and staged?
Madura sir (obs)
• Thyroid physiology changes in pregnancy?
• Maternal-fetal effects of hypothyroidism?
• Maternal-fetal effects of hyperthyroidism?
• Monitoring and treatment principles in pregnancy?
• Thyroid physiology changes in pregnancy?
• Maternal-fetal effects of hypothyroidism?
• Maternal-fetal effects of hyperthyroidism?
• Monitoring and treatment principles in pregnancy?
Student 23
Rukshan sir (gyn)
• What is PMS?
• What is PMDD?
• Diagnostic approach with symptom diary?
• Lifestyle and pharmacological treatment options?
Rukshan sir (gyn)
• What is PMS?
• What is PMDD?
• Diagnostic approach with symptom diary?
• Lifestyle and pharmacological treatment options?
Madura sir (obs)
• Why risk of DVT increases in pregnancy?
• Clinical features of DVT?
• Diagnostic test of choice in pregnancy?
• Anticoagulation regimen in pregnancy and postpartum?
• Thromboprophylaxis indications after delivery?
• Why risk of DVT increases in pregnancy?
• Clinical features of DVT?
• Diagnostic test of choice in pregnancy?
• Anticoagulation regimen in pregnancy and postpartum?
• Thromboprophylaxis indications after delivery?
If you want, I can now make Set 2 in the exact same style with new questions only (no repeats), so you can practice multiple rounds before viva.
Give answers to them as well .. no need to name them as sir
Medical Text Search
antenatal care booking visit investigations EDD calculation Bishop score induction of labour VBAC PPROM management
Medical Text Search
mechanism of labour cardinal movements stages of labour postpartum care PPH management active management third stage
GradeResponse
GradeResponse
Medical Text Search
GDM gestational diabetes screening OGTT complications neonatal hypoglycaemia macrosomia management
Medical Text Search
preeclampsia hypertension pregnancy diagnostic criteria severe features management delivery
Model call limits exceeded: run limit (5/5)
Dr c bravado mnemonic
Dr C BRAVADO Mnemonic
Used for CTG (Cardiotocograph) interpretation — a systematic approach to reading a CTG trace.
D — Determine Risk
- Is this a low-risk or high-risk pregnancy?
- Why is the CTG being done? (indication)
R — Rate (Baseline Fetal Heart Rate)
- Normal: 110–160 bpm
- Tachycardia: >160 bpm
- Bradycardia: <110 bpm
C — Contractions
- Frequency, duration, strength
- Normal: ≤5 contractions in 10 minutes
- Tachysystole: >5 contractions in 10 minutes
B — Baseline Variability
- Normal: 5–25 bpm
- Reduced: <5 bpm for >40 minutes
- Absent: <5 bpm for >90 minutes
- Saltatory (sinusoidal-like): >25 bpm
R — Rhythm
- Is the baseline stable?
- Any sinusoidal pattern? (smooth, sine wave-like, ≥10 bpm amplitude for ≥20 min → fetal anaemia)
A — Accelerations
- Rise in FHR ≥15 bpm above baseline for ≥15 seconds
- Reassuring if present
- Absence of accelerations alone is not sinister but note it
- Before 32 weeks: ≥10 bpm for ≥10 seconds
V — Variable Decelerations
- Abrupt drop in FHR
- Caused by cord compression
- Features making them concerning (atypical):
- Lasting >60 seconds
- Rising baseline after
- Loss of shouldering
- Slow recovery
A — Acceleration (post-deceleration)
- Is there a post-deceleration acceleration (shoulder)?
- Presence = reassuring
- Absence in variable decelerations = concerning
D — Decelerations (Early and Late)
| Type | Timing | Cause | Significance |
|---|---|---|---|
| Early | Mirror contractions (onset to nadir mirrors contraction) | Head compression | Normal |
| Late | After peak of contraction, slow return | Uteroplacental insufficiency | Sinister |
| Variable | Abrupt, variable timing | Cord compression | Depends on features |
| Prolonged | >3 min, <10 min | Various | Urgent assessment |
O — Overall Assessment
Classify the CTG as:
| Category | Features |
|---|---|
| Normal | All 4 features reassuring |
| Suspicious | 1 non-reassuring feature |
| Pathological | 2+ non-reassuring features OR 1 abnormal feature |
Quick Summary Table
| Feature | Normal (Reassuring) | Non-Reassuring | Abnormal |
|---|---|---|---|
| Baseline | 110–160 bpm | 100–109 or 161–180 | <100 or >180 |
| Variability | 5–25 bpm | <5 for 40–90 min | <5 for >90 min / sinusoidal |
| Accelerations | Present | Absent >40 min | — |
| Decelerations | None / early | Variable | Late / prolonged |
Tip for viva: Examiners commonly ask you to interpret a CTG trace. Always go through Dr C BRAVADO systematically, state your classification (normal/suspicious/pathological), and then say your management step.
Effacement
Effacement of the Cervix
Definition
Effacement (also called cervical ripening or taking up) is the process by which the cervix shortens, thins, and softens as it is gradually incorporated into the lower uterine segment in preparation for labour.
Normal Cervix (Non-Effaced)
- Length: 3–4 cm
- Firm consistency (like tip of nose)
- Closed external os
- Posterior position
- Not incorporated into lower segment
How Effacement Occurs
- Uterine contractions pull the cervix upward into the lower uterine segment
- The internal os opens first → cervix shortens from above downward
- The cervical canal progressively shortens until it disappears (fully effaced)
- Only then (usually) does the external os begin to dilate
How it is Expressed
As a Percentage
| Description | Meaning |
|---|---|
| 0% effaced | Cervix full length (~3–4 cm), not thinned |
| 50% effaced | Cervix ~1.5–2 cm long |
| 100% effaced | Cervix fully taken up, paper thin, continuous with lower segment |
As Length in cm (used in Bishop score)
| Score | Cervical length |
|---|---|
| 0 | >4 cm |
| 1 | 2–4 cm |
| 2 | 1–2 cm |
| 3 | <1 cm (fully effaced) |
Effacement vs Dilation
| Feature | Effacement | Dilation |
|---|---|---|
| Definition | Shortening and thinning of cervix | Opening of cervical os |
| Occurs first in | Primigravida — effacement precedes dilation | Multigravida — can occur simultaneously |
| Assessed by | VE (length of cervical canal) | VE (finger breadth / cm) |
Primigravida vs Multigravida — Key Difference
-
Primigravida: Effacement occurs first, then dilation (cervix thins completely before opening)
-
Multigravida: Effacement and dilation occur simultaneously (cervix can be 2–3 cm dilated and only partially effaced)
Effacement in Bishop Score
Effacement is one of the 5 components of the Bishop score:
| Component | 0 | 1 | 2 | 3 |
|---|---|---|---|---|
| Dilation | Closed | 1–2 cm | 3–4 cm | ≥5 cm |
| Effacement | 0–30% | 40–50% | 60–70% | ≥80% |
| Station | −3 | −2 | −1/0 | +1/+2 |
| Consistency | Firm | Medium | Soft | — |
| Position | Posterior | Mid | Anterior | — |
- Score ≥8 = favourable cervix → induction likely to succeed
- Score <6 = unfavourable → cervical ripening needed first
Clinical Importance
- Assessed by vaginal examination (VE)
- Indicates readiness of cervix for labour
- Part of deciding whether to induce, ripen, or wait
- Fully effaced cervix with no dilation = latent phase of labour
Viva Tips
Q: What is effacement? Shortening and thinning of the cervix as it is incorporated into the lower uterine segment.
Q: In a primigravida, which comes first — effacement or dilation? Effacement comes first, then dilation.
Q: How do you assess effacement? By vaginal examination — feeling the length of the cervical canal remaining.
Vbac
VBAC — Vaginal Birth After Caesarean
Definition
Planned vaginal delivery in a woman who has had one or more previous uterine caesarean section scars.
- TOLAC = Trial of Labour After Caesarean (the attempt)
- VBAC = successful vaginal delivery after that trial
Success Rate
- Overall: 60–80% of women who attempt TOLAC achieve VBAC
- Higher success if:
- Previous vaginal delivery (especially previous VBAC)
- Spontaneous onset of labour
- Favourable cervix at admission
- Reason for previous CS not recurring (e.g., breech → now cephalic)
Who is a Good Candidate for VBAC?
| Favourable Factors | Details |
|---|---|
| Single previous LSCS | Lower segment transverse scar |
| Previous vaginal delivery | Especially previous successful VBAC |
| Cephalic presentation | Head down at term |
| Spontaneous labour | Better than induced |
| No recurrent indication | e.g., previous CS for breech, now cephalic |
| Adequate pelvis | No known CPD |
| Gestation 37–41 weeks | Term pregnancy |
Contraindications to VBAC
Absolute
- Previous classical (upper segment/vertical) uterine scar
- Previous uterine rupture
- Previous inverted T or J scar
- Other contraindications to vaginal delivery (e.g., placenta previa, cord presentation, transverse lie)
Relative
- More than 2 previous CS scars
- Unknown scar type
- Previous CS with poor healing/infection
- Short inter-delivery interval (<18 months)
- Macrosomia
- Need for induction (increases failure rate)
Risks of TOLAC
| Risk | Details |
|---|---|
| Uterine rupture | ~0.5–1% (most feared complication) |
| Failed TOLAC → emergency CS | Higher morbidity than elective repeat CS |
| Fetal hypoxia/death | In event of rupture |
| Bladder/bowel injury | During emergency CS |
Uterine Rupture — Key Points
Signs and Symptoms
- Sudden severe abdominal pain (may ease then worsen)
- Loss of fetal station (head recedes)
- Fetal bradycardia / abnormal CTG (most common sign)
- Maternal tachycardia, hypotension
- Haematuria
- Cessation of contractions
- Palpable fetal parts outside uterus (late sign)
Management
- Immediate emergency laparotomy
- Deliver baby
- Repair uterus or hysterectomy depending on findings
- Blood transfusion, MDT
Benefits of VBAC over Repeat CS
| VBAC Benefits | Repeat CS Risks (Avoided) |
|---|---|
| Shorter recovery | Longer hospital stay |
| Lower infection risk | Wound/endometritis risk |
| Avoids major surgery | Anaesthetic risks |
| No adhesion formation | Adhesions → placenta accreta in future |
| Better for future pregnancies | Each CS increases accreta risk |
| Earlier mobilisation | DVT risk with CS |
Risks of Repeat Elective CS (if choosing instead of VBAC)
- Surgical risks: haemorrhage, bladder/bowel injury
- Adhesions increasing with each CS
- Placenta accreta spectrum risk rises significantly with each CS:
- 1 CS: ~0.3%
- 2 CS: ~0.6%
- 3 CS: ~2.1%
- 4+ CS: up to 10%+
- Neonatal respiratory morbidity (TTN)
- Longer recovery
Induction in TOLAC
| Method | Comment |
|---|---|
| Oxytocin augmentation | Acceptable but increases rupture risk slightly |
| Prostaglandins (PGE2/misoprostol) | Relatively contraindicated — significantly increases rupture risk |
| Balloon catheter (mechanical) | Safer option for cervical ripening |
| ARM alone | Acceptable |
Induction reduces VBAC success rate and increases uterine rupture risk compared to spontaneous labour.
Intrapartum Care During TOLAC
- Deliver in a unit with 24-hour emergency CS and anaesthetic cover
- Continuous CTG monitoring throughout labour
- IV access established
- Low threshold for CS if:
- Slow progress
- Abnormal CTG
- Any signs of scar dehiscence/rupture
- Epidural is not contraindicated (may mask scar pain — controversial but generally allowed)
- Avoid uterine hyperstimulation
Counselling Points for Patient
Tell the patient:
- 60–80% chance of successful vaginal birth
- ~0.5–1% risk of uterine rupture
- If rupture: emergency CS needed, risk to baby and mother
- If TOLAC fails: emergency CS — higher morbidity than planned CS
- Benefits of VBAC: faster recovery, no surgery, better for future pregnancies
- Repeat CS: planned, controlled, avoids rupture risk but carries surgical risks and increases accreta risk in future
- Decision is hers — document shared decision making
Inter-delivery Interval
- Recommended: at least 18 months from CS to next delivery
- <18 months: increased uterine rupture risk
- <6 months: significantly increased risk
Viva Questions
Q: What is VBAC?
Vaginal birth after caesarean — successful vaginal delivery in a woman with a previous uterine CS scar.
Q: What is TOLAC?
Trial of labour after caesarean — the attempt at vaginal delivery, which may or may not result in VBAC.
Q: What is the most feared complication of TOLAC?
Uterine rupture (~0.5–1%).
Q: What is the earliest sign of uterine rupture?
Abnormal CTG / fetal bradycardia is the most consistent sign. Scar pain and maternal tachycardia also occur.
Q: Why are prostaglandins relatively contraindicated in TOLAC?
They significantly increase the risk of uterine hyperstimulation and uterine rupture in a scarred uterus.
Q: One absolute contraindication to VBAC?
Previous classical (upper segment) uterine scar — highest rupture risk (~4–9%).
Q: Why does each CS increase accreta risk?
Repeated uterine incisions cause progressive myometrial scarring and defective decidualisation → placenta invades through scar in subsequent pregnancies.
Pih vs pre eclampsia
PIH vs Pre-eclampsia
Quick Distinction
| Feature | PIH (Gestational Hypertension) | Pre-eclampsia |
|---|---|---|
| Definition | New hypertension after 20 weeks without proteinuria or systemic features | New hypertension after 20 weeks with proteinuria or systemic organ involvement |
| Proteinuria | Absent | Present (or systemic features) |
| Systemic involvement | Absent | Present |
| Risk to mother | Lower | Significantly higher |
| Risk to fetus | Lower | Higher |
| Progression | May progress to pre-eclampsia | Already pre-eclampsia |
Definitions in Detail
PIH — Pregnancy Induced Hypertension
(also called Gestational Hypertension)
- New onset BP ≥140/90 mmHg on two occasions ≥4 hours apart
- After 20 completed weeks of gestation
- No proteinuria
- No features of systemic organ involvement
- Resolves within 12 weeks postpartum
- If it persists beyond 12 weeks → reclassified as chronic hypertension
Pre-eclampsia
- New onset BP ≥140/90 mmHg after 20 weeks
- PLUS one or more of:
- Proteinuria (≥300 mg/24h OR PCR ≥30 mg/mmol OR dipstick 2+)
- OR systemic organ involvement (even without proteinuria)
Diagnostic Criteria — Blood Pressure
| Category | Systolic | Diastolic |
|---|---|---|
| Normal | <140 | <90 |
| Mild hypertension | 140–159 | 90–109 |
| Severe hypertension | ≥160 | ≥110 |
- Must be on two occasions at least 4 hours apart (unless severe — then act immediately)
- Patient should be seated, rested 5 minutes, appropriate cuff size
- Use Korotkoff V (disappearance) for diastolic
Systemic Features that Diagnose Pre-eclampsia (without proteinuria)
| System | Feature |
|---|---|
| Renal | Creatinine ≥90 µmol/L or doubling from baseline |
| Haematological | Platelets <150,000, haemolysis |
| Hepatic | ALT/AST >40 IU/L, RUQ/epigastric pain |
| Neurological | Severe headache, visual disturbances, hyperreflexia, eclampsia |
| Pulmonary | Pulmonary oedema |
| Uteroplacental | FGR, abnormal Doppler |
Severe Features of Pre-eclampsia
| Feature | Threshold |
|---|---|
| Severe hypertension | BP ≥160/110 mmHg |
| Thrombocytopenia | Platelets <100,000 |
| Renal impairment | Creatinine >1.1 mg/dL or doubling |
| Liver dysfunction | LFTs doubled + RUQ pain |
| Pulmonary oedema | Clinical/radiological |
| Neurological | Severe headache, visual symptoms, seizure |
Comparison Table — Full
| Feature | Chronic HT | PIH | Pre-eclampsia | Severe PET |
|---|---|---|---|---|
| Onset | <20 weeks | >20 weeks | >20 weeks | >20 weeks |
| BP | ≥140/90 | ≥140/90 | ≥140/90 | ≥160/110 |
| Proteinuria | May be present | Absent | Present | Present + heavy |
| Oedema | May occur | May occur | Common | Severe |
| Systemic features | Absent | Absent | Present | Prominent |
| Resolves postpartum | No | Yes (<12 wks) | Yes | Yes |
| Risk of eclampsia | Low | Low | Present | High |
Pathophysiology of Pre-eclampsia
Defective trophoblast invasion (shallow implantation)
↓
Failure of physiological transformation of spiral arteries
↓
High resistance uteroplacental circulation
↓
Placental ischaemia / oxidative stress
↓
Release of anti-angiogenic factors (sFlt-1 ↑, PlGF ↓)
↓
Widespread endothelial dysfunction
↓
Vasospasm → hypertension
Capillary leak → oedema, proteinuria
Coagulation activation → thrombocytopenia, DIC
End organ damage → liver, kidney, brain
Complications
Maternal
- Eclampsia (seizures)
- HELLP syndrome
- Acute kidney injury
- Pulmonary oedema
- Cerebrovascular accident
- DIC / haemorrhage
- Placental abruption
- Death
Fetal
- FGR
- Preterm birth (iatrogenic)
- Placental abruption → fetal distress
- IUFD
HELLP Syndrome
A severe variant of pre-eclampsia:
- H — Haemolysis
- EL — Elevated Liver enzymes
- LP — Low Platelets
Presents with: epigastric/RUQ pain, nausea, malaise, jaundice. Can occur without severe hypertension or proteinuria. Delivery is definitive treatment.
Management
PIH (Mild, no severe features)
- Monitor BP (twice weekly)
- Urine PCR weekly
- FBC, LFTs, creatinine regularly
- Fetal surveillance (USS growth, Doppler, CTG)
- Antihypertensives if BP ≥150/100
- Deliver at 37 weeks
Pre-eclampsia (Mild–Moderate)
- Admit if any concern
- Antihypertensives: labetalol (first line), nifedipine, methyldopa
- Regular blood tests (FBC, LFTs, creatinine, urate)
- Fetal monitoring
- MgSO₄ if severe features (seizure prophylaxis)
- Delivery at 37 weeks (or earlier if deteriorating)
Severe Pre-eclampsia
- Admit to HDU
- IV antihypertensives:
- IV labetalol
- IV hydralazine
- Oral nifedipine
- MgSO₄ (loading dose 4g IV over 15–20 min → maintenance 1g/hr)
- Monitor: urine output, reflexes, RR (toxicity signs)
- Antidote: calcium gluconate 10ml of 10% IV
- Fluid balance (restrict to 80ml/hr — risk of pulmonary oedema)
- Deliver regardless of gestation once stabilised
- Corticosteroids if <34 weeks before delivery
MgSO₄ Toxicity — Monitoring
| Sign | Level |
|---|---|
| Loss of patellar reflexes | First sign — 7–10 mmol/L |
| Respiratory depression | >10 mmol/L |
| Cardiac arrest | >15 mmol/L |
Monitor every hour:
- Patellar reflexes (must be present)
- Respiratory rate (must be >12/min)
- Urine output (must be >25 ml/hr)
Antihypertensive Targets
- Mild–moderate: treat if BP ≥150/100, target 135/85
- Severe: treat immediately if ≥160/110, target <150/100
Postpartum
- BP may worsen in first 3–5 days postpartum
- Continue antihypertensives postpartum
- Pre-eclampsia resolves within 12 weeks
- Long-term risk: 7× increased risk of hypertension, 2× cardiovascular disease in later life
- Aspirin 75–150 mg from 12 weeks in next pregnancy (reduces recurrence)
Viva Questions
Q: Difference between PIH and pre-eclampsia?
PIH is new hypertension after 20 weeks without proteinuria or systemic features. Pre-eclampsia is the same plus proteinuria or systemic organ involvement.
Q: Which Korotkoff sound for diastolic?
Korotkoff V — disappearance of sounds.
Q: What is the definitive treatment of pre-eclampsia?
Delivery of the placenta (and fetus).
Q: Why does pre-eclampsia not occur before 20 weeks?
It is a placental disease requiring sufficient trophoblast. Exception: hydatidiform mole can cause pre-eclampsia before 20 weeks.
Q: First sign of MgSO₄ toxicity?
Loss of deep tendon reflexes (patellar reflex).
Q: Antidote for MgSO₄ toxicity?
Calcium gluconate 10 ml of 10% solution IV slowly.
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