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🩺 Obstetrics & Gynecology - Complete Guide: Signs, Symptoms, Maneuvers, Procedures + Hindi Tricks

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PART 1: SIGNS OF PREGNANCY (गर्भावस्था के संकेत)

A. PRESUMPTIVE SIGNS (संदिग्ध संकेत) - Subjective, felt by mother

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B. PROBABLE SIGNS (संभावित संकेत) - Objective, detected by examiner

"12 weeks = Pelvis full; 20 weeks = Umbilicus; 28 weeks = 4 fingers above umbilicus; 36 weeks = Xiphoid; 40 weeks = Lightening (thoda neeche)"

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C. POSITIVE/DEFINITIVE SIGNS (निश्चित संकेत)

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PART 2: LEOPOLD'S MANEUVERS (लियोपोल्ड के चार हाथ-फेरे)

Maneuver 1 (Fundal Grip - फंडल ग्रिप)

• What: Face the patient's head; palpate fundus with both hands
• Finds: What is in the fundus? (breech = soft, irregular, non-ballottable; head = hard, round, ballottable)
• Hindi: "Upar kya hai - sar ya pair?"

Maneuver 2 (Lateral / Umbilical Grip - पार्श्व ग्रिप)

• What: Hands slide to sides of uterus; one side feels smooth (back), other feels small parts (nodular)
• Finds: Fetal back and limb positions
• Hindi: "Peeth kidhar hai, pair kidhar"

Maneuver 3 (Pawlik's Grip / Lower Uterine Grip - पावलिक ग्रिप)

• What: Single hand grasps presenting part above symphysis pubis between thumb and finger
• Finds: What is presenting? Is it engaged?
• Hindi: "Neeche wala hissa pakad ke dekho - sar hai ya nahi, aur daba hua hai ya nahi"
• Note: If presenting part is engaged, it cannot be moved

Maneuver 4 (Pelvic Grip - पेल्विक ग्रिप)

• What: Face patient's feet; both hands press into pelvic inlet on either side
• Finds: Degree of engagement, flexion of head (cephalic prominence)
• Hindi: "Pelvis mein kitna ghusa hua hai - cephalic prominence dhundo"
• Cephalic prominence on same side as small parts = well-flexed (normal)
• Cephalic prominence on same side as back = extended head (brow/face presentation)

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PART 3: CLINICAL SIGNS IN LABOR (प्रसव के संकेत)

Cardinal Movements of Labor (प्रसव के 7 कदम)

1. Engagement - Head enters pelvis (BPD crosses pelvic inlet)
2. Descent - Head moves down
3. Flexion - Chin to chest (smallest diameter presents)
4. Internal Rotation - Occiput rotates to OA position (AP diameter of pelvis)
5. Extension - Head delivered under symphysis pubis
6. Restitution + External rotation - Head aligns with shoulders
7. Expulsion - Delivery of body

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PART 4: DELIVERY MANEUVERS (प्रसव में प्रयोग होने वाले हाथफेरे)

Modified Ritgen's Maneuver (रित्गेन मैन्यूवर)

• How: Towel-draped hand presses on fetal chin through perineum (anterior to coccyx) while other hand controls head deflexion from above
• Purpose: Control delivery of head, protect perineum, extend head at proper time for smallest diameter
• Hindi: "Ritgen = Rin (chin) pakad ke neeche se, head ko control karo"

Mauriceau-Smellie-Veit Maneuver (ब्रीच में सिर के लिए)

• When: Breech delivery - after-coming head
• How: Fetal body rests on clinician's forearm; index + middle finger placed over maxilla (not in mouth for risk of jaw injury); other hand presses on occiput for flexion
• Purpose: Deliver the after-coming head in breech delivery
• Hindi: "Mauriceau = Munh pakad ke flexion karo, sir nikaalo"

Burns-Marshall Technique

• When: After-coming head in breech
• How: Feet held and swept in arc from below upward toward mother's abdomen
• Hindi: "Burns ko uthao, Baby poora nikaalo"

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PART 5: MANEUVERS FOR SHOULDER DYSTOCIA (कंधा फंसने पर)

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PART 6: RADIOLOGICAL SIGNS IN OBSTETRICS (X-Ray/USG/CT Signs)

Biophysical Profile (BPP) - Score out of 10

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PART 7: GYNECOLOGICAL SIGNS & MANEUVERS

Signs in Pelvic/Abdominal Examination

Signs in Ovarian Pathology

Ectopic Pregnancy Signs

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PART 8: HYPERTENSIVE DISORDERS OF PREGNANCY

• Hemolysis + Elevated Liver enzymes + Low Platelets
• Hindi: "HELLP = Hemolysis Elevated LFT Low Platelets"

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PART 9: PLACENTA PREVIA vs ABRUPTIO PLACENTAE

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PART 10: SPECIAL SIGNS - HIGH-YIELD FOR EXAMS

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PART 11: NST / CTG PATTERNS

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PART 12: GYNECOLOGY - KEY SYNDROMES & SIGNS

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PART 13: HIGH-YIELD HINDI MNEMONICS SUMMARY

Pregnancy Signs याद करने का तरीका:

• Hegar = Isthmus soft (6 wks)
• Goodell = Cervix soft (2nd month)
• Chadwick = Vagina blue (4th week)

Signs of Ovulation:

• Ferning of cervical mucus (on glass slide)
• Spinnbarkeit = String-like stretching of mucus (8-10 cm)
• Basal body temperature rise 0.2-0.5°C after ovulation

Menstrual Disorders याद करने की Trick:

• Menorrhagia = Regular but Heavy (More blood)
• Metrorrhagia = Irregular bleeding between periods (Metro = anytime)
• Menometrorrhagia = Both heavy + irregular
• Oligomenorrhea = Cycles >35 days
• Polymenorrhea = Cycles <21 days
• Hindi: "Menorrhagia = Maar baat, Metrorrhagia = Metro chale kabhi bhi"

Obstetric Emergencies:

• Tone (uterine atony - 80%) = "Tone nahi = Tona (uterus nahi sik raha)"
• Tissue (retained placenta)
• Trauma (lacerations)
• Thrombin (coagulopathy)

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PART 14: CLINICAL PROCEDURES IN OBG

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PART 15: IMPORTANT X-RAY & USG SIGNS - QUICK REVISION TABLE

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PART 16: PARTOGRAM - KEY POINTS

• Alert line: Cervical dilation should cross this (1 cm/hour active phase)
• Action line: 4 hrs right of alert line; crossing = intervention needed
• Active phase: 4 cm → 10 cm dilation
• Hindi: "Alert ke baad Action - 4 ghante mein kuch karo"

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QUICK HINDI MASTER MNEMONICS

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• [The Essentials of Forensic Medicine and Toxicology (2026)](Orris Medical Library) - Signs of Pregnancy chapter
• [Parikh's Medical Jurisprudence](Orris Medical Library) - Presumptive/Probable/Positive signs
• [Creasy & Resnik's Maternal-Fetal Medicine](Orris Medical Library) - Fetal monitoring, shoulder dystocia
• [Rosen's Emergency Medicine](Orris Medical Library) - Labor maneuvers, shoulder dystocia
• [Roberts & Hedges' Clinical Procedures](Orris Medical Library) - Ritgen, Mauriceau, delivery procedures
• [Berek & Novak's Gynecology](Orris Medical Library) - Gynecologic examination and signs

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🎯 NEET PG OBG - HIGH YIELD CURATED GUIDE

Based on PYQ Pattern Analysis (2020-2025) + Topic Weightage

Exam Alert: OBG is the SINGLE HEAVIEST clinical subject in NEET PG 2025 - 19 to 30 questions expected. Nearly 49% questions are case-based vignettes in 2025 pattern. Memorize clinical decision points, NOT just definitions.

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📊 TOPIC WEIGHTAGE MAP (Most → Least Frequently Asked)

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🔴 TIER 1: SIGNS OF PREGNANCY (NEET PG Most Asked - Direct One-liners)

HGC Triad - याद करो बस यही ✅

"HGC = Hegar, Goodell, Chadwick - jaise HCG hormone"

🎯 NEET PG PYQ Pattern on Pregnancy Signs:

• Q: "Most valuable sign of early pregnancy?" → Hegar's Sign
• Q: "Earliest probable sign?" → Hegar (6 wks)
• Q: "Earliest presumptive sign?" → Chadwick (4 wks)
• Q: "Braxton Hicks present in dead fetus?" → YES (probable, not positive sign)
• Q: "Which sign is due to venous engorgement?" → Chadwick

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🔴 TIER 1: PRE-ECLAMPSIA / ECLAMPSIA / HELLP

Diagnostic Criteria (याद रखो - NEET loves these numbers)

MgSO₄ - NEET PG's Most Repeated Drug in OBG

"MgSO4 = Magic solution for eclampsia"

MgSO₄ Toxicity Signs - याद करो क्रम में:

HELLP Syndrome

• Hindi: "Hemolysis aaya, Liver badha, Low platelets = HELLP"
• Platelets <100,000 = HELLP; <50,000 = Severe HELLP
• Treatment: Delivery! (Definitive)
• MgSO₄ must be given even without seizures in HELLP

🎯 NEET PYQ Favorites:

• "First sign of MgSO₄ toxicity?" → Loss of patellar reflex
• "Drug of choice in eclampsia?" → MgSO₄
• "Antidote of MgSO₄ toxicity?" → Calcium gluconate
• "MgSO₄ continued for how long postpartum?" → 24 hours after last seizure
• "Carboprost contraindicated in?" → Asthma (remember for PPH Rx)

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🔴 TIER 1: APH - PREVIA vs ABRUPTION

"Previa = Painless; Abruption = Agonizing"

Couvelaire Uterus (NEET PG repeated!)

• Severe abruption → blood infiltrates uterine musculature → purple, rigid, non-contracting uterus
• Hindi: "Couvelaire = Colour badla (purple) + Contractions nahi"

Types of Placenta Previa (remember for NEET):

• Type I (Low-lying): Edge within 2 cm of os
• Type II (Marginal): Reaches edge of os
• Type III (Partial): Partially covers os
• Type IV (Central/Complete): Completely covers os → always C-section

🎯 NEET PYQ Pattern:

• "USG shows placenta over os. Next step?" → If asymptomatic at <28 wks: expectant; if bleeding: hospitalize
• "Painless, bright red, third trimester bleeding?" → Placenta Previa → NO vaginal exam
• "Woody hard uterus + concealed bleeding?" → Abruption

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🔴 TIER 1: PPH - POSTPARTUM HEMORRHAGE

Definition:

• Vaginal delivery: Blood loss >500 mL within 24 hours
• C-section: >1000 mL

4 T's - NEET PG Guaranteed Question

Uterotonics - Order of Use (NEET loves this):

1. Oxytocin (DOC - 1st line) 10 IU IM or 20 IU in drip
2. Misoprostol (800 mcg sublingual/rectal) - useful at home deliveries
3. Ergometrine (contraindicated in HTN, cardiac disease)
4. Carboprost/15-methyl PGF2α (contraindicated in ASTHMA)
5. Tranexamic acid - within 3 hours of delivery (reduces mortality)

Surgical options: B-Lynch suture → Uterine artery ligation → Internal iliac artery ligation → Hysterectomy

🎯 NEET PYQ Favorites:

• "PPH most common cause?" → Uterine atony (Tone)
• "Carboprost is contraindicated in?" → Bronchial asthma
• "Bimanual compression used in?" → Uterine atony
• "B-Lynch suture used for?" → PPH from atony

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🔴 TIER 1: ECTOPIC PREGNANCY

Classic Triad (याद करो - "PAA"):

Investigations:

• β-hCG > 1500-2000 mIU/mL + empty uterus on TVS = Ectopic (discriminatory zone)
• POD fullness (blood in pouch of Douglas)
• Culdocentesis: Non-clotting blood = hemoperitoneum

Signs:

Management:

🎯 NEET PYQ Pattern:

• "β-hCG level above which ectopic suspected with empty uterus?" → 1500-2000 mIU/mL
• "Contraindication to methotrexate in ectopic?" → Cardiac activity, hCG >5000, large mass, hepatic/renal disease
• "Most common site of ectopic?" → Ampulla of fallopian tube (55%)
• "Most common sign of ruptured ectopic?" → Shoulder tip pain (diaphragmatic irritation)

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🔴 TIER 1: SHOULDER DYSTOCIA - HELPERR

Answer: McRoberts Maneuver (resolves ~40% of cases alone)

🎯 NEET PYQ:

• "First maneuver in shoulder dystocia?" → McRoberts
• "Turtle sign means?" → Head delivers then retracts = Shoulder dystocia
• "HELPERR - which does NOT help bony obstruction?" → Episiotomy

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🟡 TIER 2: CTG INTERPRETATION (Image-based - High yield 2024-25)

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🟡 TIER 2: CERVICAL CANCER - FIGO 2018 STAGING

Key NEET fact: IIB onwards = Chemoradiation, NOT surgery

Screening:

• Pap smear: Start at 21 yrs (regardless of sexual activity)
• HPV testing: From 25 yrs
• HPV vaccine (Gardasil/Cervarix): Covers HPV 16 & 18 (high risk)
• Colposcopy: Abnormal Pap → visualize Transformation Zone (TZ)

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🟡 TIER 2: CONTRACEPTION (Regularly Asked in NEET PG)

🎯 NEET PYQ:

• "Emergency contraception within 72 hours?" → Levonorgestrel 1.5mg
• "Which contraceptive has NO systemic hormonal effect?" → Cu-T
• "OCP contraindicated in?" → Smoking + age >35, venous thrombosis, migraine with aura, hepatic disease

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🟡 TIER 2: PCOS - NEET PG Loves This

Rotterdam Criteria (2 out of 3):

1. Oligo/anovulation (irregular cycles)
2. Clinical/biochemical hyperandrogenism (hirsutism, acne, elevated testosterone)
3. Polycystic ovaries on USG (≥12 follicles 2-9mm OR ovarian volume >10 mL)

Treatment:

🎯 NEET PYQ:

• "Rotterdam criteria for PCOS - minimum criteria needed?" → 2 out of 3
• "DOC for ovulation induction in PCOS?" → Clomiphene / Letrozole
• "Ovarian drilling indicated when?" → Clomiphene-resistant PCOS

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🟡 TIER 2: CARDINAL MOVEMENTS OF LABOR

"Engagement, Descent, Flexion, Internal rotation, Extension, Restitution (External rotation), Expulsion"

Hindi: "Ek Din Fixed Itna Exam Roz Easy"

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🟡 TIER 2: MOLAR PREGNANCY / GTD

• Suction evacuation → follow hCG weekly
• hCG should fall to undetectable in 8 weeks
• If hCG plateaus/rises → Gestational Trophoblastic Neoplasia (GTN) → Methotrexate

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🟡 TIER 2: LEOPOLD'S MANEUVERS (Image-based PYQ)

• Same side as small parts (limbs) = well-flexed (normal LOA)
• Same side as back = extended head (face/brow presentation)

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🟢 TIER 3: QUICK HIGH-YIELD FACTS (One-liners)

Radiological Signs (Image MCQ type):

Ovarian Tumor Markers (NEET loves these):

Key Syndromes:

Biophysical Profile:

• Score 8-10 = Normal (deliver at term)
• Score 6 = Equivocal (repeat in 24 hrs)
• Score ≤4 = Deliver regardless of gestation

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🎯 NEET PG MASTER REVISION TABLE

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📝 HINDI MASTER MNEMONICS CARD

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Pro Tip for NEET PG 2026: Since 49% questions are case-based, practice reading clinical vignettes and picking the single "next best step" - especially for eclampsia (stabilize BP + MgSO₄ + deliver), PPH (oxytocin first), and ectopic (rule out rupture before MTX). Never memorize in isolation - always think: "What would I do in the ward right now?"