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MBBS obstetrics important topics exam guide 2025

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I now have solid textbook content. Here is your complete, easy-to-revise MBBS Obstetrics guide — organized by high-yield topic with clear explanations, mnemonics, and key numbers.

🤰 MBBS Obstetrics — Complete Revision Guide

Everything you need to revise, organized logically. High-yield topics first. Read actively — test yourself after each section.

How to Use This Guide

Read one section at a time — don't try to do everything in one day
Write the key numbers/criteria from memory after each topic
Focus on the bold-text and tables — that's what examiners ask
Use the mnemonics at the end of each section

🗂️ MASTER TOPIC LIST (MBBS Obstetrics)

Priority	Topic
⭐⭐⭐ High	Normal Labor & Stages, Preeclampsia/Eclampsia, APH, PPH
⭐⭐⭐ High	Gestational Diabetes, Preterm Labor, PROM
⭐⭐ Medium	Malpresentations, Cord Prolapse, Instrumental Delivery
⭐⭐ Medium	Antenatal Care, Normal Puerperium
⭐ Background	Physiology of Pregnancy, Placenta, Amniotic Fluid

TOPIC 1: NORMAL LABOR & STAGES 🏆 [Most asked topic]

Definition of Labor

Labor = regular uterine contractions of sufficient frequency, intensity, and duration to cause cervical effacement and dilation.

Contractions in active labor: every 2–3 minutes, lasting ~1 minute, intensity ~40 mmHg
Bloody show: blood-tinged mucus discharge → most women go into labor within 3 days

The 4 Stages of Labor

Stage	Onset → End	Nullipara	Multipara
1st Stage	Active labor → Full dilation (10 cm)	Up to 20 hrs (latent)	Up to 14 hrs (latent)
2nd Stage	Full dilation → Delivery of baby	≤2 hrs	≤1 hr
3rd Stage	Baby delivery → Placenta delivery	≤30 min	≤30 min
4th Stage	Placenta delivery → Uterus contracts	1 hr	1 hr

First Stage: Phases

Latent Phase: Little dilation, cervix softens/effaces. Duration variable — up to 20 hrs (nullipara), 14 hrs (multipara)

Active Phase: Dilation from ~6 cm → 10 cm. Cervix dilates at ≥1 cm/hr (nullipara) or ≥1.2 cm/hr (multipara)

Friedman Curve — Normal vs Abnormal Labor

Normal and abnormal cervical dilation curves comparing primigravid and multiparous patients

Abnormal patterns to know:

Prolonged latent phase — >20 hrs (nullipara), >14 hrs (multipara)
Protracted active phase — slow dilation rate
Secondary arrest of dilation — stops at 5–6 cm
Prolonged deceleration phase — slows near full dilation

Cardinal Movements of Labor (2nd Stage)

Mnemonic: "Every Fetal Infant Demands Immediate Expert Rearing"

Engagement
Flexion
Internal rotation
Descent
Imminent crowning (Extension)
External rotation (Restitution)
Repulsion → Expulsion

Textbook of Family Medicine 9e

TOPIC 2: PREECLAMPSIA & ECLAMPSIA 🏆 [Highest yield in theory + viva]

Classification of Hypertensive Disorders of Pregnancy

Type	BP	Timing	Proteinuria
Chronic HTN (cHTN)	≥140/90	<20 weeks or pre-existing	±
Gestational HTN (gHTN)	≥140/90	≥20 weeks	❌
Preeclampsia	≥140/90	≥20 weeks	✅ or other features
Eclampsia	≥140/90	Any time (incl. postpartum)	+ Seizures

Preeclampsia — Diagnosis

New-onset BP ≥140/90 mmHg on 2 occasions ≥4 hours apart after 20 weeks, PLUS:

Proteinuria ≥300 mg/24 hrs, OR urine protein:creatinine ratio ≥0.3

Preeclampsia WITH Severe Features — Any 1 of:

BP ≥160/110 mmHg on 2 occasions
Platelets ≤100,000/μL (thrombocytopenia)
Serum creatinine >1.1 mg/dL (or doubling without renal disease)
Liver transaminases >2× normal
Persistent epigastric / RUQ pain unresponsive to medication
Pulmonary edema
New-onset headache unresponsive to medication
Visual disturbances

Mnemonic: "HELP + Visual HEadaches" → HELLP, Epigastric pain, Low platelets, Pulm edema + Visual, Headache

HELLP Syndrome

H = Hemolysis
EL = Elevated Liver enzymes
LP = Low Platelets

Management — When to Deliver

Condition	Deliver at
Preeclampsia without severe features	≥37 weeks
Preeclampsia with severe features (stable)	≥34 weeks
Preeclampsia with severe features (unstable), HELLP, Eclampsia	Soon after maternal stabilization

Drugs

Drug	Use
Magnesium sulfate (MgSO₄)	Seizure prophylaxis and treatment of eclampsia
Labetalol / Hydralazine / Nifedipine	Acute severe HTN control
NOT methyldopa acutely	Methyldopa is for maintenance/chronic

MgSO₄ toxicity signs: Loss of DTRs (first sign), respiratory depression, cardiac arrest Antidote: Calcium gluconate 10%

Swanson's Family Medicine Review; Creasy & Resnik's Maternal-Fetal Medicine

TOPIC 3: ANTEPARTUM HEMORRHAGE (APH) 🏆

Definition: Bleeding from genital tract after 28 weeks (viability) and before delivery of baby.

The Big 3 Causes

Cause	Key Feature	Bleeding	Uterus	Pain
Placenta Previa	Low-lying placenta	Painless, bright red	Soft	❌
Placental Abruption	Premature separation	Dark, clotted ± concealed	Tender/woody hard	✅
Vasa Previa	Fetal vessels over os	Fetal blood loss	Soft	❌

Placenta Previa

Diagnosis: Ultrasound (do NOT do vaginal examination — causes massive bleed!)
Management:
- If fetus immature + bleeding not profuse → Expectant management, admit, IV access, blood ready
- If severe or fetus mature → Cesarean section
- Vaginal birth is CONTRAINDICATED
Anesthesia: Neuraxial preferred (if hemodynamically stable)
Complication: Associated with placenta accreta — risk rises from 3% (1st C/S) to 61% with 3 prior cesareans

Placental Abruption

Incidence: ~1% of deliveries, usually last 10 weeks
Risk factors: Tobacco, cocaine, trauma, multiple gestation, hypertension, preeclampsia, PPROM
Signs: Uterine tenderness + hypertonus, dark clotted blood, concealed bleeding possible
Fetal mortality: 9–12% (developed countries); if >50% separation → likely stillbirth
Complication: DIC (check coagulation studies!)
Management: Depends on GA + severity — may need emergency C/S; if fetal death + stable mother → attempt vaginal delivery

Barash, Cullen & Stoelting's Clinical Anesthesia 9e; Creasy & Resnik's

TOPIC 4: POSTPARTUM HEMORRHAGE (PPH) 🏆

Definition

PPH = Blood loss ≥1,000 mL after any delivery (ACOG updated definition), OR any blood loss with signs/symptoms of hypovolemia within 24 hours of birth.

(Old definition: >500 mL vaginal, >1,000 mL cesarean)

The "4 T's" — Causes of PPH

T	Cause	% of PPH
Tone	Uterine atony	>70% (most common!)
Trauma	Lacerations, uterine rupture	20%
Tissue	Retained placenta/products	10%
Thrombin	Coagulopathy	<1%

Risk Factors for Atony (Mnemonic "O-F-M-A-L-C")

Overdistension (multiple gestation, polyhydramnios)
Fatigue (prolonged labor)
Magnesium sulfate
Augmentation with oxytocin
Labor induction
Chorioamnionitis

Management

Bimanual uterine massage + IV oxytocin (do NOT give as IV bolus — causes hypotension!)
Uterotonics: Oxytocin → Ergometrine/Syntometrine → Misoprostol → Carboprost (PGF2α)
Surgical: B-Lynch suture, uterine artery ligation, hysterectomy (last resort)
Jada system (intrauterine vacuum device) — >90% control of atony-related PPH

Active management of 3rd stage = oxytocin before placenta delivery → reduces PPH risk

Clinical Anesthesia 9e; Textbook of Family Medicine 9e; Roberts & Hedges' Emergency Procedures

TOPIC 5: GESTATIONAL DIABETES MELLITUS (GDM)

Screening

When: After 24 weeks (USPSTF recommendation)
How: 50g oral glucose challenge test (GCT) — blood glucose at 1 hour
- Abnormal if ≥140 mg/dL → proceed to diagnostic OGTT

Diagnosis — 100g 3-hour OGTT (Carpenter-Coustan criteria)

Time	Abnormal value
Fasting	≥95 mg/dL
1 hour	≥180 mg/dL
2 hour	≥155 mg/dL
3 hour	≥140 mg/dL

≥2 abnormal values = GDM diagnosis

Management

Diet (30–35 kcal/kg lean body weight) + Exercise (walking)
Targets: Fasting <105 mg/dL, 2-hr postprandial <120 mg/dL
If not achieved → Insulin therapy
USG every 4–6 weeks (fetal size), HbA1c every 4–6 weeks
Antenatal testing in 3rd trimester for insulin-requiring patients

Neonatal Complications (if poorly controlled)

Hypoglycemia
Hypocalcemia
Polycythemia
Hyperbilirubinemia
Macrosomia (→ shoulder dystocia risk)

Long-term Risk

Mother: 30–60% chance of developing Type 2 DM lifetime
Recommend postpartum and yearly glucose tolerance testing

Textbook of Family Medicine 9e

TOPIC 6: PRETERM LABOR (PTL)

Definition: Labor before 37 completed weeks gestation

Between 24–34 weeks = treatment may be initiated to delay delivery

Management Goals

Tocolysis (delay delivery 48 hrs to give steroids): Nifedipine, Indomethacin, Terbutaline, Magnesium sulfate (also neuroprotective at <32 weeks)
Antenatal corticosteroids: Betamethasone or Dexamethasone (12 mg IM × 2 doses, 24 hrs apart) → accelerates fetal lung maturity
GBS prophylaxis if GBS status unknown or positive
Progesterone (17-OHPC) — used for prevention in women with prior preterm birth

TOPIC 7: PREMATURE RUPTURE OF MEMBRANES (PROM)

Type	Definition
PROM	Membrane rupture at term (≥37 wks) before onset of labor
PPROM	Premature PROM — rupture before 37 weeks

Diagnosis

Pooling of fluid in vagina
Nitrazine test — turns blue (alkaline pH)
Ferning on microscopy
USG — oligohydramnios

Management of PPROM

GA	Action
≥34 weeks	Deliver
24–33 weeks	Expectant management + Antibiotics (ampicillin + erythromycin) + Steroids
<24 weeks	Counseling (periviable)

TOPIC 8: NORMAL PUERPERIUM

Puerperium = Period from delivery of placenta until 6 weeks postpartum

Lochia (postpartum vaginal discharge)

Type	Duration	Color
Lochia rubra	Days 1–4	Red (blood)
Lochia serosa	Days 4–10	Pink/brown
Lochia alba	Day 10 → 6 weeks	White/yellow

Important Changes

Uterus involutes at 1 cm/day (at umbilicus immediately after delivery, reaches pelvis by ~10 days)
Menstruation returns: ~6–8 weeks (non-breastfeeding); may be delayed for months in breastfeeding
Postpartum blues vs Postpartum depression (>2 weeks) vs Postpartum psychosis (emergency)

QUICK RECALL TABLES 📋

High-Yield Numbers to Memorize

Fact	Number
Full cervical dilation	10 cm
Latent phase limit (nullipara)	20 hours
Latent phase limit (multipara)	14 hours
Preeclampsia BP cutoff	≥140/90 mmHg
Severe preeclampsia BP cutoff	≥160/110 mmHg
Proteinuria in preeclampsia	≥300 mg/24 hrs
Platelets in severe PE	≤100,000/μL
PPH blood loss cutoff (ACOG)	≥1,000 mL
GDM screening timing	After 24 weeks
GDM GCT abnormal	≥140 mg/dL at 1 hr
Abruption: stillbirth risk	>50% separation
Placenta accreta risk (3 C/S)	61%
APH definition	≥28 weeks
Preeclampsia delivery (no severe)	≥37 weeks
Preeclampsia delivery (severe, stable)	≥34 weeks

MASTER MNEMONIC SHEET 🧠

Topic	Mnemonic
Severe preeclampsia features	"HELP + VH" (HELLP, Epigastric pain, Low plts, Pulm edema, Visual, Headache)
Causes of PPH	"4 T's" — Tone, Trauma, Tissue, Thrombin
Cardinal movements	"Every Fetal Infant Demands Immediate Expert Rearing"
GDM neonatal complications	"4 H's" — Hypoglycemia, Hypocalcemia, Hyperbilirubinemia, High hematocrit (polycythemia)
Abruption risk factors	"THCMP" — Tobacco, Hypertension, Cocaine, Multiparity, Preeclampsia

EXAM STRATEGY FOR OBSTETRICS

Theory Paper: Focus on preeclampsia criteria, APH comparison table, PPH management algorithm

Short notes commonly asked:

HELLP syndrome
Active management of 3rd stage
Placenta previa vs abruption
Bishop score
GDM screening
MgSO₄ toxicity and antidote

Viva hot topics:

Differentiate true vs false labor
When do you deliver in preeclampsia?
What is Bishop score and when do you use it?
What is the first drug for PPH?
What are the 4 T's?

Sources: Creasy & Resnik's Maternal-Fetal Medicine; Textbook of Family Medicine 9e; Swanson's Family Medicine Review; Barash Clinical Anesthesia 9e; Morgan & Mikhail's Clinical Anesthesiology

What to Study Next (in order)

✅ Normal labor (done above)
✅ Preeclampsia/Eclampsia (done above)
✅ APH — Previa vs Abruption (done above)
✅ PPH and 4 T's (done above)
✅ GDM (done above)
📌 Malpresentations (breech, shoulder, brow, face)
📌 Cord prolapse (emergency management)
📌 Instrumental delivery (forceps vs ventouse)
📌 Antenatal care (ANC schedule, investigations)
📌 Contraception (MBBS exams increasingly ask this)

Ask me about any specific topic on this list and I'll give you a deep dive with clinical scenarios, MCQs, and practice questions!

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