Reproductive health kmtc notes detailed exam oriented

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These notes cover the 10 core units of KMTC Reproductive Health. Here's what's included:

Unit	Topic
1	Introduction & Definition
2	Family Planning & Contraception (FAB methods, OCPs, IUDs, medical abortion)
3	Antenatal Care (Naegele's rule, visit schedule, GBS, GDM screening)
4	STIs (table, screening, neonatal risks)
5	Hypertensive disorders (Preeclampsia, Eclampsia, HELLP, MgSO₄)
6	Postpartum Haemorrhage (4 T's, uterotonic drugs)
7	Teratogens & drugs in pregnancy
8	Adolescent reproductive health
9	Infertility
10	Cervical cancer & HPV

Exam hot spots: The 4 T's of PPH, HELLP criteria, GBS screening timing (35–37 weeks), GDM screening (26–28 weeks), Naegele's rule, and contraceptive failure rates are the most frequently tested areas. Let me know if you want any unit expanded further!

Obstetrics and gynae notes detailed exam oriented

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🏥 OBSTETRICS & GYNAECOLOGY — KMTC EXAM-ORIENTED NOTES

UNIT 1: NORMAL LABOUR & DELIVERY

1.1 Definition of Labour

Regular uterine contractions producing progressive cervical change (effacement + dilation).

True vs False Labour:

Feature	True Labour	False Labour (Braxton Hicks)
Contractions	Regular, increasing in frequency & intensity	Irregular, no progression
Cervical change	Present	Absent
Effect of walking	Intensifies contractions	No effect or diminishes
Pain location	Back → abdomen	Abdomen only

1.2 Stages of Labour (HIGH YIELD — always in exams)

Stage	Onset	End
First stage — Latent + Active	Onset of true labour	Full cervical dilation (10 cm)
Second stage	Full dilation	Delivery of baby
Third stage	Delivery of baby	Delivery of placenta
Fourth stage	Delivery of placenta	Contracted uterus (first 1–2 hours)

First Stage — Latent Phase

Variable length
Nullipara: <20 hours; Multipara: <14 hours
Little cervical dilation; mainly cervical preparation (softening, effacement, anterior positioning)
Conduction anaesthesia in this phase may prolong or arrest progress
Prolonged latent phase → treat with morphine in hospital setting

First Stage — Active Phase

Begins at approximately 4–5 cm cervical dilation
Rapid dilation
Normal dilation rate:
- Nullipara: ≥1.2 cm/hr
- Multipara: ≥1.5 cm/hr
Progress depends on: uterine contraction strength/frequency, fetal head size/position/attitude, and pelvic shape

1.3 Cardinal Movements of Labour (7 — memorise in order)

Engagement — fetal head enters pelvic inlet
Descent — downward movement
Flexion — chin to chest; reduces AP diameter
Internal rotation — occiput rotates anteriorly
Extension — head extends under symphysis pubis
External rotation (restitution) — head aligns with shoulders
Expulsion — delivery of body

Mnemonic: "Every Decent Family Is Exceedingly Extraordinary"

1.4 Fetal Heart Rate (FHR) Monitoring

Normal baseline FHR: 110–160 beats/min

Reactive NST (Non-Stress Test): ≥2 accelerations of ≥15 bpm above baseline lasting ≥15 seconds in 20 minutes

Types of Decelerations:

Type	Cause	Shape	Relation to Contraction	Significance
Early	Fetal head compression → vagal	Smooth mirror image	Begins with contraction, nadir at peak	Benign/Reassuring
Variable	Umbilical cord compression	"V", "U", or "W" shape	Variable relationship	Most common (50–80% of deliveries); concerning if severe
Late	Uteroplacental insufficiency	Gradual; begins AFTER contraction peak	Begins late, returns after contraction ends	Ominous — Category III
Sinusoidal	Fetal anaemia / severe hypoxia	Smooth sine-wave, 2–5 cycles/min	—	Ominous — Category III

FHR Tachycardia (>160 bpm) causes:

Chorioamnionitis, maternal fever
Sympathomimetic drugs (terbutaline)
Atropine, fetal tachyarrhythmia
Fetal hypoxia, prematurity

FHR Bradycardia causes:

Cord prolapse/compression
Tetanic contractions
Paracervical/epidural block
Maternal seizure

Late deceleration management:

Turn patient on side (lateral position) → ↑ cardiac output & uterine blood flow
IV fluids to correct hypotension
Stop oxytocin infusion
Administer oxygen

Tachysystole: >5 contractions in 10 minutes (averaged over 30 minutes)

1.5 NICHHD FHR Classification

Category	Interpretation	Action
I (Normal)	Normal pH, fetal well-being	Continue current management
II (Indeterminate)	Uncertain	Further evaluation
III (Abnormal)	Fetal hypoxia/acidosis	Immediate intervention; expedited delivery

UNIT 2: COMPLICATIONS OF PREGNANCY — ANTEPARTUM HAEMORRHAGE

2.1 Causes of Antepartum Haemorrhage (APH)

Complicates 3–5% of pregnancies; leading cause of maternal and perinatal mortality

Main causes:

Placenta praevia (painless)
Abruptio placentae (painful)
Vasa praevia
Cervical/vaginal lesions

2.2 Placenta Praevia

Definition: Placenta implanted in the lower uterine segment, covering or near the internal cervical os

Classification (3 types):

Type	Description
Complete/Total	Placenta completely covers the cervical os
Partial	Placenta partially covers the os
Marginal	Placenta extends to the edge of the os

Incidence: 1 in 200–250 pregnancies

Classic presentation:

Painless, bright-red vaginal bleeding in the 3rd trimester
Average first bleed: 27–32 weeks
Abnormal lie (transverse/breech) — suspicious
Initial bleed is usually not fatal and stops spontaneously, then recurs

Risk factors:

Advanced maternal age
Increased parity (multiparity)
Previous uterine surgery (C-section scar)
Prior placenta praevia
Multiple gestation
Uterine abnormalities
Smoking

Diagnosis: Transabdominal ultrasound (93–98% accurate); use transvaginal US if position unclear — do NOT do vaginal examination (risk of massive haemorrhage)

Management:

If actively bleeding → IV access, crossmatch blood, IV fluids, oxygen
If fetus viable but compromised → urgent caesarean section
Rh-negative mothers → D immune globulin (RhoGAM)

2.3 Abruptio Placentae (Placental Abruption)

Definition: Premature separation of a normally situated placenta before delivery of the fetus

Incidence: 1 in 129 births (~1–2% of pregnancies)

Classic presentation:

Painful vaginal bleeding — hallmark
Uterine tenderness (board-like/woody uterus)
Frequent contractions
Fetal distress
Blood is characteristically dark red

Note: Vaginal bleeding occurs in 70% of cases; in 30%, bleeding is concealed (retroplacental)

Grades:

Grade	Features
Grade I (Mild)	<150 mL blood loss; mother/fetus stable
Grade II (Moderate)	Fetal distress; maternal compromise
Grade III (Severe)	Fetal death; DIC possible; 25% of cases

Complications:

DIC (disseminated intravascular coagulation)
Hypovolaemic shock
Renal failure
Couvelaire uterus (blood penetrates uterine wall)

Key investigations:

CBC, coagulation studies (PT/PTT, fibrinogen, D-dimer)
Kleihauer-Betke test (feto-maternal haemorrhage)
Blood type and crossmatch

Management:

Aggressive IV fluids/resuscitation
Packed RBCs on standby
Continuous fetal monitoring
Rh-negative mothers → D immune globulin
Urgent C-section if fetus viable but compromised

2.4 Placenta Praevia vs Abruptio — EXAM COMPARISON TABLE

Feature	Placenta Praevia	Abruptio Placentae
Pain	Painless	Painful
Blood colour	Bright red	Dark red
Uterine tone	Soft	Rigid/tender ("woody")
Onset	3rd trimester; 27–32 wks	Any time
Shock	Proportional to visible blood	Out of proportion to visible blood
Fetal lie	Often abnormal	Usually normal
Diagnosis	Ultrasound	Clinical (US may be false-negative)
Vaginal examination	CONTRAINDICATED	Can be done

UNIT 3: HYPERTENSIVE DISORDERS OF PREGNANCY

3.1 Classification

Condition	BP	Proteinuria	Onset
Gestational hypertension	≥140/90 mmHg	Absent	>20 weeks
Preeclampsia	≥140/90 mmHg	Present (≥300 mg/24h)	>20 weeks
Severe preeclampsia	≥160/110 mmHg	Present + end-organ damage	>20 weeks
Eclampsia	Any	Present	Seizures in preeclamptic
Chronic hypertension	≥140/90 mmHg	Variable	<20 weeks or pre-pregnancy

3.2 Preeclampsia

Signs/symptoms of severe preeclampsia:

Severe headache
Visual disturbances (photopsia, scotoma)
Epigastric/RUQ pain (liver capsule stretch)
Pulmonary oedema
Oliguria

HELLP Syndrome:

H — Haemolysis (microangiopathic)
EL — Elevated Liver enzymes (↑AST, ↑ALT, ↑LDH)
LP — Low Platelets (<100,000/µL)

Suspect HELLP in a pregnant/postpartum woman with abdominal pain

Labs in HELLP: Peripheral blood smear → microangiopathic haemolytic anaemia; ↑transaminases; ↓platelets

3.3 Eclampsia

Definition: Seizures in a woman with pre-eclampsia; can occur up to 12 weeks postpartum

Incidence: 0.2% of pregnancies; terminates 1 in 1000 pregnancies

Major cause of maternal death: Intracranial haemorrhage

Perinatal mortality: 2–8.6%

3.4 Management of Severe Preeclampsia/Eclampsia

Magnesium Sulphate Protocol (MgSO₄ · 7H₂O):

Loading dose: 4 g (range 2–6 g) in 500 mL 5% dextrose over 15 minutes IV
Maintenance: 1–3 g/hr continuous infusion
Continue for 24 hours after delivery or last seizure
Keep calcium gluconate at bedside as antidote

Monitoring on MgSO₄:

Deep tendon reflexes (first sign of toxicity = loss of DTRs)
Respiratory rate (>12/min)
Urine output (>25 mL/hr)
Plasma Mg levels

Antihypertensives for acute severe HTN:

Labetalol IV (first-line)
Hydralazine IV
Nifedipine oral

Definitive treatment: DELIVERY of the baby

Gestational hypertension resolves within 10 days postpartum

UNIT 4: PRETERM LABOUR

Definition: Labour occurring between 20–37 weeks of gestation

Risk factors:

Prior preterm labour (most important risk factor)
Low socioeconomic status
Multiple gestation
Uterine anomalies
Bacterial vaginosis / UTI
Placenta praevia/abruption
Polyhydramnios
Low maternal weight (<50 kg)
Smoking, cocaine use
Poor prenatal care

Management of preterm labour:

Tocolytics (delay delivery 48 hrs to allow corticosteroids to work):
- Nifedipine (calcium channel blocker — preferred)
- Terbutaline (β₂-agonist)
- Indomethacin (PG inhibitor; <32 weeks)
- MgSO₄ (also neuroprotective)
Corticosteroids (fetal lung maturity):
- Betamethasone 12 mg IM × 2 doses, 24 hours apart OR
- Dexamethasone 6 mg IM × 4 doses, 12 hours apart
- Give between 24–34 weeks
Antibiotics if GBS positive or PROM

UNIT 5: PREMATURE RUPTURE OF MEMBRANES (PROM)

Definition: Rupture of membranes before onset of labour

Types:

Type	Definition
PROM	At term (≥37 weeks)
PPROM	Preterm (<37 weeks)

Diagnosis:

Pooling of fluid in vagina
Ferning (amniotic fluid crystallises in fern pattern on glass slide)
Nitrazine test — amniotic fluid turns paper blue (alkaline)
Ultrasound — oligohydramnios

Complications: Cord prolapse, infection (chorioamnionitis), preterm labour, fetal distress

Management:

≥37 weeks: Induce labour (oxytocin)
<37 weeks: Expectant management, antibiotics (ampicillin/erythromycin), corticosteroids if <34 weeks

UNIT 6: ECTOPIC PREGNANCY

Definition: Implantation of the fertilised ovum outside the uterine cavity

Sites (order of frequency):

Ampulla of fallopian tube (most common — ~70%)
Isthmus
Fimbria
Ovary
Cervix
Abdominal (rarest)

Risk factors:

Previous ectopic pregnancy (greatest risk)
Previous tubal surgery
PID/salpingitis
IUD use
Infertility treatment (IVF)
Smoking
Prior pelvic surgery

Clinical features:

Amenorrhoea (missed period)
Unilateral pelvic/lower abdominal pain
Vaginal bleeding (brown, irregular)
Ruptured ectopic: Sudden severe pain + haemoperitoneum → shoulder tip pain (diaphragmatic irritation) → shock

Investigations:

Serum β-hCG (positive even at low levels; single low level does NOT exclude ectopic)
Transvaginal ultrasound — empty uterus + adnexal mass; free fluid in Pouch of Douglas
Serial β-hCG: In normal IUP, hCG doubles every 48–72 hours; slower rise or plateau → suspect ectopic
Falling hCG — most common indicator for spontaneous resolution of ectopic

Management:

Option	Criteria	Details
Expectant	Falling hCG, small ectopic, stable patient	Close monitoring
Medical — Methotrexate	Unruptured, hCG <5000 IU/L, no cardiac activity, stable	Folate antagonist; inhibits trophoblast cells; 70–95% success
Surgical — Laparoscopy	Ruptured/unstable OR medical failed	Salpingostomy (preserve tube for future fertility); Salpingectomy (not wanting future fertility)

Methotrexate contraindications: Hepatic/renal disease, active infection, breastfeeding, immunodeficiency

UNIT 7: ABORTION (MISCARRIAGE)

Definition: Expulsion of products of conception before 28 weeks (or fetal weight <1000 g)

Incidence: ~15% of clinically recognised pregnancies; sporadic chromosomal aneuploidy accounts for ~60% of losses

Types of Abortion (HIGH YIELD)

Type	Cervical Os	Bleeding	Products Passed	Pregnancy Viable?	Management
Threatened	Closed	Mild	None	Yes (Doppler confirms)	Reassure, bed rest, avoid coitus
Inevitable	Open	Profuse	None yet	No	D&C
Incomplete	Open	Heavy	Partial	No	D&C
Complete	Closed	Minimal	All passed	No	Confirm with USS; observe
Missed (Silent)	Closed	Absent or brown	None (retained >4 wks)	No	D&C or misoprostol
Septic	Open	Foul discharge	Present	No	IV antibiotics + D&C
Recurrent	—	—	—	—	≥3 losses; investigate cause

Rh-negative management:

<13 weeks: 50 µg anti-D (Rh immunoglobulin) IM
13 weeks: 300 µg anti-D IM

Causes of Recurrent Miscarriage (≥3 losses):

Chromosomal (parental/fetal aneuploidy) — most common
Antiphospholipid syndrome
Uterine anomalies (septum, fibroids)
Cervical incompetence
Luteal phase defect
Thyroid disease

UNIT 8: MOLAR PREGNANCY (GESTATIONAL TROPHOBLASTIC DISEASE)

Definition: Abnormal fertilisation resulting in proliferating trophoblastic tissue

Types:

Feature	Complete Mole	Incomplete Mole
Fetal parts	Absent	Present (usually abnormal)
Karyotype	46XX (diploid — all paternal)	Triploid (69XXY)
Villous changes	All villi hydropic	Some villi hydropic
Risk of malignancy (GTD)	15–20%	5–10%
Uterine size	Large for dates	Small or normal
hCG	Very high	Mildly elevated

Ultrasound (complete mole): "Snowstorm" appearance — distended cavity with numerous anechoic cysts

Presentation:

Vaginal bleeding
Uterus large for dates
Hyperemesis
Early preeclampsia (<20 weeks — pathognomonic!)
Very high hCG → bilateral theca lutein cysts → bilateral ovarian enlargement

Management:

Suction curettage (D&C)
Serial β-hCG monitoring until 3 consecutive normal levels
Contraception for 1 year (to allow hCG normalisation and detect malignant transformation)
Chest X-ray (metastases)

Indications for chemotherapy: Rising or plateauing hCG after evacuation → gestational trophoblastic neoplasia (GTN) → Methotrexate ± Actinomycin D

UNIT 9: PREECLAMPSIA IN LABOUR — MgSO₄ PROTOCOL (STRUCTURED)

Step	Action
Position	Lateral recumbent
Diet	Nothing by mouth (NBM); clear liquids if muscle tone adequate
IV access	Lactated Ringer's 5% dextrose
Loading dose	MgSO₄ 4g IV over 15 min
Maintenance	MgSO₄ 1–3 g/hr IV infusion
Antidote at bedside	Calcium gluconate
Monitor	DTRs, urine output (I&O), lung bases (pulmonary oedema), plasma Mg levels
Duration	Continue 24 hours post-delivery

UNIT 10: GYNAECOLOGY — KEY TOPICS

10.1 Pelvic Inflammatory Disease (PID)

Definition: Ascending infection from the cervix/vagina → uterus, fallopian tubes, ovaries

Causative organisms:

Chlamydia trachomatis (most common in developed countries)
Neisseria gonorrhoeae
Anaerobes, Gram-negative rods

Clinical features (Chandelier sign):

Lower abdominal pain (bilateral)
Cervical motion tenderness (CMT) — "chandelier sign"
Adnexal tenderness
Fever
Vaginal discharge (mucopurulent)
↑WBC, ↑ESR, ↑CRP

Complications:

Tubo-ovarian abscess (TOA)
Infertility (blocked tubes)
Ectopic pregnancy risk ↑
Fitz-Hugh-Curtis syndrome (perihepatitis — RUQ pain + perihepatic adhesions)
Chronic pelvic pain

Treatment:

Outpatient: Ceftriaxone IM + Doxycycline + Metronidazole
Inpatient: IV Cefoxitin + Doxycycline OR Clindamycin + Gentamicin

10.2 Ovarian Cysts & Torsion

Common types:

Cyst	Features
Follicular cyst	Most common; resolves spontaneously in 4–8 weeks
Corpus luteum cyst	Can rupture → haemoperitoneum
PCOS (polycystic ovaries)	Multiple small follicles; anovulation, hyperandrogenism
Dermoid (teratoma)	Most common benign tumour in women <30; contains hair/teeth/fat
Endometrioma ("chocolate cyst")	Endometriosis; filled with old blood

Ovarian torsion:

Sudden severe unilateral pelvic pain
Nausea and vomiting
Tender adnexal mass on exam
Doppler USS: absent/reduced blood flow
Management: Surgical untwisting (detorsion) → salpingo-oophorectomy if necrotic

10.3 Uterine Fibroids (Leiomyomata)

Most common benign tumour of the uterus; oestrogen-dependent; regress after menopause

Types by location:

Intramural (most common)
Subserosal
Submucosal (most likely to cause heavy bleeding and infertility)
Pedunculated

Symptoms: Heavy menstrual bleeding (menorrhagia), pressure symptoms, infertility, recurrent miscarriage

Management:

Medical: GnRH analogues (shrink fibroid pre-surgery), tranexamic acid (bleeding), NSAIDs
Surgical: Myomectomy (fertility-sparing), hysterectomy (definitive)

10.4 Endometriosis

Definition: Presence of endometrial tissue outside the uterus

Sites: Ovaries (most common), peritoneum, Pouch of Douglas, bladder, bowel

Symptoms (3 Ds):

Dysmenorrhoea (painful periods — cyclical)
Dyspareunia (painful intercourse)
Dyschezia (painful defaecation)

Gold standard diagnosis: Laparoscopy + biopsy

Treatment: NSAIDs, OCPs (cycle suppression), GnRH analogues, laparoscopic ablation, hysterectomy

10.5 Cervical Cancer

Cause: HPV types 16 and 18 (responsible for ~70% of cases)

Risk factors:

Early sexual debut
Multiple sexual partners
Multiparity
Immunosuppression
Smoking
STIs

Screening: Pap smear (cervical cytology)

Start: Age 21 or 3 years after sexual debut
Frequency: Every 3 years if normal (cytology alone)

HPV vaccine: Ideally age 9–14 (before sexual debut); can be given up to age 26 routinely

Staging (FIGO):

Stage	Description
I	Confined to cervix
II	Extends beyond cervix but not pelvic wall
III	Extends to pelvic wall / lower third of vagina
IV	Bladder/rectum or distant metastases

Treatment: Stage I → surgery (Wertheim's hysterectomy); Stage II–IV → chemoradiotherapy

10.6 Menstrual Disorders

Term	Definition
Amenorrhoea	Absence of periods
Primary amenorrhoea	No period by age 16 (with secondary sex characteristics) or age 14 (without)
Secondary amenorrhoea	No period for ≥6 months in previously menstruating woman
Menorrhagia	Heavy periods (>80 mL/cycle)
Metrorrhagia	Irregular intermenstrual bleeding
Menometrorrhagia	Heavy + irregular bleeding
Dysmenorrhoea	Painful periods
Oligomenorrhoea	Cycles >35 days
Polymenorrhoea	Cycles <21 days

UNIT 11: POSTPARTUM HAEMORRHAGE (PPH)

Definition: Blood loss:

Vaginal delivery: >500 mL
C-section: >1000 mL

Primary PPH: Within 24 hours of delivery Secondary PPH: 24 hours–6 weeks postpartum

The 4 T's of PPH (EXAM GOLD)

T	Cause	Frequency
Tone	Uterine atony	~80% (most common)
Tissue	Retained placenta/products	~10%
Trauma	Genital tract lacerations	~7%
Thrombin	Coagulopathy (DIC, von Willebrand)	~3%

Risk factors for uterine atony:

Overdistended uterus (macrosomia, multiple gestation, polyhydramnios)
Prolonged labour
Grand multiparity
General anaesthesia
Oxytocin use

Management of PPH (stepwise)

Uterine massage (bimanual compression)
Uterotonic drugs:
- Oxytocin (1st line): 10 IU IM or IV infusion
- Ergometrine/Methylergonovine (Syntometrine): 0.2 mg IM (CI in hypertension)
- Misoprostol: 600–1000 µg rectal/sublingual (useful in low-resource settings)
- Carboprost (PGF2α): 0.25 mg IM q15 min (CI in asthma)
Balloon tamponade (Bakri balloon)
Surgical:
- B-Lynch compression suture
- Uterine artery ligation
- Internal iliac artery ligation
- Hysterectomy (last resort)
Blood products: Fresh frozen plasma (FFP), packed RBCs, cryoprecipitate for DIC

UNIT 12: PUERPERAL SEPSIS

Definition: Fever ≥38°C on ≥2 occasions, >24 hours apart, within the first 10 days postpartum (excluding first 24 hours)

Sources of infection:

Uterus (endometritis — most common)
Urinary tract
Breast (mastitis)
Wound (episiotomy, C-section)

Causative organisms: Group A Streptococcus, Staphylococcus aureus, E. coli, anaerobes

Features of endometritis:

Fever
Uterine tenderness
Foul-smelling lochia
Subinvolution of uterus

Treatment: IV Clindamycin + Gentamicin

QUICK REVISION SUMMARY TABLES

Antihypertensive Drugs in Pregnancy — Safety

Drug	Safe?	Notes
Methyldopa	✅ Safe (1st line)	—
Labetalol	✅ Safe	Also used IV for acute HTN
Nifedipine	✅ Safe	Oral; 2nd line
Hydralazine	✅ Safe	IV for acute HTN
ACE inhibitors (enalapril etc.)	❌ Contraindicated	Renal dysgenesis (2nd/3rd trimester)
ARBs	❌ Contraindicated	Same as ACE inhibitors

Types of Caesarean Section

Type	Indication
Elective	Planned; no emergency
Emergency Category 1	Immediate threat to mother/fetus; <30 min
Emergency Category 2	Maternal/fetal compromise; not immediate
Emergency Category 3	Needs early delivery; no compromise

HIGH-FREQUENCY EXAM QUESTIONS

Q: Painless APH in the 3rd trimester — diagnosis? A: Placenta praevia. Do NOT do vaginal examination. First-line investigation: ultrasound

Q: Painful APH with rigid uterus — diagnosis? A: Abruptio placentae. Clinical diagnosis; ultrasound has high false-negative rate

Q: Seizures in a patient with BP 170/110 at 34 weeks — diagnosis & management? A: Eclampsia. Give MgSO₄ (loading dose 4g IV over 15 min), stabilise, deliver baby. Antidote = calcium gluconate

Q: Empty uterus on TVS + positive hCG + unilateral pain in a woman with history of PID — diagnosis? A: Ectopic pregnancy. Manage with methotrexate if unruptured and stable; laparoscopy if ruptured

Q: Type of abortion where cervical os is closed, no products passed, but the fetus is dead on ultrasound? A: Missed abortion

Q: What is the most important risk factor for preterm labour? A: Previous preterm labour

Q: What is the 7th cardinal movement of labour? A: Expulsion

Q: At what cervical dilation does the active phase of labour begin? A: 4–5 cm

Q: What type of FHR deceleration is associated with umbilical cord compression? A: Variable deceleration

Q: What is the most common benign ovarian tumour in women under 30? A: Dermoid cyst (mature cystic teratoma)

Q: What is the gold standard for diagnosing endometriosis? A: Laparoscopy + biopsy

Sources: Textbook of Family Medicine 9e; Goldman-Cecil Medicine; Morgan & Mikhail's Clinical Anesthesiology 7e; Creasy & Resnik's Maternal-Fetal Medicine; Swanson's Family Medicine Review; Berek & Novak's Gynecology; Tintinalli's Emergency Medicine; Rosen's Emergency Medicine

These notes cover 12 units of core O&G content. Summary of topics:

#	Topic
1	Normal Labour — stages, cardinal movements, FHR monitoring
2	Antepartum Haemorrhage — placenta praevia vs abruption
3	Hypertensive disorders — preeclampsia, eclampsia, HELLP
4	Preterm labour — tocolytics, steroids
5	PROM
6	Ectopic pregnancy
7	Abortion types (6 types with complete comparison table)
8	Molar pregnancy/GTD
9	MgSO₄ protocol structured table
10	Gynaecology — PID, fibroids, endometriosis, cervical cancer, menstrual disorders
11	PPH — 4 T's + stepwise management
12	Puerperal sepsis

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