Obstetrics and Gynaecology Revision Guide ✅

🤰 Obstetrics and gynaecology combines physiology, emergencies, communication and safeguarding. Start by deciding whether the problem is pregnancy-related, menstrual/bleeding-related, pelvic pain-related, infection-related, fertility/endocrine-related, or cancer-related. For exams and clinical practice, always ask: could she be pregnant?, is she haemodynamically stable?, is there sepsis?, is there safeguarding/sexual health risk?, and does this need same-day obstetric/gynaecology escalation?

✅ 1. Core Anatomy and Physiology

🌸 1.1 Female Reproductive Anatomy

• Ovaries: produce oocytes, oestrogen, progesterone and androgens.
• Fallopian tubes: site of fertilisation; tubal damage increases ectopic pregnancy risk.
• Uterus: myometrium contracts in labour; endometrium responds to hormones and sheds during menstruation.
• Cervix: transformation zone is the key site for HPV-related cervical dysplasia.
• Vagina/vulva: symptoms may reflect infection, dermatology, atrophy, trauma, pain syndromes or malignancy.
• Pelvic floor: supports bladder, uterus and rectum; injury/weakness contributes to prolapse and incontinence.

🔁 1.2 Menstrual Cycle

• Follicular phase: FSH stimulates follicle growth; oestrogen rises and thickens the endometrium.
• Ovulation: LH surge triggers release of the oocyte.
• Luteal phase: corpus luteum produces progesterone to stabilise secretory endometrium.
• If pregnancy does not occur, progesterone falls and menstruation occurs.
• Anovulatory cycles can cause irregular, heavy or prolonged bleeding because progesterone opposition is inadequate.

🧠 Exam pearl: In any reproductive-age patient with abdominal pain, collapse, bleeding or syncope, do a pregnancy test early. Ectopic pregnancy is a time-critical diagnosis.

🧪 2. Core Investigations

• Pregnancy test: essential in reproductive-age abdominal pain, bleeding, amenorrhoea, collapse or before teratogenic drugs/procedures.
• FBC: anaemia, infection, platelets in pre-eclampsia/HELLP, bleeding severity.
• Group and save/crossmatch: if bleeding, ectopic risk, miscarriage management or obstetric emergency.
• CRP/swabs: infection, PID, sepsis, postpartum infection.
• Urinalysis: UTI, proteinuria in pre-eclampsia, ketones in hyperemesis.
• β-hCG: early pregnancy assessment, pregnancy of unknown location, suspected trophoblastic disease.
• Pelvic ultrasound: pregnancy location, fetal viability, ovarian cyst/torsion, fibroids, endometrial thickness.
• Speculum/bimanual examination: bleeding source, cervix, discharge, cervical excitation, masses; only when appropriate and consented.

⚠️ Communication pearl: Pelvic and pregnancy-related examinations require clear explanation, consent, privacy and chaperone offer. Trauma-informed care matters, especially after miscarriage, sexual assault, pain or previous difficult experiences.

🤰 3. Antenatal Care and Normal Pregnancy

Routine antenatal care aims to monitor maternal and fetal wellbeing, identify risk early, provide screening and support informed decision-making. NICE NG201 covers routine antenatal care and has been reviewed recently.

📅 3.1 Booking and Routine Care

• Booking appointment ideally occurs early in pregnancy, with risk assessment, screening discussion and baseline observations.
• Check blood group, rhesus status, antibodies, FBC and infection screening according to pathway.
• Offer screening for trisomies, fetal anomaly scan and growth surveillance where indicated.
• Assess risk factors for pre-eclampsia, gestational diabetes, VTE, mental health problems and safeguarding concerns.
• Discuss folic acid, vitamin D, smoking, alcohol, drugs, diet, exercise, vaccinations and fetal movement awareness.
• Measure blood pressure and check urine protein at antenatal visits.

🧬 3.2 Physiological Changes in Pregnancy

• Plasma volume rises more than red cell mass, causing physiological dilutional anaemia.
• Cardiac output increases and systemic vascular resistance falls.
• GFR rises, so creatinine should be lower than non-pregnant levels; “normal” creatinine may be abnormal in pregnancy.
• Pregnancy is hypercoagulable, increasing VTE risk.
• Progesterone relaxes smooth muscle, causing reflux, constipation and urinary stasis.
• Diaphragm elevates and minute ventilation increases; mild breathlessness can be physiological but hypoxia is not.

🩸 4. Early Pregnancy Problems

🚨 4.1 Ectopic Pregnancy

• Ectopic pregnancy is implantation outside the uterine cavity, most commonly in the fallopian tube.
• Risk factors: previous ectopic, tubal surgery, PID, infertility treatment, smoking, intrauterine contraception failure.
• Symptoms: abdominal/pelvic pain, vaginal bleeding, shoulder tip pain, dizziness/syncope, diarrhoea or urinary symptoms.
• Signs: abdominal tenderness, cervical excitation, adnexal tenderness/mass, shock if ruptured.
• Diagnosis: pregnancy test, transvaginal ultrasound, serial β-hCG and clinical assessment.
• Management: expectant, medical methotrexate or surgery depending on stability, symptoms, scan findings and β-hCG.
• Ruptured ectopic is a surgical emergency: resuscitate, senior gynae/anaesthetic input and urgent theatre.

💔 4.2 Miscarriage

• Miscarriage is pregnancy loss before viability; early miscarriage is common and emotionally significant.
• Threatened miscarriage: bleeding with closed cervix and viable intrauterine pregnancy.
• Inevitable/incomplete miscarriage: bleeding/pain with open cervix or retained products.
• Missed miscarriage: non-viable pregnancy retained in uterus, often minimal symptoms.
• Management options may include expectant, medical or surgical management depending on clinical situation and patient preference.
• Provide clear safety-netting for heavy bleeding, severe pain, fever, offensive discharge or collapse.

🧬 4.3 Molar Pregnancy

• Gestational trophoblastic disease due to abnormal trophoblastic proliferation.
• Features: bleeding, severe nausea/vomiting, uterus large for dates, very high β-hCG, early pre-eclampsia, hyperthyroid symptoms.
• Ultrasound may show cystic “snowstorm” appearance.
• Management: specialist evacuation and follow-up β-hCG surveillance.

🚨 Exam pearl: Shoulder tip pain, syncope or shock in early pregnancy suggests intra-abdominal bleeding from ruptured ectopic until proven otherwise.

🩺 5. Medical Disorders in Pregnancy

⚡ 5.1 Hypertension and Pre-eclampsia

• Gestational hypertension: new hypertension after 20 weeks without significant proteinuria or end-organ features.
• Pre-eclampsia: hypertension after 20 weeks with proteinuria and/or maternal organ dysfunction and/or uteroplacental dysfunction.
• Symptoms: headache, visual disturbance, epigastric/RUQ pain, vomiting, sudden swelling, reduced fetal movements.
• Complications: eclampsia, stroke, HELLP syndrome, placental abruption, fetal growth restriction, maternal organ failure.
• Investigations: BP, urine protein/ACR, FBC, platelets, LFTs, U&E/creatinine, fetal assessment.
• Definitive treatment is delivery of placenta, balanced against gestation and maternal/fetal condition.
• Magnesium sulfate is used for eclampsia treatment and seizure prophylaxis in severe cases.

🧪 5.2 HELLP Syndrome

• HELLP = Haemolysis, Elevated Liver enzymes, Low Platelets.
• May occur with or without severe hypertension/proteinuria.
• Features: RUQ/epigastric pain, nausea/vomiting, malaise, headache, bleeding tendency.
• Requires urgent obstetric, anaesthetic and haematology involvement.

🍬 5.3 Gestational Diabetes

• Glucose intolerance first recognised in pregnancy, driven by placental hormones causing insulin resistance.
• Risk factors: raised BMI, previous macrosomic baby, previous gestational diabetes, family history, high-risk ethnicity.
• Complications: macrosomia, shoulder dystocia, neonatal hypoglycaemia, pre-eclampsia, caesarean birth, future type 2 diabetes.
• Management: dietary advice, glucose monitoring, metformin and/or insulin if targets not met, fetal growth surveillance.
• Postnatal diabetes screening is important because future type 2 diabetes risk is increased.

🩸 5.4 Venous Thromboembolism in Pregnancy

• Pregnancy and postpartum period are hypercoagulable states.
• Risk factors: previous VTE, thrombophilia, obesity, immobility, hyperemesis, infection, caesarean birth, age, smoking.
• Symptoms of PE: sudden dyspnoea, pleuritic chest pain, haemoptysis, syncope, tachycardia or hypoxia.
• LMWH is commonly used for treatment and prophylaxis; warfarin and DOACs are generally avoided in pregnancy.
• Do not dismiss dyspnoea as “just pregnancy” if there are hypoxia, chest pain, tachycardia or risk factors.

🧃 6. Obstetric Complications

🤢 6.1 Hyperemesis Gravidarum

• Severe nausea/vomiting with dehydration, ketonuria, electrolyte disturbance and weight loss.
• Assess hydration, ketones, U&E, weight loss and alternative diagnoses.
• Treatment: antiemetics, fluids, thiamine before dextrose if prolonged vomiting/malnutrition risk, VTE assessment.
• Red flags: abdominal pain, fever, neurological symptoms, severe electrolyte disturbance.

🟡 6.2 Intrahepatic Cholestasis of Pregnancy

• Pregnancy-specific cholestatic disorder, usually presenting with itch, often palms and soles, without primary rash.
• Bloods: raised bile acids ± abnormal LFTs.
• Associated with fetal risks including preterm birth and stillbirth risk related to bile acid level.
• Management: obstetric review, bile acid monitoring, symptom control and planned birth timing depending on severity.

👶 6.3 Reduced Fetal Movements

• Reduced fetal movements after viability require same-day maternity assessment.
• Do not advise home Doppler use for reassurance.
• Assessment may include fetal heart monitoring, ultrasound for growth/liquor and review of maternal risk factors.
• Maternal perception of reduced movement is clinically important.

🩸 6.4 Antepartum Haemorrhage

• Bleeding after 24 weeks is antepartum haemorrhage.
• Causes: placenta praevia, placental abruption, vasa praevia, local cervical/vaginal causes and labour.
• Placenta praevia: painless bright red bleeding; avoid digital vaginal examination until placental location known.
• Placental abruption: painful bleeding, tender/woody uterus, fetal distress; bleeding may be concealed.
• Management: ABCDE, left lateral tilt, IV access, bloods/crossmatch, fetal assessment, senior obstetric/anaesthetic input.

🚨 Safety pearl: In late pregnancy bleeding, do not perform a digital vaginal examination until placenta praevia has been excluded.

🍼 7. Labour and Birth

⏱️ 7.1 Stages of Labour

• First stage: cervical dilatation to 10 cm.
• Second stage: full dilatation to birth of baby.
• Third stage: birth of baby to delivery of placenta.
• Latent phase can be prolonged and painful but does not necessarily mean obstructed labour.
• Assess progress using contractions, cervical change, fetal station, maternal condition and fetal wellbeing.

🧭 7.2 Fetal Monitoring

• Intermittent auscultation may be suitable for low-risk labour.
• Continuous CTG is used when risk factors are present.
• CTG interpretation assesses baseline rate, variability, accelerations, decelerations and contraction frequency.
• Always interpret CTG in clinical context: gestation, maternal fever, bleeding, oxytocin, meconium, pain and progress.

🔪 7.3 Caesarean Birth

• Caesarean birth may be planned or emergency depending on maternal/fetal indication.
• Indications include fetal compromise, malpresentation, placenta praevia, previous uterine surgery, obstructed labour and maternal request after discussion.
• NICE NG192 covers when to offer/discuss caesarean birth, procedural aspects and care after caesarean birth.
• Risks include bleeding, infection, VTE, bladder/bowel injury, neonatal respiratory morbidity and implications for future pregnancies.

🧷 7.4 Operative Vaginal Birth

• Forceps or ventouse may be used for fetal compromise, prolonged second stage or maternal indications.
• Prerequisites include full dilatation, ruptured membranes, known position, engaged head, adequate analgesia, empty bladder and consent.
• Risks include maternal perineal trauma and neonatal scalp/facial injury depending on instrument and circumstances.

🚨 8. Obstetric Emergencies

🩸 8.1 Postpartum Haemorrhage

• Primary PPH occurs within 24 hours of birth; secondary PPH occurs from 24 hours to 12 weeks postpartum.
• Four Ts: Tone, Tissue, Trauma, Thrombin.
• Uterine atony is the commonest cause of primary PPH.
• Management: call help, ABCDE, uterine massage, IV access, bloods/crossmatch, uterotonics, tranexamic acid if appropriate, identify cause, escalate to theatre/interventional radiology if ongoing.

👶 8.2 Shoulder Dystocia

• Delivery of the head occurs but shoulders fail to deliver with gentle traction.
• Risk factors: macrosomia, diabetes, obesity, previous shoulder dystocia, prolonged second stage - but many cases are unpredictable.
• Emergency manoeuvres include call for help, McRoberts position, suprapubic pressure and internal manoeuvres.
• Avoid fundal pressure because it can worsen impaction and increase injury risk.

⚡ 8.3 Eclampsia

• Generalised seizure in association with pre-eclampsia.
• Management: left lateral position, airway protection, oxygen, magnesium sulfate, control severe hypertension, plan delivery once stable.
• Do not use diazepam/phenytoin as first-line seizure prevention in eclampsia unless magnesium contraindicated or ineffective per specialist advice.

🫁 8.4 Amniotic Fluid Embolism

• Rare catastrophic obstetric emergency with sudden hypoxia, hypotension, collapse and DIC during labour or postpartum.
• Management is supportive: resuscitation, oxygenation, haemodynamic support, correction of coagulopathy and multidisciplinary critical care.

🧱 8.5 Uterine Rupture

• Risk increased with previous caesarean/uterine surgery and obstructed labour.
• Features: sudden abdominal pain, abnormal CTG, vaginal bleeding, loss of station, maternal shock, cessation of contractions.
• Requires immediate senior obstetric and surgical intervention.

🍼 9. Postnatal Care

• Monitor bleeding, pain, perineum/wound, bladder/bowel function, VTE risk, mood, feeding and safeguarding.
• Postpartum sepsis can arise from endometritis, wound infection, mastitis, UTI or retained products.
• Endometritis: fever, uterine tenderness, offensive lochia, abdominal pain.
• Mastitis: painful red breast, fever, flu-like symptoms; continue milk removal and treat infection if needed.
• Postnatal mental health: baby blues are common and short-lived; depression, anxiety, psychosis and intrusive thoughts need assessment.
• Postpartum psychosis is an emergency: hallucinations, delusions, severe mood disturbance, confusion or risk to baby/self.

🩸 9.1 Secondary Postpartum Haemorrhage

• Bleeding from 24 hours to 12 weeks postpartum.
• Causes: retained products, infection/endometritis, subinvolution, coagulation disorder.
• Assess haemodynamic status, fever, uterine tenderness and bleeding severity.
• Management may include antibiotics, ultrasound and evacuation if retained products suspected.

🌸 10. Menstrual Disorders

🩸 10.1 Heavy Menstrual Bleeding

Heavy menstrual bleeding is excessive menstrual blood loss that affects quality of life. NICE NG88 covers assessment and management and emphasises patient priorities, fertility wishes and uterine pathology.

• Causes: fibroids, adenomyosis, endometrial polyps, endometrial hyperplasia/cancer, ovulatory dysfunction, coagulopathy, medications.
• Assess impact, anaemia symptoms, bleeding pattern, intermenstrual/postcoital bleeding, pelvic pain and pressure symptoms.
• Investigations: FBC, pregnancy test if relevant, pelvic ultrasound if structural pathology suspected; consider hysteroscopy for suspected cavity pathology.
• Treatment options: LNG-IUS, tranexamic acid, NSAIDs, combined hormonal contraception, cyclical progestogens, endometrial ablation, myomectomy, hysterectomy depending on cause and preference.

😣 10.2 Dysmenorrhoea

• Primary dysmenorrhoea: prostaglandin-mediated cramping pain with no pelvic pathology, often starts soon after menarche.
• Secondary dysmenorrhoea: due to endometriosis, adenomyosis, fibroids, PID or intrauterine pathology.
• Red flags: new pain after years of painless periods, dyspareunia, infertility, abnormal bleeding, pelvic mass, systemic symptoms.
• Treatment: NSAIDs, hormonal suppression and investigation/referral if secondary features.

📅 10.3 Amenorrhoea and Irregular Periods

• Always exclude pregnancy first.
• Causes: PCOS, hypothalamic amenorrhoea, hyperprolactinaemia, thyroid disease, premature ovarian insufficiency, contraception, pregnancy, menopause.
• Assessment: weight/exercise/stress, galactorrhoea, androgen symptoms, menopausal symptoms, chronic disease, medications.
• Bloods may include FSH/LH, prolactin, TSH, androgens and pregnancy test depending on context.

🧬 11. Endometriosis, Fibroids and Adenomyosis

🔥 11.1 Endometriosis

• Endometrial-like tissue outside the uterus causing inflammation, fibrosis and pain.
• Symptoms: dysmenorrhoea, deep dyspareunia, chronic pelvic pain, cyclical bowel/bladder symptoms, infertility, fatigue.
• Examination and ultrasound can be normal, especially in superficial disease.
• Management: analgesia, hormonal suppression, specialist imaging/laparoscopy and surgery in selected cases.
• Consider endometriosis in adolescents with severe period pain not responding to simple treatment.

🧱 11.2 Fibroids

• Benign smooth muscle tumours of the uterus.
• Symptoms: heavy bleeding, pressure, urinary frequency, constipation, subfertility, pregnancy complications.
• Submucosal fibroids are most associated with heavy bleeding and fertility issues.
• Treatment: medical bleeding control, uterine artery embolisation, myomectomy or hysterectomy depending on symptoms/fertility wishes.

🌧️ 11.3 Adenomyosis

• Endometrial tissue within myometrium causing enlarged tender uterus.
• Symptoms: heavy painful periods, pelvic pain, dyspareunia.
• Often occurs in women over 35 and after childbirth, but can occur earlier.
• Management: NSAIDs, hormonal treatment such as LNG-IUS, or hysterectomy if severe and family complete.

🦠 12. Gynaecological Infection and Sexual Health

🧫 12.1 Vaginal Discharge

🔥 12.2 Pelvic Inflammatory Disease

• PID is infection/inflammation of upper genital tract, often polymicrobial and associated with STIs.
• Features: lower abdominal pain, cervical excitation, adnexal tenderness, abnormal discharge, fever, deep dyspareunia, postcoital/intermenstrual bleeding.
• Complications: infertility, ectopic pregnancy, chronic pelvic pain, tubo-ovarian abscess.
• Management: pregnancy test, STI testing, empirical antibiotics if clinically suspected, partner notification and safety-netting.
• Severe illness, pregnancy, tubo-ovarian abscess or failed oral treatment needs hospital/specialist care.

🛡️ 12.3 Sexual Health and Safeguarding

• Take a non-judgemental sexual history: partners, practices, protection, past STIs, pregnancy plans and safeguarding concerns.
• Consider STI screening in pelvic pain, discharge, postcoital bleeding, new partner or under-25s.
• Assess consent, coercion, exploitation, domestic abuse and female genital mutilation risk where relevant.

💊 13. Contraception and Abortion Care

🛡️ 13.1 Contraceptive Options

⏱️ 13.2 Emergency Contraception

• Copper IUD is the most effective emergency contraception and provides ongoing contraception.
• Oral options include levonorgestrel and ulipristal acetate depending on timing, BMI/drug interactions and breastfeeding considerations.
• Always consider pregnancy risk, timing of unprotected sex, cycle timing, safeguarding and STI testing.

🕊️ 13.3 Abortion Care

• Care should be non-judgemental, confidential and supportive.
• Options include medical and surgical abortion depending on gestation, clinical circumstances and patient preference.
• Assess safeguarding, coercion, ectopic risk, rhesus considerations and contraception planning.
• Safety-net for heavy bleeding, severe pain, fever, offensive discharge or ongoing pregnancy symptoms.

🌿 14. Fertility and Reproductive Endocrinology

🧪 14.1 Infertility Assessment

• Infertility is usually assessed after 12 months of regular unprotected intercourse, earlier if older age, amenorrhoea, known pelvic disease or male factor concerns.
• Female factors: ovulatory dysfunction, tubal disease, endometriosis, uterine factors, age-related ovarian reserve.
• Male factors: sperm count/motility/morphology, varicocele, endocrine disease, medications, lifestyle.
• Initial work-up: semen analysis, ovulation assessment, thyroid/prolactin if indicated, rubella status, STI screen and tubal assessment depending on pathway.

🌸 14.2 PCOS

• Features: irregular periods, anovulation, subfertility, acne, hirsutism, androgenic alopecia.
• Associated with insulin resistance, type 2 diabetes risk, dyslipidaemia and endometrial hyperplasia if prolonged amenorrhoea.
• Exclude mimics: pregnancy, thyroid disease, hyperprolactinaemia, congenital adrenal hyperplasia, Cushing’s and androgen-secreting tumour.
• Management: lifestyle support, cycle protection, symptom control and ovulation induction if trying to conceive.

🍂 14.3 Menopause

• Menopause is usually diagnosed clinically after 12 months of amenorrhoea in the appropriate age group.
• Symptoms: hot flushes, night sweats, sleep disturbance, mood change, brain fog, vaginal dryness, urinary symptoms and reduced libido.
• HRT can be very effective; choice depends on uterus status, risks, age/time since menopause and patient preference.
• Vaginal oestrogen is useful for genitourinary symptoms and has low systemic absorption.
• Premature ovarian insufficiency needs specialist support and hormone replacement unless contraindicated.

🎗️ 15. Gynaecological Cancers

⚫ 15.1 Cervical Cancer

• Strongly associated with persistent high-risk HPV infection.
• Symptoms: postcoital bleeding, intermenstrual bleeding, abnormal discharge, pelvic pain, advanced disease symptoms.
• Screening detects HPV and precancerous change; vaccination reduces risk but does not remove need for screening.
• Visible suspicious cervical lesion needs urgent referral, regardless of screening history.

🩸 15.2 Endometrial Cancer

• Postmenopausal bleeding is endometrial cancer until proven otherwise.
• Risk factors: obesity, unopposed oestrogen, PCOS/anovulation, tamoxifen, diabetes, Lynch syndrome, nulliparity, late menopause.
• Investigations: transvaginal ultrasound endometrial thickness and endometrial biopsy/hysteroscopy depending on pathway.

🎗️ 15.3 Ovarian Cancer

• Often presents late with vague symptoms.
• Symptoms: persistent bloating, early satiety, pelvic/abdominal pain, urinary frequency, weight loss.
• Assessment: CA125 and pelvic ultrasound in appropriate symptomatic patients.
• Risk factors: age, family history, BRCA mutations, Lynch syndrome, endometriosis for some subtypes.

🌺 15.4 Vulval Cancer

• Symptoms: persistent vulval itch, pain, lump, ulcer, bleeding or colour change.
• Risk factors: HPV, lichen sclerosus, smoking, immunosuppression.
• Any persistent vulval lesion needs examination and possible biopsy/referral.

🚩 Exam pearl: Postmenopausal bleeding is never “normal”. Even if bleeding is light or intermittent, it needs assessment.

🚨 16. Acute Gynaecology Emergencies

🌀 16.1 Ovarian Torsion

• Twisting of ovary/adnexa compromises blood supply.
• Features: sudden unilateral pelvic pain, nausea/vomiting, adnexal tenderness, ovarian cyst/mass risk.
• Ultrasound may help but normal Doppler flow does not exclude torsion.
• Urgent laparoscopy is needed to save ovarian function.

🚨 17. Obstetric Red Flag Table

📚 18. OSCE / Exam Pearls

• Always do a pregnancy test in reproductive-age abdominal pain, collapse or abnormal bleeding.
• Ectopic pregnancy can present with diarrhoea, urinary symptoms or shoulder tip pain.
• Pre-eclampsia can present with headache, visual symptoms, epigastric pain or reduced fetal movements.
• Do not perform digital vaginal examination in late pregnancy bleeding until placenta praevia is excluded.
• Postmenopausal bleeding needs cancer-pathway assessment.
• Visible suspicious cervix needs urgent referral even if smear history is normal.
• BV is usually fishy discharge without itch; candida is usually itchy/sore.
• Cervical excitation plus pelvic pain suggests PID or ectopic - pregnancy test is essential.
• Normal ultrasound Doppler does not fully exclude ovarian torsion.
• Postpartum psychosis is an emergency, not routine postnatal low mood.

📌 19. Quick Differentials Table

📚 References

• NICE. Antenatal care. NG201.
• NICE. Ectopic pregnancy and miscarriage: diagnosis and initial management. NG126.
• NICE. Heavy menstrual bleeding: assessment and management. NG88.
• NICE. Caesarean birth. NG192.
• NICE. Hypertension in pregnancy: diagnosis and management. NG133.
• NICE. Endometriosis: diagnosis and management. NG73.
• NICE. Menopause: identification and management. NG23.
• RCOG Green-top Guidelines and local maternity/gynaecology pathways should be checked for obstetric emergencies, VTE, fetal monitoring, sepsis, miscarriage, contraception and operative care.

⚠️ Disclaimer

This article is for medical education and exam revision. Clinical decisions should follow current local maternity and gynaecology guidelines, safeguarding policies, antimicrobial guidance, emergency protocols, formularies, senior advice, NICE guidance and RCOG guidance. Obstetric and gynaecological emergencies such as ectopic pregnancy, severe pre-eclampsia/eclampsia, major haemorrhage, sepsis, ovarian torsion, placental abruption and postpartum psychosis require urgent senior input.