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Obstetric and Gynaecological Pathology

16 topics in Obstetric and Gynaecological Pathology for PGET Paper II Obstetrics & Gynaecology. Each one explains the concept simply, then gives exam-focus points and a quick revision list.

Benign gynaecological disorders: fibroids, endometriosis, adenomyosis and ovarian cystsThe common benign conditions of the uterus and ovary: fibroids and their degenerations, adenomyosis, endometriosis, polyps, cervical ectropion and the main benign ovarian cysts, with the tests and treatments PGET asks about.

Pelvic organ prolapse and urinary incontinenceHow the pelvic floor holds the uterus and vagina up, why it fails after childbirth, how prolapse and stress or urge incontinence present, and how they are assessed and treated, including obstetric fistula.

Cervical intraepithelial neoplasia, cervical screening and cervical cancerHow persistent high-risk HPV infection at the transformation zone leads to CIN and then cervical cancer, how screening, colposcopy and LLETZ prevent it, and how cervical cancer is staged and treated.

Endometrial hyperplasia and endometrial cancerWhy unopposed oestrogen leads to endometrial hyperplasia and cancer, how postmenopausal bleeding is investigated, and how endometrial cancer is staged and treated, with uterine sarcomas in brief.

Ovarian tumours and ovarian cancerThe types of malignant ovarian tumour (epithelial, sex cord stromal, germ cell and metastatic), their risk factors and tumour markers, why ovarian cancer presents late, and how it is staged and treated.

Vulval and vaginal disease and cancerBenign vulval and vaginal problems (pruritus, lichen sclerosus, Bartholin cyst, atrophy, vaginal discharge) and the premalignant and malignant diseases of the vulva and vagina, with how each is diagnosed and treated.

MiscarriageThe definition and types of miscarriage (threatened, inevitable, incomplete, complete, missed and septic), the causes, the ultrasound criteria for diagnosis, expectant, medical and surgical management, and recurrent and second-trimester loss.

Ectopic pregnancyImplantation outside the uterine cavity: sites, risk factors, the classic and the subtle presentations, how transvaginal scan and serial hCG make the diagnosis, and when to choose expectant, methotrexate or surgical treatment.

Gestational trophoblastic disease: molar pregnancy and choriocarcinomaGestational trophoblastic disease covers complete and partial moles, invasive mole and choriocarcinoma. This chapter explains their genetics, how a mole presents, the snowstorm scan, suction evacuation, hCG follow-up and when chemotherapy is needed.

Fetal growth restriction (IUGR) and intrauterine fetal deathHow to tell a small but healthy baby from a growth-restricted one, symmetrical and asymmetrical growth restriction, the Doppler changes that guide delivery, and how intrauterine fetal death is confirmed, investigated and managed.

Antepartum haemorrhage: placenta praevia, placental abruption and vasa praeviaBleeding from the genital tract in the second half of pregnancy: how to tell placenta praevia from placental abruption and vasa praevia, what not to do on examination, and how each is managed.

Postpartum haemorrhage: primary and secondary PPHPostpartum haemorrhage is the leading cause of maternal death worldwide. This chapter covers definitions, the four causes (tone, tissue, trauma, thrombin), active management of the third stage, the drug ladder from oxytocin to carboprost, surgical steps and secondary PPH.

Multiple pregnancy: twins, chorionicity and twin-to-twin transfusionTwin and higher-order pregnancies: zygosity and chorionicity, the lambda and T signs, maternal and fetal risks, twin-to-twin transfusion syndrome, antenatal care and how twins are delivered.

Preterm labour and prelabour rupture of membranesLabour before 37 weeks and rupture of the membranes before labour: causes and risk factors, how to predict preterm birth, tocolytics, steroids, magnesium for neuroprotection, erythromycin in PPROM, and prevention with progesterone and cerclage.

Diabetes in pregnancy: pre-existing and gestational diabetesWhy pregnancy makes glucose control harder, how pre-existing and gestational diabetes affect mother and baby, the OGTT cut-offs, glucose targets, metformin and insulin, timing of delivery and care of the baby after birth.

Hypertensive disorders of pregnancy: pre-eclampsia, eclampsia and HELLPGestational hypertension, pre-eclampsia, eclampsia, HELLP syndrome and chronic hypertension in pregnancy: definitions, risk factors, the placental cause, investigations, labetalol and other antihypertensives, magnesium sulphate and the timing of delivery.

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