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Obstetrics

Describe routine antenatal care, including booking, risk assessment, options in patterns of

care (shared, midwife-led), normal symptoms of pregnancy


Early pregnancy: miscarriage, ectopic pregnancy, hyperemesis
Common problems in pregnancy: hyperemesis, reflux, pruritus, symphysis pubis dysfunction,

dependant oedema, UTI, hypertension


Bleeding in pregnancy
Understand the place of screening in obstetric care e.g. Downs syndrome
Postnatal care

Gynaecology

Describe different methods of contraception for men and women and discuss their

advantages and disadvantages


Unplanned pregnancy, counselling and terminations
Understand community gynaecological screening e.g. cervical cytology
Dysmenorrhoea, menorrhagia, oligomenorrhoea, amenorrhoea
Intermenstrual bleeding and post-coital bleeding
Pelvic pain- acute and chronic
Vaginal discharge
Preconception counselling
Subfertility
Climacteric and Menopause
Postmenopausal bleeding

Gynecology (Outpatient Clinic)


1. Develop competence in the medical interview and physical examination of women and will
incorporate ethical, social and diversity perspectives to provide culturally competent health
care.
Perform pelvic exam (including speculum and bimanual examination)
Perform clinical breast exam
Conduct, record and present GYN patient H & P
2. Apply recommended prevention strategies to women throughout the lifespan.
Annual well-woman exam
3. Recognize your role as a leader and advocate for women. (one of following)
Domestic violence screening, teen pregnancy
4. Describe menstrual cycle physiology, discuss puberty and menopause, and explain normal
and abnormal bleeding.

Menopause/perimenopause
Abnormal uterine bleeding
5. Develop a thorough understanding of contraception, including abortion and sterilization.
Contraceptive counseling
6. Provide a preliminary assessment of patients with sexual concerns.
Take a sexual history
7. Demonstrate knowledge of common benign gynecological conditions.
Vulvar/vaginal benign disease
Fibroids
Endometriosis
8. Formulate a differential diagnosis of the acute abdomen and chronic pelvic pain.
Pelvic pain
Ectopic pregnancy
9. Describe the etiology and evaluation of infertility
10. Describe common breast conditions and outline the evaluation of breast complaints.

Perform clinical breast examination


Breast mass
Nipple discharge
Mastitis

11. Pelvic Organ Prolapse

Discuss the levels of pelvic organ support


Identify symptoms
Identify risk factors
Identify surgical and non-surgical treatment options for prolapse

12. Lower Urinary Tract Symptoms


Take a history regarding voiding and storage disorders to identify symptoms of irritation,
obstruction, and incontinence
Define types of urinary incontinence: stress, urge, mixed, overflow, functional, continuous
Explain primary evaluation for urinary incontinence: urinalysis, post void residual, voiding
diary, stress test
Identify treatments for Incontinence: physical therapy, behavioral, medications, pessary,
surgery
UTI management- antibiotic choice, prophylaxis

13. Describe gynecologic malignancies including risk factors, signs and symptoms and initial
evaluation.
Abnormal Pap smear
Postmenopausal bleeding
Adnexal mass/cyst
Gynecology Surgery
1. Gynecology Perioperative Care Perform pelvic exam and digital rectal exam. (may be under anesthesia)
Insert Foley catheter
Demonstrate ability to write the following notesi.
GYN preoperative note, including appropriate studies and prophylaxis
ii. GYN operative note
iii. GYN postoperative note
iv. GYN postoperative progress note
2. Demonstrate familiarity with gynecologic procedures.
Observe hysterectomy
Observe laparoscopy
Observe other gynecology procedure (enter below)
i.
____________________
ii. ____________________
iii. ____________________
iv. ____________________
v. ____________________
Obstetrics
1. Demonstrate knowledge of preconception care including the impact of genetics, medical
conditions and environmental factors on maternal health and fetal development.
Preconception care
1st trimester care
Prenatal diagnosis
2. Explain the normal physiologic changes of pregnancy including interpretation of common
diagnostic studies.
New OB prenatal visit
Routine prenatal care follow-up visit
Conduct, record and present OB patient history

3. Describe common problems in obstetrics.

Diabetes in pregnancy
Preeclampsia/eclampsia
3rd trimester bleeding
Peripartum infection
1st trimester bleeding

4. Demonstrate knowledge of intrapartum care.

Present patient for labor admission


Clinical course of labor
Premature rupture of membranes (PROM)
Preterm labor (PTL)
Normal Spontaneous Vaginal Birth (NSVD), participate/observe
Observe perineal laceration repair
Write delivery note

5. Demonstrate knowledge of postpartum care of the mother and newborn.

Postpartum discharge instructions


Current breastfeeding recommendations regarding indications/contraindications
Postpartum hemorrhage
Write postpartum note
Present postpartum patient

Well-Woman Care (Routine Preventive Health Care)


1.

Elicit a comprehensive history (menstrual, obstetric, gynecologic, contraceptive, sexual, family and social),
perform a well woman exam (with pelvic and breast exam), and recommend screening adhering to the
primary preventative care standards established by ACOG.

2.

List and describe age-appropriate screening procedures and appropriate time intervals for these tests:

3.

Mammogram

Bone density

Pap tests

Sexually transmitted infections

Demonstrate the ability to counsel patients in a non-directive manner on the following methods of
contraception, their mechanism of action, and the risk associated with each:
o

Natural family planning

Barrier methods

Oral contraceptives

Emergency contraception

LARC methods

Permanent contraception

4.

Demonstrate how to perform a comprehensive breast exam and discuss the diagnostic approach to a
woman with the chief complaint of breast mass, nipple discharge or breast pain.

5.

Explain the identification and appropriate management of menopausal and peri-menopausal symptoms.

6.

Assess patients' risk for the following after reviewing their history:
o

Unintended pregnancy

STIs

Cervical pathology

Breast malignancy

Gynecologic malignancies

Domestic violence

Obstetrics
1.

Participate in a first prenatal visit observing the taking of a history, physical exam, pelvic exam,
determination of due date and lifestyle counseling

2.

Analyze prenatal patient vitals and laboratory assessments

3.

Describe how to diagnose a pregnancy and assess gestational age

4.

Demonstrate appropriate counseling for pregnant patients or those considering pregnancy regarding the
effects of the following on pregnancy:

5.

Substance abuse

Medications

Environmental hazards

Describe common symptoms, clinical manifestations and management of the following obstetric
complications:
o

Second-trimester loss

Preterm labor

Third-trimester bleeding

Hypertension

GDM

Multiple gestation

IUGR

Post-term pregnancy

Fetal death

6.

Participate in the care of high-risk obstetric patients and be able to discuss the use of integrated care
resources in the high-risk obstetrics setting.

7.

Discuss the maternal physiologic anatomic changes associated with pregnancy.

8.

List the normal anatomic and physiologic changes to the breast during pregnancy and postpartum periods
and the benefits of breastfeeding to mother and newborn.

9.

Perform and interpret the following methods of fetal monitoring:


o

Intermittent auscultation

Electronic monitoring

Fetal scalp stimulation

Vibroacoustic stimulation

Non stress test

Biophysical profile

10. Explain the management for the following medical and surgical conditions in pregnancy:
o

Anemia

Diabetes mellitus

Chronic hypertension

Urinary tract disorders

TORCH infections

Group B streptococcus

HIV

Asthma

DVT

Alcohol, tobacco, drugs

Appendicitis

Pneumonia

Gynecology Outpatient
1.

Participate/observe in a pertinent history, a focused physical examination, select and interpret diagnostic
tests and establish an initial treatment plan for some/all of the following conditions:
o

Sexually transmitted infections

Vaginitis

Amenorrhea

Pelvic pain

Breast mass

Abnormal uterine bleeding

Uterine fibroids

Galactorrhea

2.

Explain the etiologies of abnormal menstrual bleeding as well as its diagnosis and management.

3.

Identify the risk factors for cervical neoplasia and discuss the management of an abnormal Pap smear and
appropriate follow-up for patients with that finding.

4.

Interpret abnormal Pap smear results and establish a treatment plan in accordance with the latest ASCCP
guidelines.

5.

Compare the characteristics of functional cysts, benign ovarian neoplasm and ovarian malignancies.

6.

Describe the pathophysiology, diagnosis and management of urinary tract infections.

7.

Differentiate stress, urge and mixed urinary incontinence using history, physical exam, and test results.

8.

Describe the most common dermatologic disorders of the vulva and their evaluation and treatment
including:
o

Vulvovaginitis

Herpes simplex virus

Lichen planus

Lichen sclerosis

Vulvar neoplasia

9.

Analyze accurately patient vitals and laboratory assessments.

10. Perform and interpret the results of tests to confirm the diagnosis of vaginal infections including:
o

Vaginal pH

Saline and potassium

Hydroxide microscopy

Bacterial and viral culture

11. As part of the patient care team participate/observe in the history, physical exam, and management of
women with one of these gynecologic cancers:
o

Cervical

Endometrial

Vulvar

Ovarian

12. Demonstrate via patient discussions the different modalities of aneuploidy screening including:
o

First trimester screen

Free fetal DNA analysis

Amniocentesis

Quadruple screening versus definitive testing via chorionic villus sampling

Obstetrics Inpatient
1.

List the signs and symptoms of pre-labor contractions and labor contractions.

2.

Describe the cardinal movements of labor and the steps of performing a vaginal delivery.

3.

Describe the stages of labor and recognize common abnormalities including:


o

Prolonged latent phase

Arrest of dilation

Protracted descent

Arrest of descent

4.

Discuss indications for and potential risks associated with cesarean delivery.

5.

Elicit an accurate history, and assist in the performance of a focused exam and development of a
treatment plan for term patients presenting with:

Labor concerns

ROM

Vaginal bleeding

Decreased fetal movement

6.

Demonstrate respect for the patient by respecting her preferences in the care of the infant and mother
immediately after delivery.

7.

During delivery demonstrate proper self-positioning, delivery technique, and handling of baby after
delivery.

8.

Describe the causes and management of postpartum hemorrhage including delayed hemorrhage.

9.

Perform a focused postpartum exam, and participate in the counseling of patients regarding contraception,
future pregnancies and breast feeding.

10. Be able to identify and explain treatment for the most common maternal complications including:
o

Mastitis

Perineal discomfort

Wound infection

Postpartum depression

Gynecology Inpatient
1.

2.

Perform a pertinent history, assist in a focused physical examination, the selection and interpretation of
diagnostic tests and the initial treatment plan for common presenting patient complaints including:
o

Abdominal pain

Vaginal bleeding

Pelvic mass

Urologic/gynecologic infections

Vulvar/vaginal symptoms

Describe pre-operative indications for and explain the basic procedure and the potential intra and postoperative complications for:
o

Dilatation and sharp/suction curettage

Diagnostic and simple operative hysteroscopy

Diagnostic and simple operative laparoscopy

Open versus vaginal hysterectomy

Excision of vulvar lesions

Sterilization procedures

3.

Meet patients prior to surgery and review their history and physical, when advised by supervisors.

4.

Describe the anatomy of the anterior abdominal wall, pros and cons of surgical incisions, and use of pre
and post incision anesthesia.

5.

Describe the anatomy of the pelvis including:

6.

7.

Arterial blood supply

Venous and lymphatic drainage

Neurologic innervation

Anatomic relationship between reproductive organs and the non-gynecologic abdominal viscera

Evaluate patients and develop treatment plans for post-operative complications including:
o

Fever

Bleeding

Pain control

Ileus/obstruction

Nausea

Wound complications

Infection

Cardiovascular symptoms

Change in mental status

Renal/fluid balance issues

Respiratory symptoms

Thromboembolism

Analyze accurately patient vitals and laboratory assessments.

Rounding
1.

Perform appropriate pre-rounding assessment of patients.

2.

Analyze patient vitals and laboratory assessments.

3.

Present patients to healthcare team in a well-organized manner during morning board report, highlighting
pertinent positives and negatives.

4.

Present and appropriately prioritize differential diagnosis for patients and develop a postpartum or postsurgery management plan.

Basics of Labor and Delivery


1.

Define the medical students role at a delivery and a C-section.

2.

Describe the basics of labor evaluation and how to complete a cervical assessment.

3.

Explain the stages of normal labor.

4.

Explain the proper delivery technique in a standard birth.

Introduction to Gynecology
1.

List the four age categories of women patients and explain the major health concerns for each category.

2.

Describe the process of proper breast cancer screening.

3.

Discuss the etiology and treatment of abnormal uterine bleeding.

4.

Discuss the diagnosis and treatment of patients with the human papilloma virus.

Basics of Fetal Heart Tracings


1.

Explain the ACOG categories for fetal heart tracings.

2.

Discuss the normal parameters of the fetal heart strip and how the readings relate to labor.

3.

Identify accelerations and decelerations on the fetal heart strip and explain their significance relating to
fetal health and the labor process.

Clerkship Online Lectures


The Menstrual Cycle and Abnormalities
1.

List the parameters of a normal menstrual cycle throughout a womans life.

2.

Describe abnormal uterine bleeding and list the most common causes.

3.

Describe pharmacologic and non-pharmacologic treatments for common menstrual-related disorders.

Sexually Transmitted Infections


1.

Explain proper counseling of patients regarding STI treatment and public health consequences.

2.

List the presenting signs and symptoms of common STIs.

3.

Explain the impact of STIs on pregnancy, birth, and infant health.

Prenatal Care

1.

Explain, using specific examples, the importance of prenatal care to the health of baby and mother.

2.

List and explain the purpose of laboratory tests completed during the first prenatal visit.

3.

Explain the assessment of fetal growth, well-being, maturity, and amniotic fluid volume.

First Trimester Bleeding


1.

List common causes of first trimester vaginal bleeding and proper treatment for each.

2.

List the symptoms, test to diagnose, and proper management of ectopic pregnancy.

3.

Explain the various methods for determining fetal viability.

Ectopic Pregnancy
1.

List the factors predisposing patients to ectopic pregnancy.

2.

Explain the diagnostic tests used to confirm ectopic pregnancy.

3.

Discuss treatment options for ectopic pregnancy.

Menopause
1.

List the symptoms that commonly occur with menopause.

2.

Discuss the benefits and risks of treatments, including hormone therapy, for menopausal symptoms.

3.

Discuss the physiological and psychosocial aspects of menopause.

Core Case Discussions


Third Trimester Bleeding
1.

List the causes of third trimester bleeding.

2.

Describe the initial evaluation of a patient with third trimester bleeding.

3.

Differentiate the signs and symptoms of third trimester bleeding.

4.

List the maternal and fetal complications of placental previa and abruption placenta.

5.

Describe the initial evaluation and management plan for acute blood loss.

List the indications and potential complications of blood product transfusion.


Endometriosis
1.

Describe theories of the pathogenesis of endometriosis.

2.

List the most common sites of endometriosis.

3.

Describe the symptoms and physical examination findings in a patient with endometriosis.

4.

Describe the diagnosis and management options of endometriosis.

Disorders of the Breast


1.

List factors that place individuals at risk for breast disorders.

2.

Describe symptoms and physical examination finding of benign or malignant conditions of the breast.

3.

Demonstrate the performance of a clinical breast examination.

4.

Discuss the steps in the evaluation of common breast complaints: mastalgia, mass, nipple discharge.

5.

Discuss initial management options for benign and malignant conditions of the breast.

Normal and Abnormal Uterine Bleeding


1.

Define the normal menstrual cycle and describe its endocrinology and physiology.

2.

Define abnormal uterine bleeding.

3.

Describe the pathophysiology and identify etiologies of abnormal uterine bleeding.

4.

Describe the steps in the evaluation and initial management of abnormal uterine bleeding.

5.

Summarize medical and surgical management options for patients with abnormal uterine bleeding.

Fibroids
1.

Cite the prevalence of uterine leiomyoma.

2.

Identify symptoms and physical findings in patients with uterine leiomyoma.

3.

Describe the diagnostic methods to confirm uterine leiomyomas.

4.

Describe the management options for the treatment of uterine leiomyomas.

Sexual Assault
1.

Identify patients at increased risk for sexual assault.

2.

Describe the medical and psychosocial management of a victim of sexual assault.

Domestic Violence
1.

Cite prevalence and incidence of violence against women, elder abuse, and child abuse.

2.

Screen a patient for intimate partner violence.

3.

Summarize the available resources for a victim of intimate partner violence including short-term safety.

Simulation Stations
Labor and Delivery Simulation
1.

Explain the medical students role in the labor and delivery room.

2.

Describe the 7 cardinal movements of labor.

3.

Demonstrate proper delivery technique, traction, and handling of infant after delivery.

4.

Discuss cultural sensitivity to family preferences regarding the post-delivery handling of the infant and
care for the mother.

Pelvic Exam Simulation


1.

Demonstrate proper positioning and draping of the patient.

2.

Demonstrate proper technique of an effective pelvic exam.

3.

Explain how to reposition the patient and handle the equipment after the exam.

4.

Describe a proper explanation of exam results to the patient.

B. EDUCATIONAL CORE OBJECTIVES

I. SKILLS - TECHNICAL AND PROCEDURAL

By the end of the Obstetrics and Gynaecology Clerkship rotation, the medical student should be able to
perform the skills/procedures listed below. Competency to complete these skills may be acquired
during clinical shifts, seminars, workshops, or simulations.

1.

Bimanual pelvic examination

9.

GBS (group B streptococcus) culture for antenatal

2.

Vaginal speculum insertion

3.

Cultures of vagina and cervix

10. Nitrazine test for SROM

4.

Pap test

11. Fern testing for SROM (spontaneous rupture of

5.

Fetal heart rate tracing interpretation normal and

screening

membranes)

abnormal tracings

12. Cervical examination during labour

6.

Fetal heart auscultation with doptone

13. Spontaneous vaginal birth

7.

Leopold manoeuvres

14. Delivery and examination of placenta

8.

Symphysis fundal height measurement

15. Obtaining cord blood

II. PROBLEM-BASED ENCOUNTERS

By the end of the Obstetrics & Gynaecology Clerkship rotation, the student should be able to
demonstrate an approach (including differential diagnosis, investigation and initial treatment) to
women presenting for antenatal care, intrapartum care, gynaecological consultation (outpatient,
inpatient, emergency room), and gynaecologic surgery, based on real or simulated encounters listed
with the following issues:

Gynaecological:
1.

Abnormal vaginal bleeding (pre and

8.

Endometriosis

postmenopausal)

9.

Fibroids

2.

Adnexal mass and/or ovarian cyst

10.

Genital tract infections

3.

Amenorrhea/oligomenorrhea

11.

Incontinence

4.

Contraceptive methods

12.

Infertility

5.

First trimester or early second trimester

13.

Irregular periods

complications:

14. Menopausal counselling

a.

Spontaneous abortion

15.

Pap test counselling

b.

Unwanted pregnancy and therapeutic

16.

Pelvic pain acute and chronic

abortion

17.

Post-gynaecologic surgery complications

c.

Ectopic pregnancy

18.

Sexual disorders

d.

Recurrent pregnancy loss

19.

Urogenital prolapse/disorder

6.

Dysmenorrhea

20. Vaginal discharge

7.

Dyspareunia

21.

Vulvar lesion or pruritis

7.

Labour progression normal and abnormal

delivery)

8.

Pain management in labour

3.

9.

Preterm labour

10.

Preterm premature rupture of membranes

diagnosis

11.

Nausea and vomiting in pregnancy

b.

Small/large for gestation age fetus

12.

Postpartum care and complications:

c.

Management of Rh negative status

a.

Postpartum hemorrhage

d.

Fetal demise

b.

Postpartum fever

c.

Postpartum mood disorder

Obstetrical:
1.

Antepartum haemorrhage

2.

Assisted birth (vacuum, forceps, Caesarean

Fetal well-being issues:


a.

Genetic screening and prenatal

4.

Diabetes in pregnancy

5.

Hypertension in pregnancy

13.

6.

Induction of labour

14. Obstetrical ultrasound

Obstetrical emergencies

1.

Dysgerminoma of ovary does not produce


Placental alkaline phosphatase
Lactate dehydrogenase

A.
B.
C.
D.

AFP
AFP and HCG.

2.

Most common pure germ cell tumor of the ovary is


Choriocarcinoma
Dysgerminoma
Embryonal cell tumor
Malignant Teratoma

A.
B.
C.
D.

3.

Initial treatment of rectovaginal fistula Should be


Colostomy
Colporrhaphy
Anterior resection
Primary repair

A.
B.
C.
D.

4.

Risk of preterm delivery is increased if cervical length is


1.5 cm

A.
B.
C.
D.

2 cm
2.5 cm
3cm

5.

Most common cause of PPH (many times asked)


Uterine atonicity
Coagulopathy
Trauma
Infection

A.
B.
C.
D.

6.

Lambda sign or twin peak sign indicates


Monochorionicity
Dichorionicity

A.
B.
C.
D.

Both
None

7.

Most common cause of tubal block in lndia is


Gonorrhea infection
Bacterial vaginosis
Tuberculosis
Chlamydia infection

A.
B.
C.
D.

8.

Surgical procedure with highest incidence of ureteric injury is


Vaginal hysterectomy
Abdominal hysterectomy
Anterior colporrhaphy
Wertheims hysterectomy

A.
B.
C.
D.

9.

Clue cells are seen in

Syphilis
Bacterial vaginosis
Trichomoniasis
Chlamydial infection

A.
B.
C.
D.

10.

Strawberry Vagina is seen in


Syphilis
Bacterial vaginosis
Trichomoniasis
Chlamydial infection

A.
B.
C.
D.

11.

Most common cause of Bartholin's abscesses


Syphilis
Bacterial vaginosis
Trichomoniasis
Gonococci

A.
B.
C.
D.

12.

Treatment of choice for Bartholin's abscesses


Excision
Marsupialization

A.
B.
C.
D.

I&D
Any of the above

13.

Pregnancy should not be allowed in


ASD

A.
B.
C.
D.

Aortic stenosis
Mitral stenosis
Eisenmengers complex

14.

Hepatitis infection that is fulminant in in pregnancy


C
D

A.
B.
C.
D.

E
F

15.

Colon cancer
Ovarian cancer
Brain cancer
Breast cancer

A.
B.
C.
D.

16.

Hormone Replacement Threapy does not prevent


Flushing
Coronary heart disease
Vaginal atrophy
Osteoporosis

A.
B.
C.
D.

17.
A.

Carbohydrate Antigen - 125 is a marker of

Which one is NOT a physiological change in pregnancy ?


stroke volume

B.
C.
D.

intravascular volume
peripheral vascular resistance
cardiac output

18.

Red degeneration of myoma is most common during


1st trimester
2nd trimester
3rd trimester
None of the above

A.
B.
C.
D.

19.

Drug useful in preventing vertical transmission of HIV


Nevirapine
Stavudine
Lamivudine
Abacavir

A.
B.
C.
D.

20.

Vertical transmission of HIV is more common during


1st trimester
2nd trimester
3rd trimester
During labour

A.
B.
C.
D.

21.

X ray of a premature baby with bullous lesions showed periostitis, next diagnostic work up is
ELISA for HIV
PCR for Tuberculosis
HbSAg for mother
VDRL for mother & baby

A.
B.
C.
D.

22.

Acetyl cholinesterase enzyme in amniotic fluid is diagnostic of


Open spina bifida
Osteogenesis imperfecta
Omphalocele
Spina bifida occulta

A.
B.
C.
D.

23.

Answer the following


Theme: Tumors and characteristic features
A. SchillerDuval body
B. CallExner body
C. Reinke crystals

OBSTETRICS & Gynaecology


1. Prevention and treatment of Thromboembolism during pregnancy.
2. Describe the consequences of child birth on pelvic floor.
3. Gestational Diabetes Mellitus: Screening and principles of management.

4. Define Obstructed Labor. Discuss the place of destructive operations in modern obstetrics in developing
nations.
5. Partographic management of Labor.
6. What is the pathophysiology of Rh-Allo-Immunization? Discuss the management of Pregnancy in a RhImmunized Woman.
7. Antepartum assessment of fetal well-being.
8. Recent advances in the management of Atonic PPH (Post Partal Hemorrhage)
9. Prevention of mother to child transmission of HIV.
10. Septic Abortion: Pathophysiology and Complications
11. Management of Persistent Vaginal Discharge.
12. Evaluation and treatment of tubal factor in sub-fertility.
13. Management of post-menopausal bleeding in a 60 year old lady.
14. Current concepts in the management of Ovarian Carcinoma.
15. Management of Ectopic Pregnancy.
16. Avoiding post-operative adhesions.
17 Hysteroscopy in Gynaecology .
18. Management of Pruritis Vulvae.
19. Clinical application of urodynamic investigations.
20 Investigations and treatment of Primary Amenorrhoea
21 Etiopathogenesis of Pre-Eclampsia
22 Perinatal complications of Preterm Baby.
23 Causes of Azoospermia and its evaluation.
24 Management of a woman with Cu-T 380A with Missing Thread
25. Estrogen Free Pills
26 Preconceptional counseling in a young woman with previous birth of a baby with Spina Bifida.
27. Management options for Polycystic Ovary Syndrome in woman desirous of fertility.
28. Mullerian Agenesis
29. Reconstructive Tubal Surgery.

30. Advantages and disadvantages of Manual Vaccum Aspiration (MVA).


31. Ureteric injuries during Obstetrics and Gynaecological Surgeries.
32. Amniotic fluid volume and its clinical relevance.
33. Etiological factors for Intrauterine Growth Retardation.
34. Structure and function of Human Placenta.
35. Lactational Amenrrhoea Method (LAM)
36. Enumerate causes of Jaundice during pregnancy and discuss complications of Viral Hepatitis during
pregnancy.
37. Use of Tocolytic Agents during pregnancy.
38. Advantages and disadvantages of forceps over ventouse application in labor.
39. Risk factors for Pelvic Inflammatory Disease.

40 Lymphatic Drainage of Vulva.