Obstetrics and gynaecology is 15% of our bank, 22 to 23 items on a 150-item paper, but it is much heavier in the published blueprints: 25% in the SMLE and 36 of 150 items (24%) at Qatar DHP. If you are sitting either, revise it harder than the bank weight suggests. The SMLE rates pre-eclampsia, third-trimester bleeding, preterm labour and PPROM, postpartum haemorrhage, ectopic pregnancy, spontaneous abortion and abnormal uterine bleeding at mastery level 3.
Weight and expected items
| Source | Share | Items on 150 |
|---|---|---|
| Our bank (editorial) | 15% | 22 to 23 |
| SMLE 2026 blueprint | 25% (can vary by plus or minus 5) | about 37 to 38 if applied to 150 |
| Qatar DHP GP blueprint | 24% (our arithmetic) | 36 |
The gap between our weight and the published ones is deliberate: our bank is wider than the SMLE, with psychiatry, primary care and public health. For SMLE or Qatar preparation, add hours here. Planning guidance is on the overview page and in the study plan.
What is tested
Antenatal and medical disorders in pregnancy
Antenatal care and booking investigations, preconception care with folic acid and consanguinity counselling, hypertensive disorders and pre-eclampsia, gestational and pre-existing diabetes, medical conditions in pregnancy (thyroid, epilepsy, anaemia, haemoglobinopathy), multiple pregnancy and Rhesus alloimmunisation, fetal surveillance, growth restriction and post-term pregnancy.
Bleeding and emergencies
Early pregnancy loss and ectopic pregnancy, antepartum haemorrhage (placenta praevia, abruption), postpartum haemorrhage and obstetric emergencies, preterm labour and PPROM.
Labour and puerperium
Intrapartum care, induction and caesarean birth, puerperium, postpartum infection and breastfeeding.
Gynaecology
Abnormal uterine bleeding and fibroids, endometriosis, chronic pelvic pain and dysmenorrhoea, amenorrhoea, PCOS and hirsutism, contraception, family planning and infertility, menopause and hormone therapy, cervical screening, CIN and gynaecological cancers, prolapse, incontinence, vaginal discharge and PID.
Guideline points to hold
- Gestational diabetes (WHO 2013, 75 g OGTT): fasting 5.1 to 6.9 mmol/L, 1 hour 10.0 mmol/L or more, 2 hour 8.5 to 11.0 mmol/L. Diabetes in pregnancy is fasting 7.0 or more, or 2 hour 11.1 or more.
- Pre-eclampsia: new hypertension of 140/90 or more after 20 weeks with proteinuria or maternal organ dysfunction. Severe features include blood pressure of 160/110 or more. Magnesium sulphate: 4 g IV over 5 to 10 minutes, then 1 g/h, monitoring reflexes, respiratory rate and urine output. Low-dose aspirin from 12 weeks for high-risk women.
- Postpartum haemorrhage: blood loss of 500 mL or more within 24 hours. Oxytocin 10 IU IM or IV is first-line; tranexamic acid 1 g IV within 3 hours of birth; uterine massage, then escalate.
- Cervical screening (WHO): HPV DNA testing from age 30 in the general population at 5 to 10-year intervals, and from 25 in women living with HIV.
- Consanguinity and carrier couples: if both parents carry beta-thalassaemia, each pregnancy has a 25% risk of thalassaemia major, and prenatal diagnosis by chorionic villus sampling is offered at 11 to 13+6 weeks.
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Reading an obstetric stem
Four details decide most obstetric items: the gestational age, the parity and previous obstetric history, the vital signs, and what has already been done. A woman at 34 weeks with bleeding and a tender, rigid uterus is a different problem from one at 34 weeks with painless bleeding, and the investigation you must not do first (a vaginal examination when placenta praevia is possible) may be the point of the question. Read the stem twice, the second time looking only for the dates and the numbers.
Gynaecology: pathways, screening and cancer
Gynaecology items are usually pathway items. Abnormal bleeding asks for the pregnancy test and then the cause by age; amenorrhoea asks for the first investigations in the right order; pelvic pain asks you to separate the surgical from the medical; discharge asks you to separate infection from physiology. Cervical screening and CIN items rely on the WHO approach above. Gynaecological cancer items usually test the red-flag presentation and the correct referral, not staging detail. Contraception stems add medical eligibility: read the patient's conditions, then choose the method, since the stem will usually include a detail that rules out the obvious option. Fertility and menopause items follow the same logic: identify the patient's goal and risks first, then the option that fits both.
Three typical traps
- Assuming the first step is definitive. In a postpartum haemorrhage the order matters: call for help, uterine massage, oxytocin, tranexamic acid, then surgical options. Stems ask for the next step in a sequence, so locate where the patient is on the ladder.
- Misreading the gestational age. Pre-eclampsia is defined after 20 weeks, so hypertension before 20 weeks points to chronic hypertension. The same dates decide preterm versus term and viability questions.
- Ignoring the carrier-couple clue. A stem that mentions cousin marriage and a child with anaemia is testing consanguinity and haemoglobinopathy counselling, not routine antenatal care.
How to revise it
- Make the emergencies a flow chart each: eclampsia, PPH, antepartum haemorrhage, ectopic pregnancy. Practise saying the steps aloud.
- Tabulate the bleeding causes by trimester, with the classic presentation and the investigation of choice.
- Learn the gynaecology as pathways: abnormal bleeding, amenorrhoea, pelvic pain, discharge, each with the first test.
- Add the SMLE mastery level 3 list from high-yield topics to your tracker.
- Revisit weekly alongside paediatrics, which pairs with this block in both published blueprints.
Frequently asked questions
Why is obstetrics heavier in the SMLE than in your bank?
The SMLE blueprint gives Obstetrics and Gynaecology 25%, and Qatar DHP lists 36 of 150 items. Our bank is wider, with psychiatry, primary care and public health, so it gives 15%. For SMLE or Qatar preparation, add hours.
Which obstetric topics does the SMLE rate highest?
Pre-eclampsia, third-trimester bleeding, preterm labour and PPROM, postpartum haemorrhage, ectopic pregnancy, spontaneous abortion and abnormal uterine bleeding are at mastery level 3.
What is the WHO first-line drug for postpartum haemorrhage?
Oxytocin 10 IU IM or IV. Tranexamic acid 1 g IV within 3 hours of birth is also recommended, with uterine massage and escalation.
What are the WHO gestational diabetes thresholds?
On a 75 g OGTT: fasting 5.1 to 6.9 mmol/L, 1 hour 10.0 mmol/L or more, or 2 hour 8.5 to 11.0 mmol/L.
Do I need national antenatal schedules?
We could not verify national schedule details, so we do not teach them. Answer from WHO, RCOG or ACOG logic.