Women's Health for the AMC MCQ: Obstetrics and Gynaecology Revision

Women's health, meaning obstetrics and gynaecology, makes up 12.5% of the AMC CAT MCQ Examination blueprint. That is about 19 questions in a 150-item exam. AMC obstetrics and gynaecology MCQ items lean heavily on Australian programs and statements, such as the National Cervical Screening Program, the Immunisation Handbook pregnancy schedule, RhD prophylaxis and SOMANZ hypertension guidance. That makes it one of the most learnable domains if you revise the right numbers.

This hub covers antenatal care, pregnancy complications, labour and the postpartum period, early pregnancy and gynaecology. Each section focuses on what Australian guidance says today.

How AMC obstetrics and gynaecology MCQ questions are examined

Women's health items use the standard single best answer format and test all three AMC clinician tasks. Typical stems include:

• Antenatal care: a booking visit or routine review where you choose the test, vaccine or supplement due at that gestation.
• Acute obstetrics: bleeding, hypertension, reduced fetal movements or postpartum deterioration, where the question is the immediate next step.
• Early pregnancy: pain or bleeding with a positive pregnancy test, where the stem tests whether you can exclude ectopic pregnancy safely.
• Gynaecology and sexual health: a screening result to act on, a menstrual problem to investigate, or a contraception choice.

Gestational age is the most important number in every obstetric stem. Read it first, then work out which tests, vaccines and decisions apply at that point.

Antenatal care in Australia

The first antenatal visit

The RACGP recommends the first antenatal visit within the first 10 weeks of pregnancy. Offer the following:

Supplements

• Folic acid: 400 micrograms daily from 1 month before conception through the first 3 months. Use 5 mg daily if risk is higher, for example with anticonvulsant use, pre-existing diabetes, a previous neural tube defect or BMI over 30.
• Iodine: 150 micrograms daily throughout pregnancy, except in women with Graves' disease.
• Calcium: at least 1 g daily for women at high risk of pre-eclampsia with low dietary intake.
• High-dose vitamins A, C and E: not recommended.

Vaccination in pregnancy

Live vaccines such as MMR and varicella are contraindicated in pregnancy. A rubella non-immune woman is vaccinated postnatally.

Rh D immunoglobulin (anti-D)

Australian guidance for Rh D-negative women without preformed anti-D:

• Routine prophylaxis: 625 IU at 28 weeks (after the antibody screen is taken) and 625 IU at 34 weeks.
• Sensitising events in the first 12 weeks (miscarriage, ectopic, molar pregnancy, termination after 10 weeks): 250 IU.
• Sensitising events after 12+6 weeks (antepartum haemorrhage, abdominal trauma, external cephalic version): 625 IU, with fetomaternal haemorrhage quantified after 20 weeks.
• Timing: as soon as practical within 72 hours. If that is missed, give up to 10 days after the event.
• After birth: 625 IU if the baby is Rh D positive.

Routine anti-D is not supported for termination before 10 weeks. Candidates often lose this mark by giving anti-D for every early loss.

Medical complications of pregnancy

Gestational diabetes

The routine test is a 75 g two-hour OGTT at 24–28 weeks. Women with risk factors should have an HbA1c in the first trimester. Those with previous gestational diabetes, or an early HbA1c of 6.0–6.4% (42–47 mmol/mol), should have an OGTT before 20 weeks, ideally at 10–14 weeks. An HbA1c of 6.5% or more, fasting glucose of 7.0 mmol/L or more, or a 2-hour value of 11.1 mmol/L or more at any gestation indicates overt diabetes in pregnancy.

The ADIPS 2025 consensus raised the diagnostic thresholds for gestational diabetes. One or more of the following now confirms the diagnosis:

• fasting glucose 5.3–6.9 mmol/L
• 1-hour glucose 10.6 mmol/L or more
• 2-hour glucose 9.0–11.0 mmol/L

These replace the earlier 5.1, 10.0 and 8.5 mmol/L cut-offs. Services are moving to the new thresholds at different speeds, so read the values in the stem carefully. A clearly diabetic result is unambiguous under either set.

Hypertensive disorders of pregnancy

The SOMANZ 2023 guideline is the Australian reference. The core decisions are:

• Prevention: aspirin 150 mg daily, ideally at night, started before 16 weeks for women at high risk. It may be stopped between 34 weeks and birth. Universal aspirin for low-risk first pregnancies is not recommended.
• Stable hypertension: labetalol, methyldopa or nifedipine as first-line, with the choice individualised.
• Severe hypertension (160/110 mmHg or above): an emergency. Use short-acting agents, such as IV hydralazine, IV labetalol or oral immediate-release nifedipine, and treat to below 160/110.
• Eclampsia prevention: magnesium sulfate, 4 g IV loading dose, then 1 g per hour, continued for 24 hours.
• Timing of birth: plan birth for pre-eclampsia at 37 weeks or later. Before 37 weeks, decide on maternal and fetal stability, and deliver at any gestation if the mother deteriorates.
• After birth: review within 1 week of discharge. Women with pre-eclampsia carry long-term cardiovascular risk, so they need ongoing follow-up.

Other medical problems in pregnancy

Cystitis in pregnancy is treated with nitrofurantoin 100 mg 6-hourly for 5 days (send a urine culture first and avoid nitrofurantoin close to delivery), and asymptomatic bacteriuria is always treated. Also revise thyroid disease (check TSH if risk factors are present), VTE risk assessment, anaemia, and the safety of common drugs in pregnancy and breastfeeding.

Labour, birth and the postpartum period

Threatened preterm birth

• Antenatal corticosteroids: recommended when preterm birth is planned or expected within 7 days at up to 34 weeks and 6 days. The ideal timing is within 48 hours of birth. The regimen is betamethasone 11.4 mg IM, two doses 24 hours apart.
• Magnesium sulfate for fetal neuroprotection: recommended when birth is likely before 30 weeks. Between 30 and 34 weeks the decision is individualised.

Postpartum haemorrhage

Primary PPH is blood loss of 500 mL or more within 24 hours of birth. Severe PPH is 1,000 mL or more. Think of the 4 Ts: tone (70–80% of cases), trauma, tissue and thrombin.

Perinatal mental health

Screen with the Edinburgh Postnatal Depression Scale at the first visit, at least once later in pregnancy and after birth. Distinguish the baby blues (first days, self-limiting) from postnatal depression and from postpartum psychosis, which is a psychiatric emergency needing same-day assessment. For more on this, see the mental health hub.

Early pregnancy problems

Bleeding or pain in early pregnancy needs a quantitative β-hCG and a transvaginal ultrasound to locate the pregnancy. An unstable patient with a positive pregnancy test and abdominal pain has a ruptured ectopic pregnancy until proven otherwise. Resuscitate and take her straight to theatre. A pregnancy of unknown location in a stable patient is followed with serial hCG levels and repeat ultrasound.

Early medical abortion with mifepristone and misoprostol (MS-2 Step) is approved in Australia up to 63 days of gestation. Since 2023, any registered medical practitioner can prescribe it without additional certification, and nurse practitioners and endorsed midwives may also prescribe. Ultrasound helps confirm gestation and exclude ectopic pregnancy. State laws on later abortion differ, so stems usually focus on early care.

Gynaecology and sexual health

National Cervical Screening Program

Asymptomatic women and people with a cervix aged 25–74 have an HPV-based Cervical Screening Test every 5 years. Self-collection is offered to everyone eligible, has the same accuracy for HPV testing as a clinician-collected sample, and is safe in pregnancy.

After treatment for HSIL, test of cure is an annual HPV test starting 12 months after treatment. The patient returns to routine screening after two consecutive negative results.

Abnormal uterine bleeding and postmenopausal bleeding

Assess heavy menstrual bleeding for anaemia, structural causes and coagulopathy. Postmenopausal bleeding is endometrial cancer until proven otherwise. Investigate with transvaginal ultrasound and endometrial sampling as indicated. Unexplained bleeding on menopausal hormone therapy after the first 6 months also needs investigation.

Polycystic ovary syndrome

The 2023 International PCOS Guideline, led from Australia, diagnoses adults with at least two of hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology. AMH can replace ultrasound for morphology in adults. Ultrasound and AMH are not used in adolescents. The guideline's management points:

• lifestyle support for everyone
• the combined pill for irregular cycles or hirsutism
• metformin for metabolic features
• letrozole as first-line ovulation induction

Contraception and emergency contraception

Long-acting reversible contraception (implant and IUDs) is the most effective option and suits most women, including adolescents and nulliparous women. For emergency contraception:

• Copper IUD: within 120 hours (5 days). This is the most effective option, and it continues as contraception afterwards.
• Ulipristal acetate: up to 5 days. It is more effective than levonorgestrel, but hormonal contraception should be delayed for 5 days afterwards.
• Levonorgestrel: as soon as possible, up to 4 days. A double dose is recommended over 70 kg or BMI over 26.

Menopause

Menopausal hormone therapy is the most effective treatment for vasomotor symptoms. A woman with a uterus needs a progestogen to protect the endometrium, but a woman after hysterectomy does not. Transdermal oestrogen carries less VTE risk than oral, and it suits women with migraine, VTE risk or liver disease. Breast cancer risk is linked mainly to combined therapy and rises with duration.

Common traps for IMGs in women's health

• Old cervical screening rules: 3-yearly Pap smears from 18 or 21 are not Australian practice.
• Wrong pertussis timing: dTpa is given in every pregnancy, ideally 20–32 weeks, even if given in a recent pregnancy.
• Early RSV vaccine: Abrysvo is not given before 28 weeks.
• Anti-D overuse: not routine for termination before 10 weeks; 250 IU, not 625 IU, for events in the first 12 weeks.
• Aspirin dose: Australian guidance uses 150 mg, not 75 mg, started before 16 weeks.
• Skipping hCG: every woman of reproductive age with pain or bleeding needs a pregnancy test first.

How to study AMC obstetrics and gynaecology MCQs in our question bank

Women's health has a smaller share of questions than medicine or surgery. It is also dense with numbers that are easy to memorise and easy to confuse.

1. Build a gestation timeline: write each test, vaccine and decision against the week it applies, then drill it in the question bank in tutor mode.
2. Drill screening results: run every cervical screening outcome until the next step is automatic.
3. Practise emergencies under time: PPH, eclampsia, ectopic pregnancy and severe hypertension, at 84 seconds per question.
4. Review across domains: pregnancy-related items overlap with the adult medicine hub, and neonatal questions sit in child health.
5. Test in mixed blocks: about one item in eight should be women's health, as in the real exam.

For the full list of Australian screening and immunisation differences across domains, see Australian guidelines for the AMC MCQ.

Worked practice questions