Obstetrics and gynaecology is about 7% of NRE Step I, roughly 14 of 200 items, and PM&DC's published blueprint gives the same figure of 14 for it. The syllabus text for this discipline was not legible in the copy we read, so the topic list below follows the standard Pakistani MBBS final-year scope and the structure of the 2024 document. Expect emergency obstetrics (pre-eclampsia and eclampsia, postpartum haemorrhage, antepartum haemorrhage, obstructed labour), early pregnancy problems, contraception, abnormal uterine bleeding, infertility and gynaecological cancers. Local points: magnesium sulphate for eclampsia, oxytocin for PPH prevention, and the maternal health picture in Pakistan.
Weight and expected item count
With 14 items, obstetrics and gynaecology is worth about 28 minutes of paper time. It shares the same weight as paediatrics. The core is a small set of emergencies, so mastering the first ten topics below covers the ground that matters most. Step II also has two obstetrics and gynaecology stations, so what you learn feeds both exams.
What is tested
| Block | Topics |
|---|---|
| Antenatal | Antenatal care and screening in Pakistani practice; physiological changes of pregnancy; gestational diabetes and medical disorders in pregnancy |
| Hypertension and bleeding | Pre-eclampsia and eclampsia; placenta praevia and abruption; postpartum haemorrhage prevention and management |
| Labour | Stages of labour, partograph, induction, malpresentation; obstructed labour, uterine rupture, caesarean section; preterm labour, PROM, multiple pregnancy |
| Infection and anaemia | Maternal sepsis, anaemia, malaria and hepatitis in pregnancy |
| Early pregnancy | Miscarriage and ectopic pregnancy |
| Gynaecology | Contraception and family planning; menstrual disorders and abnormal uterine bleeding; infertility and PCOS; pelvic inflammatory disease, fibroids and prolapse; menopause and HRT |
| Oncology | Cancers of the cervix, ovary and endometrium |
Local guideline points
- Postpartum haemorrhage: WHO recommends oxytocin 10 IU intramuscularly for prophylaxis and tranexamic acid 1 g intravenously within three hours of birth for treatment. PPH is a leading cause of maternal death in Pakistan.
- Eclampsia: magnesium sulphate is the anticonvulsant of choice, per WHO.
- Maternal mortality: leading causes are PPH, hypertensive disorders, sepsis and obstructed labour. Reported national ratios differ between surveys, so learn the causes, not a single figure.
- Lady Health Worker Programme: community workers who deliver antenatal, postnatal and family planning support in rural and peri-urban areas. It features in questions on referral and the continuum of care.
- Infections in pregnancy: hepatitis B and C and malaria are relevant in the local disease burden. Check the drug's safety in pregnancy before you select it.
- Anaemia: iron deficiency is the common pattern; thalassaemia trait is a differential in microcytosis not responding to iron.
Three typical traps
- Treating the number instead of the patient. In hypertension in pregnancy the right answer depends on severity, gestation and symptoms. A blood pressure that is only mildly raised does not call for delivery, whereas severe features or a seizure do. Read gestation and symptoms first.
- Forgetting that some drugs are unsafe in pregnancy. ACE inhibitors, warfarin, tetracyclines and some antiepileptics have specific risks. When a stem gives a pregnant patient, check each option against pregnancy safety before choosing.
- Skipping the ectopic. Lower abdominal pain, amenorrhoea and a positive pregnancy test with no intrauterine pregnancy on scan is ectopic until proved otherwise. The trap is picking a gynaecological diagnosis that fits the pain but ignores the positive test.
Try PMDC NRE Step I practice questions free
Create a free account and answer sample questions with full explanations before you buy a pass.
How to revise it
| Day | Focus |
|---|---|
| 1 | Antenatal care, physiology, gestational diabetes; 20 questions |
| 2 | Pre-eclampsia, eclampsia, HELLP; antihypertensive choices in pregnancy; magnesium sulphate toxicity signs |
| 3 | Antepartum and postpartum haemorrhage; a step-wise PPH algorithm in your own words |
| 4 | Labour: partograph reading, malpresentations, obstructed labour, induction |
| 5 | Early pregnancy loss, ectopic pregnancy, pelvic inflammatory disease |
| 6 | Contraception, abnormal uterine bleeding, infertility, PCOS, menopause |
| 7 | Gynaecological cancers, fibroids, prolapse; mixed block of 40 |
Draw the partograph once from memory. It is a common route to marks on both Step I and Step II. For the schedule across domains see the study plan.
Core facts to state without notes
- Pre-eclampsia: new hypertension after 20 weeks with proteinuria or other organ involvement. Severe features (headache, visual disturbance, epigastric pain, very high pressure, low platelets, abnormal liver tests) change the plan to magnesium sulphate, blood pressure control and delivery planning.
- Magnesium toxicity: loss of patellar reflexes, then respiratory depression. Calcium gluconate is the antidote.
- PPH causes: think tone, trauma, tissue and thrombin. Atony is the commonest; uterine massage and oxytocin come first, then escalation.
- Antepartum haemorrhage: placenta praevia is painless bleeding, and a digital vaginal examination is avoided until it is excluded; abruption is painful with a firm, tender uterus.
- Ectopic pregnancy: an unstable woman with a positive pregnancy test needs resuscitation and surgery; a stable woman is managed by hCG trend and scan.
- Obstructed labour: a prolonged labour with a tender, banded uterus and a rising pulse points to impending rupture. Early referral and caesarean section are the principle.
- Combined oral contraceptive: contraindicated with migraine with aura, past venous thromboembolism, smoking over age 35 and some other conditions.
- Cervical cancer: screening detects precancer; the commonest cause is persistent high-risk HPV infection.
Self-check list
| Can you say, in one sentence each... | Mark |
|---|---|
| The first-line drugs for severe pre-eclampsia and eclampsia, and how to monitor | red, amber or green |
| The step-wise management of PPH from the first minute | red, amber or green |
| How to read a partograph and when to act | red, amber or green |
| Safe and unsafe antihypertensives and antiepileptics in pregnancy | red, amber or green |
| How you counsel a woman choosing contraception after delivery | red, amber or green |
Links to other domains
Related pages: paediatrics for neonatal care, community medicine for maternal and child health programmes, and clinical pharmacology for drugs in pregnancy and lactation. The local guidelines page carries the maternal health facts with sources.
This page contains no practice questions.
Sit a timed PMDC NRE Step I mock exam
Blueprint-weighted questions under exam timing, then a breakdown of your result by domain.
Frequently asked questions
How many obstetrics and gynaecology questions are in NRE Step I?
PM&DC's published blueprint gives 14 of the 140 clinical items, about 7% of the paper.
Is the OBG syllabus published in full?
The copy of the 2024 syllabus that we read did not include readable text for obstetrics and gynaecology, so our topic list follows the standard Pakistani MBBS final-year scope. Check the PDF on pmdc.pk for the official wording.
What is the drug of choice for eclampsia?
Magnesium sulphate, according to WHO guidance.
What is first-line prevention of postpartum haemorrhage?
Oxytocin 10 IU intramuscularly, per WHO. Tranexamic acid 1 g IV within three hours of birth is used for treatment.
Which obstetric topics should I prioritise?
Hypertensive disorders, antepartum and postpartum haemorrhage, labour and the partograph, obstructed labour, ectopic pregnancy and contraception, then the gynaecological topics.
Does Step II test obstetrics and gynaecology?
Yes. Two of the 20 Step II OSCE stations are obstetrics and gynaecology.