From clinical problem
to the next decision.
Find the assessment, treatment pathway, drug regimen and follow-up in one guide. Open the sources beside the clinical detail, or go straight to an emergency protocol.
Urgent problems
Recognition, help, immediate actions and escalation are grouped in each emergency pathway.
Haemorrhage
Postpartum Haemorrhage →
Start the PPH bundle for measured blood loss ≥500 mL, or ≥300 mL with abnormal haemodynamics (WHO 2025); treat concerning ongoing bleeding/shock immediately without waiting for a volume threshold.
HypertensiveEclampsia →
New seizure during pregnancy after 20 weeks or postpartum: treat suspected eclampsia promptly while considering other causes. Normal BP or absent proteinuria does NOT exclude it.
HypertensiveAcute Severe Hypertension (>=160/110) →
Systolic ≥160 OR diastolic ≥110 mmHg persisting on prompt repeat measurement, generally within 15 min; do not wait 4 h to confirm an emergency.
CollapseMaternal Collapse / Cardiac Arrest →
Unresponsive with absent/abnormal breathing: activate the cardiac-arrest response and start CPR; a trained clinician checks pulse without delaying compressions.
Obstetrics & gynaecology, by clinical problem
Read the full guide or focus on one section. Each topic displays its own review status; section-specific source checks do not imply that the entire module has been audited.
Obstetrics
Labour, induction, mode of birth, fetal assessment and membrane rupture.
- Chronic Hypertension in PregnancyHypertension present before conception or diagnosed <20 weeks; treat from ≥140/90 (CHAP-driven), prevent superimposed pre-eclampsia with aspirin, plan delivery around 38–39 weeks if controlled.
- Gestational HypertensionDe novo BP ≥140/90 after 20 weeks WITHOUT proteinuria/organ dysfunction; ~25% progress to pre-eclampsia; deliver by 37 weeks.
- Pre-eclampsia (without severe features)De novo hypertension after 20 wks + proteinuria OR end-organ dysfunction; ISSHP advises avoiding “mild/severe” labels in ongoing pregnancy — stratify instead by gestation and trajectory; birth at 37 weeks for stable disease.
- Postpartum Hypertension & Postpartum Pre-eclampsiaBP can peak 3–6 days postpartum even after normotensive pregnancies; de novo postpartum PE occurs. Monitor, treat ≥150/95 (or lower threshold per chronic-HTN logic), choose lactation-compatible agents.
- Placenta Praevia & Low-lying Placenta (APH pathway)Painless bright-red APH after 20 wks with malpresentation/high presenting part. NEVER digital examination. Localise with ultrasound; plan birth: resolve by 32 wks if minor/low-lying; caesarean for true praevia ~36–37 wks.
- Vasa PraeviaFetal vessels traversing membranes over the os — ROM tears them → exsanguinating FETAL blood loss with sinus bradycardia. Antenatal detection (TVS colour Doppler) converts a catastrophe into a planned 35-week caesarean.
- Placenta Accreta Spectrum (acreta/increta/percreta)Abnormal placental invasion through the decidua — the modern maternal-surgery killer (praevia + previous caesarean is the classic setup). OUTCOME IS PLANNED: detect on imaging, refer to a centre with blood bank + IR + urology, deliver electively 35–37 wks with multidisciplinary team.
- Labour Management (term)Term labour care per NICE NG235 (updated Jun 2026): one-to-one care, partogram, conservative measures before oxytocin, continuous support. Recognise dystocia early; augment judiciously; active third stage for everyone.
- Induction of Labour (IOL)Bishop <7 needs ripening: prostaglandins OR balloon catheter (lower hyperstimulation). Membrane sweep from term. Failed induction is DEFINED then reassessed - not an automatic caesarean.
- Caesarean SectionClassify URGENCY (Lucas 1-4). Single-dose IV antibiotic BEFORE incision cuts infection ~40%. ERAS bundle: warming, VTE prophylaxis, early feeding, opioid-sparing analgesia with TAP blocks.
- VBAC / TOLACOne prior lower-segment caesarean, no contraindications -> OFFER TOLAC (success 72-75%; rupture ~0.5%). Excluded: classical/J scar, prior rupture, extensive transfundal surgery. Continuous CTG + instant theatre are non-negotiable.
- Breech Presentation & ECVOffer ECV 36+0 wks (nullip) / 37+0 (multip): success ~50-60%. Vaginal breech only for selected cases by experienced attenders under strict criteria; otherwise planned caesarean ~39 wks.
- CTG Interpretation & Intrauterine ResuscitationClassify systematically: baseline, variability, accelerations, decelerations vs contractions. NORMAL/SUSPICIOUS/PATHOLOGICAL categories drive action. Pathological = conservative measures x30 min then escalate; bradycardia = act within minutes.
- Threatened Preterm Labour (<37 weeks with contractions, unchanging cervix)Regular contractions WITHOUT cervical change are often false labour. Objective testing (transvaginal cervical length; fFN where available) prevents unnecessary admissions and treatments.
- Established Preterm Labour (<37 weeks, cervical change)Steroids <34 (+/-34+6), MgSO4 neuroprotection <30-32, nifedipine tocolysis ONLY to complete these + transfer. GBS prophylaxis per protocol. Birth in right place beats heroic delay.
- PPROM (Preterm Prelabour Rupture of Membranes 24+0-36+6)Confirm rupture, exclude labour/infection, then EXPECTANCY with latency antibiotics (erythromycin 250 mg QDS x10 days per GTG73), steroids, surveillance for chorioamnionitis; deliver ~34 wks (individualise 30-36+6).
- Term PROM (>=37 weeks)Confirm rupture; offer choice of induction (usually within 24 h) vs supervised waiting 24 h if GBS-negative and reassuring. GBS-positive/recent positive screen -> induction + intrapartum penicillin.
- Fetal Growth Restriction / SGASGA = size <10th centile; FGR = failure to reach genetic potential (pathology). Doppler-driven management: UA/MCA/DV surveillance, steroids <34+6 at risk of birth, MgSO4 <32, deliver by severity trajectory - not by centile alone.
- Multiple Pregnancy (twins incl. TTTS/TAPS/TRAP)Chorionicity at 11-13+6 wks is destiny-defining: DCDA surveillance q4 wks; MCDA q2 wks from 16 wks (TTTS screening); MCMA inpatient from 26-28 wks typical. Delivery timing: DCDA 37-38, MCDA 36-37 (+/-34-37 range), MCMA ~32-34.
- Reduced Fetal MovementsNever dismiss. Assessment = CTG + US (growth/fluid/Doppler as indicated). Recurrent RFM warrants structured follow-up; associated with stillbirth risk elevation.
Obstetric Emergencies
Haemorrhage, hypertensive emergencies and complications of early pregnancy and birth.
- Pre-eclampsia with Severe Features / Severe Pre-eclampsiaPE plus severe-range BP, neurology, hepatic/renal/haematological involvement or pulmonary oedema. Stabilise with MgSO4 + antihypertensives, steroids if <34+6, then deliver ≥34 wks (expectancy 24–33+6 only in expert centres with intensive surveillance).
- EclampsiaGeneralised seizures in a woman with pre-eclampsia (any time antepartum/intrapartum/up to several days postpartum). MgSO4 halves recurrent seizures; stabilise THEN deliver. National Eclampsia Registry: >50% antepartum, ~13% postpartum.
- HELLP SyndromeHaemolysis + Elevated Liver enzymes + Low Platelets — a variant of severe pre-eclampsia that may present WITHOUT marked hypertension. Birth is definitive; transfuse selectively; beware misdiagnosis as gastritis/hepatitis.
- Postpartum Haemorrhage (PPH)Recognise PPH early: measured loss ≥500 mL, or ≥300 mL with abnormal haemodynamics; treat concerning ongoing bleeding/shock immediately. Resuscitation, uterotonics, early TXA and 4Ts source control proceed together, with timely tamponade or surgery.
- Placental AbruptionPremature separation — PAINFUL tense uterus ± dark bleeding ± fetal distress. Hidden losses mislead; DIC is the killer. Delivery decision dominates management; steroids <34, MgSO4 <32, aggressive coagulation support.
- Ectopic PregnancyImplantation outside endometrial cavity (95% tubal). Rupture kills young women — ANY reproductive-age woman with pain+bleeding has an ectopic until proven otherwise. Choose expectant/medical/surgical by stability, hCG, size, heartbeat.
- Shoulder DystociaHead delivers; anterior shoulder impacts behind symphysis (turtle sign). CALL HELP then McRoberts + suprapubic pressure resolves most; then internal manoeuvres. Record times. Expect PPH and neonatal review.
- Cord ProlapseCord beside/below presenting part after ROM -> relieve compression NOW, birth FAST. Knee-chest/Sims tilt, bladder fill, manual elevation, category-1 caesarean unless vaginal birth imminent.
- VTE in Pregnancy (DVT/PE + Thromboprophylaxis)Suspect PE -> LMWH immediately pending imaging in most stable patients. Weight-based enoxaparin. Neuraxial rules: prophylactic dose 12 h before/4 h after epidural-spinal (24h therapeutic). Continue >=6 wks postpartum; breastfeeding-compatible.
- Maternal SepsisPregnancy-specific triggers (septic abortion, chorioamnionitis, endometritis, mastitis necrosis, UTI/pyelo). Sepsis Six adapted: cultures+lactate, broad antibiotics within 1 h, fluids, oxygen as needed, source control (EVACUATE retained products!), hourly reassessment.
Early Pregnancy & Abortion Care
Pregnancy location, pregnancy loss, recurrent miscarriage and termination care.
- Pregnancy of Unknown Location (PUL)Positive pregnancy test with no pregnancy visualised on TVS. It is a DESCRIPTION, not a diagnosis. Serial hCG + review until location declared; ~7–20% are ectopic.
- Miscarriage Management (threatened/incomplete/missed)Offer ALL three management routes (expectant, medical, surgical) where safe. Medical: mifepristone+miso or miso-alone regimens. Surgical: MVA/EVA under analgesia. Watch: sepsis, heavy bleeding, Rh prophylaxis, psychological care.
- Recurrent Miscarriage≥3 early losses, not necessarily consecutive (consider earlier assessment by clinical context): investigate APS, parental karyotypes, thyroid/PCOS/anatomical factors; evidence-supported treatments: progesterone for bleeding+prior loss (PRISM), LMWH+aspirin ONLY for APS.
- Medical Termination of Pregnancy — Indian Legal FrameworkVERIFIED against Gazette (Aug 2026): ≤20 wks needs ONE RMP; >20–24 wks needs TWO RMPs for Rule 3B categories; >24 wks ONLY via State Medical Board for substantial foetal abnormalities; NO upper limit where woman’s life at risk. Section 5A confidentiality is statutory.
Gynaecological Oncology
Cancer recognition, screening, staging references and specialist referral.
- Molar Pregnancy & Gestational Trophoblastic DiseaseConfirm molar histology, arrange safe uterine evacuation and register hCG follow-up. Partial and complete moles have different surveillance after hCG normalisation; plateauing/rising hCG requires trophoblastic-centre assessment.
- Endometrial CancerPMB workup -> biopsy. Staged per FIGO 2023 (molecular classes POLEmut/MMRd/NSMP/p53abn integrated; IAm/IICm annotations). Surgery core; adjuvant by risk group per ESGO-ESTRO-ESP Update 2025.
- Cervical CancerScreening-detected CIN vs invasive cancer pathways diverge at histology. FIGO 2018 clinical staging drives therapy: early = radical hysterectomy; locally advanced = concurrent chemoradiation (cisplatin-based standard). India: HPV vaccination + VIA/screening scale-up national priority.
- Ovarian · Vulval · Vaginal Cancer & GTN IndexAdnexal mass with malignancy markers -> direct oncology referral (avoid incomplete surgery outside centres). Ovarian: cytoreductive surgery + platinum chemo backbone. Vulval/vaginal: stage-based surgery±radiotherapy. GTN: hCG registry + single/multi-agent chemo at trophoblastic centres (>90% cure).
Medical Disorders in Pregnancy
Diabetes, anaemia, thrombosis and other medical disorders during pregnancy.
- Gestational Diabetes MellitusThe India programme tests all pregnancies at the first ANC and repeats a negative early test at 24–28 weeks. Record the diagnostic framework: its non-fasting 75 g method differs from a fasting OGTT. Nutrition, monitoring and individualised medication follow diagnosis; plan birth and postpartum testing.
- Pregestational Diabetes (T1/T2)NICE advises a preconception HbA1c below 6.5% when achievable without problematic hypoglycaemia. Assess retinal/renal disease, review pregnancy-inappropriate medicines, and plan individual insulin, glucose monitoring, birth and postpartum dose changes.
- Thyroid Disease in PregnancyTreat overt hypothyroidism with TFT-guided levothyroxine. Graves treatment uses the lowest effective antithyroid dose, with PTU favoured early and a possible carbimazole switch beyond 20 weeks. Thyroid storm requires ICU-led treatment with attention to cardiac function, liver risk and iodine timing.
- Anaemia in Pregnancy (Iron/Folate/B12)Assess anaemia using the gestational reference range and confirm iron deficiency rather than assuming every microcytic anaemia is IDA. Distinguish preventive iron/folate from treatment; calculate the full IV replacement need and review response.
- Hyperemesis GravidarumPUQE scoring guides severity. Rehydrate (thiamine BEFORE dextrose!), pyridoxine+doxylamine/pyridoxine monotherapy first line, add ondansetron/promethazine/metoclopramide ladder; steroids late-resort; thromboprophylaxis when immobile.
- Intrahepatic Cholestasis of PregnancyPruritus (palms/soles) + raised bile acids WITHOUT rash/other liver cause. Ursodeoxycholic acid improves itch (not clearly outcomes). Fetal risk rises with bile acids >100 µmol/L; individualise delivery timing ~35-38+ wks by severity.
- Chronic Medical Disorders Quick-Reference (asthma · epilepsy · cardiac · CKD · SLE/APS)Continuity beats novelty: keep effective pre-pregnancy regimens (with teratogen switches), monitor organ function each trimester, plan birth in appropriately equipped units.
Infections in Pregnancy
Maternal infection, pregnancy-specific treatment, partner care and follow-up.
- UTI & Pyelonephritis in PregnancyScreen asymptomatic bacteriuria (treat ALL positive - pyelo/preterm risk). Cystitis: nitrofurantoin/cephalexin courses. Pyelonephritis = ADMISSION + IV ceftriaxone; preterm-labour watch.
- Chorioamnionitis / Intra-amniotic InfectionFever >=38 intrapartum or maternal/fetal tachycardia+foul liquor: antibiotics NOW + expedite birth. Ampicillin+gentamicin(+metronidazole post-CS). Neonatal team alerted.
- GBS Colonisation (prevention of early-onset neonatal disease)Rectovaginal screening 36-37 wks where policy-based; risk-based approach where not. Intrapartum benzylpenicillin for positives/risk factors.
- Syphilis in PregnancyUniversal early screening (India programme) + third-trimester repeat in high-risk. Penicillin is the ONLY fetal-safe curative agent - desensitise if allergic. Treat stage-appropriately; partner management; follow-up titres.
- Chlamydia in PregnancyAzithromycin 1 g PO single dose (doxycycline CONTRAINDICATED in pregnancy). Re-test 4 weeks post-completion; partner treatment; re-screen T3 high-risk.
- Gonorrhoea in PregnancyCeftriaxone 500 mg IM single dose (<150 kg; 1 g >=150 kg) + chlamydia cover if unexcluded. Test-of-cure NAAT 2 wks (pregnancy-specific recommendation).
- Genital Herpes in PregnancyFirst episode: acyclovir 400 mg TDS x7-10d + suppressive acyclovir from 36 wks for recurrent-genital-HSV mothers. Active lesions AT BIRTH -> caesarean offered (primary episode esp.).
- Vaginitis Bundle (BV · candidiasis · trichomoniasis)Treat the diagnosed cause: symptomatic BV, Candida and trichomoniasis have different regimens. Use the complete seven-day oral metronidazole/BV-alternative cards or the pregnancy topical-azole course; trichomoniasis also needs partner care.
- Pelvic Inflammatory DiseaseLow threshold to treat. Outpatient (uncomplicated): ceftriaxone 500 mg IM x1 + doxycycline 100 BD x14 d + metronidazole 500 BD x14 d (CDC 2021 PID). Inpatient criteria incl. TOA/pregnancy/severe. TOA >5 cm or rupturing -> drainage.
- Viral Infections Quick-Reference (HIV · HBV · HCV · rubella · CMV · varicella · influenza · COVID)Key actions: universal HIV/HBV/HCV screening; ART for all HIV+ (viral suppression = near-zero transmission); HBV immunoglobulin+vaccine to newborns of HBsAg+ mothers; NO live vaccines in pregnancy (MMR/varicella) - immunoglobulin post-exposure instead; influenza vaccine safe & recommended; COVID current-era management per national guidance.
Gynaecology
Bleeding, pelvic pain, benign gynaecology, menopause and pelvic-floor symptoms.
- Abnormal Uterine Bleeding (PALM-COEIN)Classify PALM-COEIN after excluding pregnancy/cervical/endometrial pathology by age/risk. Acute heavy bleeding: resuscitate -> TXA -> hormonal stop ladder -> D&C if failing. Chronic HMB: LNG-IUS first-line medical where suitable.
- Polycystic Ovary Syndrome2 of 3 criteria (hyperandrogenism/OV dysfunction/PCOM-or-elevated AMH in adults). Lifestyle foundation. Menstrual control COCP/progestogens; metformin metabolic; LETROZOLE first-line ovulation induction (2023 guideline, high certainty).
- EndometriosisDysmenorrhoea/dyspareunia/chronic pain ± subfertility. Empirical hormonal suppression reasonable with negative imaging; laparoscopy diagnostic+therapeutic; post-surgical suppression reduces recurrence.
- Uterine FibroidsManage by symptoms/fertility/location: medical as AUB module; hysteroscopic resection submucous FIGO 0-1; myomectomy fertility-preserving; UAE completed families alternative; hysterectomy definitive.
- Adnexal Masses, Ovarian Cysts & TorsionFunctional cysts observe/reimage 6-12 wks. Risk scoring directs oncology referral. TORSION = emergency laparoscopy with DETORSION (ovary-sparing standard); normal Doppler does NOT exclude.
- Menopause, Perimenopause & POIIndividualise HRT: uterus intact = estrogen+progestogen; hysterectomy = estrogen-only; POI = replacement AT LEAST to average natural menopause age. Vaginal estrogen safe long-term. EVERY postmenopausal bleed investigated.
- Cervical Screening & HPV (incl. vaccination)India lacks universal organised screening - opportunistic VIA/Pap/HPV testing per national cancer-programme guidance; WHO elimination strategy: HPV vaccination girls 9-14 + lifetime screening targets. Abnormal results -> colposcopy pathway with defined biopsy/treatment rules.
Urogynaecology
Urinary symptoms, prolapse, continence assessment and pelvic-floor care.
Contraception & Infertility
Contraceptive choices, reproductive goals and fertility assessment.
- Contraception Master ModuleEffectiveness hierarchy favours LARC. WHO MEC categories guide eligibility by condition. Postpartum: PPIUCD/POP/DMPA anytime; implant anytime; COCP delayed 6 wks breastfeeding. Emergency contraception: copper IUD gold standard; LNG 1.5 mg within 72 h (or 3 d window); ulipristal where available.
- Female Infertility Evaluation & ManagementStructured workup at 12 m trying (<35 y) or 6 m (>=35). Ovulation status, semen analysis FIRST, tubal patency (HSG/hyCoSy), ovarian reserve contextualised. Treat cause: letrozole-first OI for anovulation (PCOS 2023), gonadotrophins second line, ART escalation.
Antenatal Care
Antenatal contacts, maternal assessment and the routine-care schedule.
Clinical tools beside the guide
Use differential-diagnosis presentations for structured workup, drug references for indication-specific regimens, calculators for entered clinical values, and procedure guides for preparation and follow-up.
66 modules remain in review or marked outdated. Check the page status and source register when using the reference.