Which high‑yield tables should I prepare for the Royal College OBGYN exam covering congenital malformations, teratogenic agents, perinatal infections with ultrasound correlates, obstetric emergencies, and hypertensive disorders of pregnancy?

High-Yield Tables for Royal College OBGYN Exam Preparation

You should create comprehensive tables covering congenital malformations with ultrasound findings, teratogenic medications, perinatal infections, obstetric emergencies, and hypertensive disorders—these represent the core high-yield topics consistently tested on Royal College examinations.

Essential Table Categories

1. Congenital Malformations & Ultrasound Correlates

Create a table linking specific congenital anomalies to their characteristic ultrasound findings, organized by organ system:

• Cardiac anomalies should include congenital heart block (particularly in context of maternal autoimmune disease), structural defects, and their sonographic markers 1
• Neural tube defects with specific measurements and associated soft markers 1
• Renal anomalies including hydronephrosis, multicystic dysplastic kidney, and renal agenesis with their ultrasound characteristics 1
• Skeletal dysplasias with long bone measurements and characteristic features 1
• Gastrointestinal malformations including bowel obstruction patterns and abdominal wall defects 1

2. Teratogenic Medications & Pregnancy Categories

Develop a comprehensive table of medications contraindicated or requiring modification in pregnancy:

• DMARDs and immunosuppressants with specific timing of discontinuation (e.g., methotrexate, mycophenolate) and pregnancy-compatible alternatives 1
• Anticoagulants including warfarin (teratogenic in first trimester), with safe alternatives like LMWH 1
• Antihypertensives noting ACE inhibitors and ARBs as contraindicated, with safe alternatives 1
• Antiepileptics with specific malformation risks (valproate carries highest risk) 1
• Cytotoxic agents used in myeloproliferative disorders, with timing considerations 1
• Hormonal contraceptives and their absorption considerations post-bariatric surgery 1

3. Perinatal Infections (TORCH-Plus)

Create a table with organism, transmission timing, ultrasound findings, and neonatal manifestations:

• Toxoplasmosis: intracranial calcifications, hydrocephalus, chorioretinitis 1
• Rubella: cardiac defects, cataracts, growth restriction 1
• Cytomegalovirus: periventricular calcifications, ventriculomegaly, microcephaly 1
• Herpes simplex: microcephaly, intracranial calcifications (less common than CMV) 1
• Syphilis: hepatosplenomegaly, hydrops, placentomegaly 2
• HIV: vertical transmission rates and prevention strategies 2
• Hepatitis B & C: screening recommendations and neonatal prophylaxis 2
• Gonorrhea & Chlamydia: screening timing and treatment to prevent neonatal complications 2

4. Hypertensive Disorders of Pregnancy

Construct a comparison table with diagnostic criteria, management, and complications:

• Gestational hypertension: BP ≥140/90 after 20 weeks without proteinuria, cardiovascular risk RR 1.67 1
• Pre-eclampsia: BP ≥140/90 plus proteinuria or end-organ dysfunction, with moderate (OR 2.24) and severe (OR 2.74) forms carrying different cardiovascular risks 1
• Eclampsia: seizures in context of pre-eclampsia 1
• HELLP syndrome: hemolysis, elevated liver enzymes, low platelets as severe variant 1
• Chronic hypertension: pre-existing or diagnosed before 20 weeks 1
• Superimposed pre-eclampsia: pre-eclampsia developing on chronic hypertension 1
• Include long-term cardiovascular implications: recurrent pre-eclampsia increases ischemic heart disease risk (RR 2.40) and stroke risk (RR 1.69) 1

5. Obstetric Emergencies

Develop an action-oriented table with recognition criteria and immediate management:

• Postpartum hemorrhage: definition (>500 mL vaginal, >1000 mL cesarean), causes (4 T's), stepwise management 1, 3
• Placental abruption: clinical presentation, ultrasound limitations, fetal monitoring, delivery timing (associated with OR 1.82 for cardiovascular disease) 1
• Cord prolapse: immediate management including manual elevation and emergency cesarean 3
• Shoulder dystocia: recognition and sequential maneuvers (McRoberts, suprapubic pressure, internal rotation) 3
• Uterine rupture: risk factors (prior cesarean, high-dose oxytocin), presentation, management 1
• Amniotic fluid embolism: clinical triad, supportive management 1
• Maternal cardiac arrest: modifications to ACLS (left lateral tilt, perimortem cesarean timing) 1

6. Adverse Pregnancy Outcomes & Long-Term Risks

Create a table linking pregnancy complications to future maternal cardiovascular disease:

• Stillbirth: non-fatal cardiovascular disease OR 1.49, fatal OR 2.23 1
• Preterm birth: composite cardiovascular disease OR 1.63 (non-fatal), OR 1.93 (fatal), HR 2.01 (combined) 1
• Recurrent preterm birth: ischemic heart disease HR 1.4-1.8, stroke HR 1.8 1
• Gestational diabetes: ischemic heart disease RR 2.09, stroke RR 1.25, composite cardiovascular disease RR 1.98 1
• Miscarriage: ischemic heart disease OR 1.45 1
• Early menopause: ischemic heart disease RR 1.50, cardiovascular mortality RR 1.19 1

7. Gestational Diabetes Diagnostic Criteria

Include both 75g and 100g OGTT thresholds:

• 75g OGTT: Fasting ≥95 mg/dL (5.3 mmol/L), 1-hour ≥180 mg/dL (10.0 mmol/L), 2-hour ≥155 mg/dL (8.6 mmol/L) 1
• 100g OGTT: Fasting ≥95 mg/dL (5.3 mmol/L), 1-hour ≥180 mg/dL (10.0 mmol/L), 2-hour ≥155 mg/dL (8.6 mmol/L), 3-hour ≥140 mg/dL (7.8 mmol/L); requires two or more abnormal values 1
• Treatment targets: Fasting plasma glucose ≤105 mg/dL (5.8 mmol/L), 1-hour postprandial ≤155 mg/dL (8.6 mmol/L), 2-hour postprandial ≤130 mg/dL (7.2 mmol/L) 1
• Postpartum reclassification: at 6 weeks minimum using standard diabetes diagnostic criteria 1

8. Bariatric Surgery & Pregnancy Complications

Construct a table of timing, monitoring, and specific complications:

• Contraception counseling: LARC preferred over oral contraceptives due to malabsorption concerns post-RYGB/SG 1
• Preconception optimization: delay pregnancy until weight stabilization, optimize micronutrient status 1
• Gestational weight gain monitoring: monthly fetal growth scans from viability, adjust gastric band if growth restriction 1
• Internal herniation: specific to RYGB, requires high index of suspicion with any abdominal pain, early surgical intervention critical 1
• Micronutrient monitoring: iron, B12, folate, vitamin D, calcium, PTH throughout pregnancy and lactation 1
• Hyperemesis management: deflate adjustable gastric band to prevent slippage and meet nutrient requirements 1

9. Maternal Risk Stratification & Levels of Care

Develop a table categorizing conditions by required care level:

• Level I (basic care): low-risk pregnancies, standard prenatal monitoring 4
• Level II (specialty care): gestational diabetes, mild hypertension, prior cesarean 4
• Level III (subspecialty care): pre-existing diabetes, cardiac disease, multiple gestations, severe pre-eclampsia 4
• Level IV (regional centers): complex maternal conditions, severe cardiac disease (pulmonary arterial hypertension requires surgical termination capability if needed), myeloproliferative neoplasms 1, 2, 4

10. Physiological Changes in Pregnancy vs. Pathology

Create a reference table distinguishing normal from abnormal findings:

• Heart rate: increase of 10-20 bpm normal, particularly third trimester 1
• Blood pressure: decrease 10-15 mmHg by 20 weeks normal, returns to baseline by term 1
• Respiratory rate: unchanged; RR >20 suggests pathology 1
• Cardiac output: increases 40-50% by 32 weeks, further increase during labor 1
• BNP and troponin: should remain normal; elevation suggests pathology (though troponin may elevate in pre-eclampsia, PE, myocarditis) 1
• D-dimer: not recommended for use in pregnancy due to physiologic elevation 1
• ECG changes: sinus tachycardia, 15° left axis deviation, T-wave inversions in III/aVF are normal 1

Common Pitfalls to Avoid

• Do not rely solely on Grade A evidence: only 9-12% of Royal College guidelines are based on highest-quality evidence, so familiarity with Grade B and C recommendations is essential 5
• Recognize exam format: the OSCE format tests clinical skills across stations; tables should support both knowledge recall and clinical application 6
• Include long-term implications: pregnancy complications predict future cardiovascular disease, a concept increasingly emphasized in guidelines 1
• Document medication timing: many teratogenic effects are trimester-specific (e.g., warfarin in first trimester, ACE inhibitors in second/third) 1
• Distinguish between screening and diagnostic tests: know when to use each for conditions like gestational diabetes 1

The Royal College examination emphasizes integration of knowledge across obstetrics and gynecology subspecialties, so your tables should facilitate rapid cross-referencing between related conditions 6, 5.