OG35.{1-14,19},OG36.1-2,OG38.4 | Core Clinical Skills — Glossary

Mnemonic for the four causes of postpartum haemorrhage: Tone (uterine atony, ~80%), Trauma (lacerations, uterine rupture), Tissue (retained placenta or products), Thrombin (coagulopathy/DIC).

Systematic first-response assessment framework: Airway, Breathing, Circulation, Disability (neurological), Exposure; applied to every critically ill obstetric patient before focused obstetric management.

The number of pregnancy losses (spontaneous or induced) before 28 weeks of gestation.

Premature separation of a normally situated placenta before delivery; presents with painful, board-like uterine rigidity, dark-red vaginal bleeding (which may be concealed), and fetal compromise; DIC is a serious complication.

A package of interventions to reduce PPH: oxytocin 10 IU IM immediately after delivery of the anterior shoulder, controlled cord traction, and uterine massage after placental delivery; recommended by WHO as standard care for all deliveries.

Attitude, Ethics and Communication module integrated across the NMC 2019 MBBS curriculum; includes competencies in medical ethics, professional behaviour, communication skills, and doctor-patient relationship.

Four criteria for clinical diagnosis of bacterial vaginosis: homogeneous grey-white adherent discharge; vaginal pH >4.5; positive whiff test (fishy odour on adding 10% KOH); >20% clue cells on wet mount. Three of four positive = BV.

Auxiliary Nurse Midwife — a paramedical health worker posted at Sub-Centre and PHC level responsible for ANC registration, vitals recording, immunisation, and register maintenance.

Vaginal bleeding after 20 weeks of gestation; the two most important causes are placenta praevia and abruptio placentae, distinguished clinically by the presence or absence of pain and uterine tenderness.

Serum antibody level to hepatitis B surface antigen; a titre of ≥10 mIU/mL indicates protective immunity following vaccination; healthcare workers are screened post-vaccination to confirm protection.

Accredited Social Health Activist — a trained female community health worker who mobilises women for ANC registration, escort to facility, follow-up of defaulters, and linkage to government health services.

The ethical principle recognising a competent patient's right to make decisions about her own body, including refusing recommended treatment; foundational to reproductive rights in OG.

Communication from the higher-level receiving facility back to the referring clinic informing them of the patient's diagnosis, management, and outcome — essential for continuity of care and quality audit.

A pelvic examination technique in which two fingers of the right hand are placed in the vagina while the left hand palpates the abdomen simultaneously, allowing the uterus and adnexae to be assessed between both hands.

A technique for managing PPH from uterine atony: one fist is placed vaginally against the anterior uterine wall while the abdominal hand compresses the posterior wall, compressing the uterus between both hands to stimulate contraction and reduce bleeding.

Enlarged, tender, fluctuant inguinal lymph node(s) characteristic of lymphogranuloma venereum (LGV) and chancroid; in LGV the groove sign (a groove between nodes above and below the inguinal ligament) is pathognomonic.

Cancer antigen 125; a serum glycoprotein elevated in epithelial ovarian cancer but also in endometriosis, PID, and fibroids; most useful for post-operative monitoring of known ovarian cancer, not as a primary screening test.

The specific antidote for magnesium sulphate toxicity; given as 1 g IV (10 mL of 10% solution) slowly over 10 minutes when signs of toxicity appear (absent knee jerk, respiratory rate <12/min, urine output <25 mL/h).

The ability of a patient to understand information, retain it, weigh it in decision-making, and communicate a decision; assessed at the time of the specific decision and may fluctuate with clinical condition.

A prostaglandin uterotonic (250 µg IM) used for PPH not responding to oxytocin; contraindicated in asthma because it causes bronchospasm; also avoid in hepatic, renal, and cardiac disease.

The primary lesion of syphilis caused by Treponema pallidum; a single, painless, indurated ulcer with a clean base and firm rolled edge, typically healing spontaneously in 3–6 weeks without treatment.

A trained staff member (usually a female nurse) who is present during intimate clinical examinations to protect the dignity, privacy, and safety of the patient and the clinician.

Community Health Centre / First Referral Unit — a facility with specialist OG cover and caesarean section capability, the first level to which complicated obstetric cases are referred from PHC.

Vaginal squamous epithelial cells whose surface is studded with numerous coccobacilli (Gardnerella vaginalis), obliterating the cell border; >20% clue cells on saline wet mount is diagnostic of bacterial vaginosis.

Punctate haemorrhagic spots on the cervix seen in Trichomonas vaginalis infection; visible to the naked eye in fewer than 10% of cases but pathognomonic when present.

The ethical and legal obligation to protect patient information from unauthorised disclosure; clinical documents must be transmitted through secure channels; in medicolegal cases, disclosure to police or court follows specific statutory rules.

A microscopy technique using oblique illumination to visualise unstained, motile Treponema pallidum spirochaetes from fresh ulcer exudate; requires immediate processing and is impractical in most Indian settings.

A consumptive coagulopathy complicating severe obstetric emergencies (abruption, IUFD, amniotic fluid embolism); characterised by bleeding from multiple sites, prolonged PT/aPTT, low fibrinogen, and thrombocytopaenia.

Diabetes in Pregnancy Study Group of India protocol — a GDM screening method using 75 g oral glucose in the non-fasting state; 2-hour blood glucose ≥140 mg/dL = GDM.

A structured clinical communication document completed when a patient leaves inpatient care, providing the receiving provider with administrative details, clinical narrative, and a forward care plan including named medications and follow-up targets.

The correct sequence for putting on (donning) and removing (doffing) personal protective equipment; doffing is performed in reverse order with hand hygiene between each step to prevent self-contamination.

Intracellular rod-shaped inclusions within mononuclear cells visible on Giemsa or silver stain of tissue smear; pathognomonic of granuloma inguinale (donovanosis) caused by Klebsiella granulomatis.

Descent of the widest diameter of the presenting part (usually the biparietal diameter for cephalic presentation) below the plane of the pelvic inlet; clinically, the head is no longer ballotable on Pawlik's grip.

Employees' State Insurance Act governing sickness benefit certification; doctors issue Form 10 (initial) or Form 14 (extension) to certify a patient's incapacity for work.

The estimated date of birth calculated as LMP + 280 days (40 weeks); equivalent to Naegele's rule for a 28-day cycle. Also called estimated date of confinement (EDC).

The rate of the fetal heartbeat; normal range is 110–160 bpm. Persistent bradycardia (<110 bpm) or tachycardia (>160 bpm) may indicate fetal compromise.

The relationship between the long axis of the fetus and the long axis of the uterus: longitudinal (head or breech presenting), transverse, or oblique.

The section of a discharge summary covering medications at discharge, specific follow-up instructions, measurable targets, red-flag symptoms, and restrictions; the most clinically important section for continuity of care.

The first Leopold's manoeuvre: both hands cup the fundus to identify which fetal pole (head or breech) occupies the uppermost part of the uterus.

The distance in centimetres from the upper border of the symphysis pubis to the uterine fundus; after 20 weeks, approximates gestational age in weeks (±2 cm).

The age of the pregnancy measured in completed weeks and days from the first day of the LMP. The normal gestational period is 37–42 weeks.

The obstetric formula: Gravida (total pregnancies), Para (deliveries ≥28 weeks), Abortus (losses <28 weeks), Living (children currently alive).

The total number of pregnancies a woman has had, including the current pregnancy, regardless of outcome. A primigravida is pregnant for the first time.

A dedicated clinic register listing all pregnant or gynaecological patients with conditions requiring enhanced monitoring, referral, or follow-up, with action dates and responsible staff named for each entry.

High-Level Disinfection — a decontamination process that kills all microorganisms except high numbers of bacterial endospores; used for reusable instruments (speculums) that cannot be autoclaved.

Health Management Information System — the NHM's national web-based platform for monthly reporting of health service delivery data from facility to district to national level.

Integrated Counselling and Testing Centre — a facility providing voluntary HIV counselling and testing, including PPTCT services for pregnant women under the National AIDS Control Programme.

Iron-Folic Acid — the government-supplied supplementation given to pregnant women (180 mg elemental iron + 500 mcg folic acid daily for 180 days) to prevent iron-deficiency anaemia in pregnancy.

A legally valid agreement to a medical procedure obtained through a five-step process — capacity, disclosure, understanding, voluntariness, and decision — documented in writing.

International Ovarian Tumour Analysis malignancy rules for ultrasound classification of adnexal masses; M-rule features include ascites, at least four papillary projections, irregular solid tumour, and solid component in multilocular-solid tumour >10 cm; any M-rule without a B-rule = refer for oncology assessment.

Indian Penal Code section criminalising the issuance of a false certificate by a person lawfully authorised to certify — applies to doctors who issue false or backdated medical certificates.

Labour Room Quality Improvement Initiative — an NHM programme providing quality standards and a checklist-based audit framework for obstetric care facilities, applicable to ANC/OG clinic quality audit.

The first day of the last normal menstrual period; the reference point for gestational-age calculation and EDD determination by Naegele's rule.

A benign smooth-muscle tumour of the uterus; the commonest pelvic tumour in women; presents as an irregular, non-tender, firm uterine enlargement often associated with menorrhagia.

Four sequential abdominal palpation grips used to determine fetal lie, presentation, position, attitude, and engagement: (1) fundal grip, (2) lateral grip, (3) first pelvic/Pawlik's grip, (4) second pelvic grip.

A risk that a reasonable patient in the patient's position would consider significant in deciding whether to undergo the procedure; must be disclosed during the consent process regardless of statistical frequency.

A facility-based process requiring documentation of every maternal death within 24 hours using a prescribed review form; mandated by the Ministry of Health and Family Welfare to identify avoidable factors.

Indian legislation entitling employed women to maternity leave; requires a certificate from the attending doctor stating expected or actual date of confinement; 26 weeks paid leave for the first two surviving children.

Mother and Child Protection card — a patient-held booklet recording all antenatal visits, investigations, immunisations, delivery details, and child health records from birth to 5 years.

Mother and Child Tracking System — the NHM national registry that assigns a unique identifier to each pregnant woman and child, enabling tracking across facilities and follow-up of defaulters.

A legal document signed by an NMC-registered medical practitioner after personally examining the patient, attesting to a clinical fact for a defined official purpose such as maternity benefit, sickness leave, or MTP authorisation.

The process of comparing a patient's current medication orders to all medications the patient has been taking, identifying and resolving discrepancies before discharge.

IM magnesium sulphate regimen for eclampsia: loading dose of 4 g IV over 10–15 minutes PLUS 10 g IM (5 g into each buttock); maintenance 5 g deep IM every 4 hours in alternate buttocks; suitable for PHC-level settings without continuous IV monitoring.

IV magnesium sulphate regimen for eclampsia: loading dose 4 g IV over 10–15 minutes followed by 1 g/h IV maintenance infusion; requires continuous IV monitoring of respiratory rate, knee jerks, and urine output.

A clinic contact in which an eligible patient did not receive a recommended service (e.g., HIV counselling, family planning, anaemia screening) — a key quality indicator in integrated OG clinics.

Medical Termination of Pregnancy (Amendment) Act 2021; requires certificate from one registered medical practitioner up to 20 weeks and from two registered medical practitioners for 20–24 weeks in specified categories.

National AIDS Control Organisation 2014 guidelines governing occupational HIV exposure management, including PEP drug regimen (TDF + 3TC + LPV/r), initiation window, and follow-up testing schedule.

Method for calculating EDD: add 1 year, subtract 3 months, and add 7 days to the LMP. Assumes a regular 28-day cycle; add (cycle length − 28) days to adjust for longer cycles.

National Quality Assurance Standards — the MoHFW framework for quality certification of public health facilities, including standards for infrastructure, infection control, patient safety, and service delivery.

The number of deliveries at or beyond 28 weeks of gestation, whether the baby was born alive or stillborn. A nullipara has had no deliveries beyond 28 weeks.

Standardised shorthand for obstetric history: para/gravida notation (e.g. G2P1L1 = gravida 2, para 1, living child 1); must be accurately recorded in every obstetric document to contextualise clinical decisions.

The third Leopold's manoeuvre (first pelvic grip): one hand grasps the lower pole just above the symphysis pubis to identify the presenting part and assess its engagement.

Pre-Conception and Pre-Natal Diagnostic Techniques Act prohibiting sex determination and sex-selective practices; requires registration of all ultrasound facilities and carries criminal penalties for violation.

A trumpet-shaped monaural stethoscope placed directly on the maternal abdomen over the fetal back to auscultate the fetal heart; the simplest and most widely available method of FHS monitoring.

Abnormal implantation of the placenta in the lower uterine segment, covering or near the internal cervical os; presents with painless, bright-red antepartum bleeding; vaginal examination is absolutely contraindicated.

Antiretroviral therapy initiated within 72 hours of occupational HIV exposure (ideally within 2 hours) to prevent HIV seroconversion; standard 28-day regimen per NACO 2014 guidelines.

Blood loss ≥500 mL after vaginal delivery, ≥1000 mL after caesarean section, or any blood loss causing haemodynamic instability; primary PPH occurs within 24 hours, secondary PPH between 24 hours and 12 weeks postpartum.

Prevention of Parent-to-Child Transmission — the national programme providing HIV testing, counselling, and antiretroviral prophylaxis to HIV-positive pregnant women to prevent perinatal transmission.

The part of the fetus that occupies the lower pole of the uterus and will lead through the pelvis during delivery: vertex (cephalic), breech, shoulder (in transverse lie), face, or brow.

A structured working hypothesis formulated after history and examination, combining the obstetric formula, gestational age, fetal presentation and status, and the primary clinical problem; it guides further investigations and management.

Consent given on behalf of an unconscious or incapacitated patient by a legally recognised next-of-kin (spouse, adult child, or parent in order of priority); valid when patient-directed advance directives are absent.

Specific symptoms listed in a discharge summary that should prompt the patient to seek immediate medical attention — in OG postnatal context: heavy vaginal bleeding, severe headache, blurred vision, convulsion, fever, chest pain.

A professional-to-professional communication that transfers clinical responsibility from one provider to another, stating reason for referral, clinical summary, urgency grade, and accompanying materials.

A doctor registered under the National Medical Commission Act 2020 (or its predecessors); the only category of health professional legally authorised to issue medical certificates and MTP opinions in India.

Reproductive, Maternal, Newborn, Child, and Adolescent Health — the umbrella National Health Mission strategy for comprehensive reproductive and child health services in India.

Pulse rate divided by systolic blood pressure; a value >1 indicates significant haemorrhage requiring immediate IV access and volume replacement; a normal value is approximately 0.5–0.7.

A safe needle-resheathing method in which the needle cap is placed on a flat surface and the syringe is scooped one-handed without bringing the free hand near the needle tip, reducing needle-stick risk.

A six-step protocol for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, Strategy-and-Summary; widely used in oncology and obstetrics for difficult-news consultations.

WHO-recommended minimum infection-prevention measures applied to all patients regardless of known infection status, including hand hygiene, PPE selection, safe sharps handling, and waste segregation.

Empirical treatment of a clinical syndrome (e.g. genital ulcer) covering the most common causative organisms without awaiting laboratory confirmation; recommended by WHO when laboratory facilities are unavailable.

Variant of the obstetric formula subdividing Para into Term (≥37 weeks), Preterm (28–<37 weeks), Abortus (<28 weeks), Living.

The clinical process of sorting patients by acuity of need so that high-risk or acutely unwell patients are seen before stable low-risk patients, preventing dangerous delays in a high-volume clinic.

A complex adnexal mass resulting from severe pelvic inflammatory disease containing pus involving the fallopian tube and ovary; presents with pelvic pain, fever, and adnexal tenderness; requires IV antibiotics and possibly surgical drainage.

A rapid bedside test for herpetic ulcers: a scraping from the ulcer base stained with Giemsa; presence of multinucleate giant cells is characteristic of HSV; sensitivity is low (approximately 50–70%).

Classification of a referral as emergency, urgent, semi-urgent, or routine based on clinical acuity; determines how quickly the receiving facility allocates resources to the patient.

Failure of the uterus to contract adequately after delivery; the leading cause of PPH (~80% of cases); clinically identified as a boggy, soft, poorly defined uterine fundus that does not firm up on massage.

Venereal Disease Research Laboratory test; a non-treponemal flocculation test for syphilis screening; becomes positive 4–6 weeks after infection and must be confirmed with a specific treponemal test (TPHA/FTA-ABS).

The ethical principle of truthfulness; requires the clinician to communicate accurate information honestly, including in difficult circumstances such as adverse outcomes or diagnostic uncertainty.

World Health Organization Medical Eligibility Criteria for contraceptive use — a classification system (categories 1–4) rating the safety of contraceptive methods in specific clinical conditions; category 3–4 = avoid.