Gynaecology & Obstetrics

NICE NG25 · NICE NG23 · RCOG · FSRH 2023

700k+
Pregnancies per year in UK
1 in 3
Women with significant gynaecological symptoms
80%
Menopausal women experience vasomotor symptoms
1 in 100
Women have premature ovarian insufficiency

GP Scope of Practice in Gynaecology & Obstetrics

GPs manage the majority of women's health presentations — from antenatal monitoring and menopause to contraception and common gynaecological conditions. Knowing when to refer is as important as knowing how to treat.

Antenatal MonitoringHRT PrescribingLARC CounsellingCervical Screening2WW Referrals

GP vs Specialist Care — Quick Reference

AreaGP-LedRefer / Shared Care
Antenatal CareBooking visit, ANC monitoring, GDM screening, iron deficiency, UTI, minor complications, referral for high-riskPre-eclampsia, eclampsia, GDM management, obstetric cholestasis, twin/triplet pregnancy, IUGR, structural abnormalities
Obstetric EmergenciesImmediate recognition, resuscitation, call 999, stabilise, anti-DAll obstetric emergencies — hospital/obstetric team definitively manages
GynaecologyPID, HMB (Mirena/tranexamic acid), PCOS, mild endometriosis, cervical screening, contraception, UTISuspected malignancy, fibroids failing medical treatment, severe endometriosis, infertility, surgical management
ContraceptionCOCP, POP, emergency contraception, DMPA injection, referral for LARC fitting or shared-care LARC fitting (if FSRH-trained)Complex UKMEC 3/4 cases, LARC fitting if not trained
MenopauseDiagnosis, HRT initiation and management, non-hormonal options, annual review, POI referralPOI <40 years, complex HRT cases, suspected malignancy, surgical menopause
Booking visit ideally at 8–10 weeks. Aim to complete all screening, assessments, and risk stratification at this visit. Identify women needing consultant-led or shared care immediately.

History

  • LMP & EDD (Naegele's rule: LMP + 9 months + 7 days)
  • Obstetric history (gravida, para, previous CS, miscarriages, complications)
  • Medical history (diabetes, hypertension, epilepsy, thyroid, cardiac, renal)
  • Medications & allergies — stop teratogenic drugs immediately
  • Smoking, alcohol, recreational drug use
  • Family history (chromosomal conditions, gestational diabetes, pre-eclampsia)
  • Social circumstances, domestic violence screening (ask alone)

Investigations (Booking Bloods)

  • FBC — baseline, detect anaemia (Hb <110 g/L = anaemia in pregnancy)
  • Blood group & antibody screen (Rhesus status)
  • Rubella immunity status
  • VDRL/RPR — syphilis screen
  • HIV test (offer to all)
  • Hepatitis B surface antigen
  • Hepatitis C antibody (risk-based)
  • HbA1c if diabetes risk factors
  • MSU for asymptomatic bacteriuria (treat if positive — pyelonephritis risk)

Screening Offered

  • Combined first-trimester screening (nuchal translucency + hCG + PAPP-A) at 11–14 weeks
  • Anomaly scan at 18–21 weeks
  • Cell-free DNA / NIPT (if combined screen positive or maternal request)
  • Chlamydia screening if <25 years
  • Domestic violence and safeguarding assessment

Supplements & Advice

  • Folic acid 400 mcg/day (start before conception, continue until 12 weeks)
  • High-risk: folic acid 5 mg/day (epilepsy, BMI >30, diabetes, previous NTD)
  • Vitamin D 10 mcg/day throughout pregnancy and breastfeeding
  • Avoid: vitamin A supplements, raw/undercooked meat, liver, unpasteurised dairy, high-mercury fish, alcohol (no safe limit)
  • Flu vaccine (any trimester) — safe and recommended
  • Whooping cough vaccine (16–32 weeks)

Drug Safety

Safety in pregnancy

Drug Database

Full dosing reference

Emergency

ACLS protocols

Lab Reference

Normal ranges

Based on NICE NG25 (Antenatal care), NICE NG23 (Menopause), FSRH guidelines, RCOG greentops, and NHS cervical screening programme. Always individualise management and refer appropriately.