Dr. Aditya Nimbkar

INI SS Dec 2025 Paper Recall: What Actually Came in the Exam Insights by Dr. Aditya Nimbkar 

by with No Comment OBS-GYN
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For many aspirants preparing for INI SS, one of the most useful ways to revise is by looking at paper recalls. They give a real sense of how concepts are tested and where the examiners focus. 

In this session, Dr. Aditya Nimbkar walked through several questions that appeared in the December 2025 INI SS exam.  

Lecture details: 
1. Fertility-Sparing Management in Endometrial Carcinoma:- 

One question described a 30-year-old nulliparous woman diagnosed with grade 1, stage IA endometrioid endometrial carcinoma who still wished to preserve fertility. 

Normally, the standard treatment for Endometrial Carcinoma is hysterectomy, but in women who strongly desire future pregnancy, a fertility-preserving approach can sometimes be considered. 

When is fertility-sparing treatment acceptable? 

It is considered only in carefully selected cases: 

  • Type 1 endometrioid carcinoma 
  • Stage IA disease 
  • No lymphovascular space invasion (LVSI) 
  • No evidence of extra-uterine spread 
Preferred Management 

The treatment used in such cases is high-dose progestin therapy, most commonly: 

  • Medroxyprogesterone acetate 
  • Dose: 400–600 mg per day 

Another option is placing a levonorgestrel-releasing intrauterine system (LNG-IUS) such as Mirena intrauterine system, sometimes combined with oral progestins initially. 

Follow-up is Critical 

These patients require strict monitoring, which includes: 

  • Endometrial sampling every 6 months 
  • Assessing regression or progression of disease 

If the disease progresses, definitive surgery (hysterectomy) must be advised. Even if fertility treatment succeeds and pregnancy occurs, hysterectomy is usually recommended once childbearing is complete. 

2. Lifetime Risk of Ovarian Cancer in BRCA Mutation:- 

Another question asked about the lifetime risk of ovarian cancer associated with BRCA1 mutation. 

To understand the significance, it helps to compare it with the background risk. 

Ovarian Cancer Risk 
  • General population: 1–2% 
  • BRCA1 mutation: 35–45% lifetime risk 
  • BRCA2 mutation: 10–20% lifetime risk 

Because of this high risk, women with confirmed BRCA mutations are often advised risk-reducing surgery. 

Preventive Strategy 

Recommended measures may include: 

  • Risk-reducing salpingo-oophorectomy 
  • Sometimes prophylactic mastectomy 
  • Surgery usually advised around 35–40 years, after completing family planning. 
3. Family History of Breast and Ovarian Cancer: What Should Be Done? 

Another scenario involved a 30-year-old woman using oral contraceptive pills for three years, with a strong family history: 

  • Mother diagnosed with Breast Cancer at 47 years 
  • Sister diagnosed with Ovarian Cancer at 36 years 

The key question was: What is the most appropriate advice? 

Correct Approach 

The best step is genetic testing for BRCA mutation. 

Before considering any preventive surgery, it is important to confirm whether a hereditary mutation is present. 

Important Points About OCPs 

Interestingly, oral contraceptive pills: 

  • Increase risk of breast cancer slightly 
  • But reduce the risk of ovarian cancer 
  • Also reduce the risk of endometrial cancer 

This protective effect occurs because: 

  • Progesterone causes endometrial atrophy 
  • Ovulation suppression reduces ovarian epithelial injury and repair cycles 
4. Bakri Balloon Maximum Capacity:- 

A practical obstetrics question asked about the maximum capacity of the Bakri Balloon. 

Answer is 600 mL 

Why? 

The Bakri balloon is used to treat postpartum hemorrhage, especially atonic PPH, in which the uterus does not contract following delivery. 

Mechanism 

The balloon is filled with fluid and placed inside the uterus. Hydrostatic pressure is produced as a result, which  

  • Stops bleeding sinuses.  
  • Creates a tamponade effect.  
  • Aids in stopping bleeding  

The balloon is usually stored for a maximum of 24 hours. Surgical treatment, such as a hysterectomy, may be necessary if the bleeding persists or the uterus does not regain tone. 

Alternative Technique 

A commonly used low-cost alternative is the Shivkar’s Balloon Pack, which uses a condom attached to a Foley catheter and filled with saline to create the same tamponade effect. 

5. Misoprostol Dose in Postpartum Hemorrhage:- 

Another tricky question focused on the dose of Misoprostol used in postpartum hemorrhage treatment. 

The key detail was the route of administration. 

Therapeutic Oral Dose 
  • 600 micrograms orally 

Students often mark 1000 micrograms, but that dose is usually associated with rectal administration. 

The exam question specifically mentioned oral dosing, which makes 600 micrograms the correct answer according to World Health Organization guidelines. 

Final Takeaway 

Paper recalls like these give a clear idea of how concept-based clinical thinking is tested in exams like INI SS. Instead of rote memorization, the focus is often on understanding guidelines, risk assessment, and real-world management decisions. 

If you want more such exam-focused discussions, concept breakdowns, and clinical insights, make sure to explore more sessions from Conceptual OBG and stay updated with expert explanations that simplify even the most complex topics. 

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FET Exam

How to Prepare for the FET Exam in One Month? A Complete Guide for OBG Aspirants 

by with No Comment OBS-GYN
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Estimated reading time: 7 minutes

Preparing for the FET Exam in just one month away which may sound very overwhelming, especially if you’re targeting FET Obstetrics and Gynecology. But here’s the final truth, if you have a focused preparation strategy, and the right study material, disciplined execution, then cracking the FET entrance examination in 30 days is absolutely achievable. 

This blog is designed specifically for doctors who are preparing for FNB programs in Obstetrics and Gynecology and those appearing for NEET SS Obstetrics and Gynecology, level exams. If you are short on time and need clarity, direction, and confidence, this guide is for you. 

Understanding the FET Examination 

The Fellowship Entrance Test (FET examination) is basically conducted for admission into various FNB programs which come across different specialties. But for COBG aspirants, the exam tests your deep conceptual understanding, clinical decision-making skills, and how familiar you are with official recent guidelines.  

The FET exam is not about just memorizing facts, it perfectly accesses how well you apply your postgraduate knowledge in real clinical scenarios, which are similar in standard to SS Obstetrics and Gynecology and NEET SS. 

FET Exam Pattern: What You Need to Know First 

Although before planning your studies, y6ou need to understand the exam pattern is non-negotiable. 

Key Highlights of the FET Exam Pattern: 
  • Mode: it will be the computer-based test 
  • Question type: Single best answer MCQs 
  • Focus: the focus should be on clinical application and problem-solving task 
  • Specialty-specific paper (where COBG candidates get FET Obstetrics and Gynecology paper) 

The FET 2026 exam pattern is expected to remain consistent with the previous years, which highlights the concept-driven questions rather than giving direct recall. Although reviewing the FET question paper from the previous sessions gives a very clear idea of how questions are framed. 

FET Syllabus for Obstetrics and Gynecology 

The FET syllabus for COBG covering significantly with NEET SS Obstetrics and Gynecology, which helps to make the preparation more streamlined for SS aspirants. 

Core Areas to Focus On: 
  • more possibilities of pregnancy 
  • Operative obstetrics 
  • Unproductiveness and reproductive endocrinology 
  • Gynecologic oncology 
  • Urogynecology 
  • Recent guidelines and protocols 
  • Imaging and case-based management 

Since the syllabus is very wide, the key is basically selective and strategic revision, not just exhaustive reading. 

One-Month FET Preparation Strategy (Week-Wise Plan) 

The first week is really about getting your bearings and figuring out where you stand. 

Here’s what you need to do: 
  • Take a complete run through the FET syllabus—just once, to get the lay of the land 
  • Go back to your standard notes and brush up on the high-yield topics 
  • Start working through topic-wise MCQs 
  • Look at how previous FET question papers were structured 

What you’re aiming for: Getting comfortable with the material, not mastering everything right away. 

Week 2: Building Your Strength Where It Matters 

This is honestly the make-or-break week of your entire preparation. 

Here’s what you need to do: 
  • Zero in on areas where you’re shaky or just okay—these need your attention 
  • Go through important guidelines and flowcharts again 
  • Solve mixed MCQs every single day 
  • Start practicing with a timer 

At this point, you should be doing more than just reading. Get your hands dirty with questions. Active practice beats passive reading every time. 

Week 3: Testing Yourself and Fine-Tuning 

This is where you stop being a student and start being your own evaluator. 

Here’s what you need to do: 
  • Take the full-length mock tests or specialty-specific ones 
  • If you really dig into the questions, you got wrong, don’t just move on 
  • Revisit the topics that you keep forgetting always 
  • Work on getting faster and more accurate 

This week is all about the closing the gap between knowing your stuff and actually performing under pressure. 

Week 4: Polishing Up and Building Confidence 

Don’t even think about picking up new topics now. 

Here’s what you need to do: 
  • You should stick to your own notes and the questions you’ve already marked 
  • You should focus on the important concepts that show up repeatedly 
  • Do some light MCQ practice just to keep yourself very sharp 
  • Actually, get some rest before exam day 

What you want right now is a clear head, steady nerves, and solid confidence. 

Smart Tips for COBG Aspirants 
  • Don’t collect a library of resources, stick to a few good ones. Too many sources will just eat up your time. 
  • Put your energy into topics that actually matter clinically. 
  • Don’t just memorize answers. Understand why something is right or wrong. 
  • Spend more time reviewing your mistakes than patting yourself on the back for correct answers. 
  • Stop comparing yourself to everyone else, it’ll only stress you out. 

When you’re working with limited time, these aren’t just tips, they’re survival tactics. 

Why Previous Year Questions Are Gold?

Going through old FET question papers and the FET 2026 paper (once it’s out) is honestly one of the smartest moves you can make. Here’s why: 

  • You start thinking like the person who’s writing the questions 
  • You spot which topics keep coming back 
  • You get better at eliminating wrong options quickly 

And if you’re also preparing for NEET SS Obstetrics and Gynecology, this same strategy works beautifully there too. 

Don’t Forget the Paperwork 

The admin stuff is just as critical as your actual studying. 

  • When the FET application form goes live online, fill it out carefully—and don’t wait till the last minute 
  • Grab your FET admit card the moment it’s available for download 
  • After you’re done with the exam, keep checking for the FET result announcement 

Missing a deadline can throw away all your hard work. Don’t let that happen. 

Conclusion  

Look, preparing for the FET entrance examination in just one month is tough—I’m not going to sugarcoat it. But it’s absolutely doable. With a solid plan, focused revision, and regular practice, COBG aspirants can do really well. 

Here’s the thing to remember: the FET examination isn’t looking for people who crammed everything the night before. It rewards people who understand concepts clearly, can make good clinical calls, and can stay calm under pressure. 

Stay disciplined, trust your preparation, and walk into the exam with confidence. One focused month can change your career trajectory. 

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Dr. Smita

From NEET PG to DNB and Beyond: Dr. Smita’s Inspiring Journey in OBGYN 

by with No Comment OBS-GYN
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Estimated reading time: 7 minutes

Getting success in medicine can be rarely an overnight story, it but you know what ? It is built over years of consistent effort, the right mentorship, and the you should have that ability to perfectly balance the clinical work along with your academics. In a heartfelt conversation, Dr. Raina Chawla from Conceptual OBG sat down with Dr. Smita, who is a long-time Conceptual student has recently she cleared her DNB OBG examination with the excellent scores, and she is also secured a commendable rank in NEET SS. 

This preferred discussion was not just about only exams, but it also tells about the growth, confidence, and navigating one of the most demanding specialties in medicine. 

A Journey That Began Long Before DNB 

Dr. Raina has shares that she has known Dr. Smita Jugnu very well since her NEET PG preparation days, and she closely observed her utmost evolution from a student to a colleague. Just like so many Conceptual students, Dr. Smita’s journey has been one of the balanced progress which has been starting with NEET PG preparation, and now it’s finally moving into postgraduate training, and emerging as a confident OBGYN. 

Dr. Smita Jugnu has recently completed her DNB OBG from a government institute and after that she has now begun her senior residency at GEMS, Greater Noida. Which perfectly reflecting on her utmost achievements, although she candidly admits that while her NEET SS rank may not be that much “perfect,” but it has motivated her to prepare even more harder for the next attempt. 

DNB vs MS: Clearing the Common Doubts 

One of the most common concerns that always generates among postgraduate aspirants is whether DNB is as good as MS/MD, especially when they pursue it from a government hospital. 

Sharing her overall experience, Dr. Smita Jugnu has explained that her institute has offered excellent clinical exposure due to an sufficient patient load. However, it is like many busy government setups, which are highly structured academic discussions and regular theory were classes that were very limited. This is where online academic support is very important. 

She highlighted that DNB is a very highly structured and guideline-based examination, which is particularly practical. With all types of clear formats, perfectly defined answer keys, and objective appraisals, the DNB exam rewards the utmost strong fundamentals and conceptual clarity. But you know, according to her, if your basics are clear, it is actually difficult to fail a DNB practical exam. 

Integrating Academics with a Hectic OBGYN Life 

You know, OBGYN is considered one of the most demanding branches, in both phases physically and mentally. It perfectly managing the emergency duties, labor rooms, surgeries, and keeping up with the academics is no easy task. 

Dr. Smita Jugnu shares that during her second year, her clinical workload was very overwhelming, but when she came by the third year, she intentionally made time for the focused academic preparation. Although she heavily relied on eConceptual, especially for: 

  • All types of updated guidelines 
  • Formatted teaching 
  • Revisions of previous year questions 
  • Case discussions 

She perfectly describes the previous year’s questions as actual “gem,” which has revised them repeatedly, as it also played a key role in her theory of preparation. 

The Power of Case Presentations 

You know what a memorable part of Dr. Smita’s journey was? It was presenting all the cases early on in her training, as the first to Dr. Raina Chawla, and later to JB Sir. These utmost experiences, she recalls, were indispensable. 

Although, during her DNB practical exam, she usually felt as though that she was presenting cases to her mentors again. This familiarity gradually reduced anxiety and helped her to perform very confidently. The preferred structured case discussions at Conceptual have mirrored the actual exam format and made the transition seem seamless. 

Facing the DNB Exam with Confidence 

Like so many other candidates, Dr. Smita Jugnu admits that she carried a constant fear until the exam day comes. However, once the examination began, it unravels exactly as she had been guided. 

She highlights that the biggest challenge of the DNB exam is often the unfamiliar examination center, not the exam itself. With proper preparation and conceptual clarity, the exam is very much manageable. 

NEET SS Preparation: Making the Most of Limited Time 

Dr. Smita  Jugnu had barely 20–25 days between her DNB result and the NEET SS exam. During this period, she was also involved in locum work and clinical exposure. 

She honestly shares that she did nothing “extraordinary” for NEET SS. Her preparation was rooted in the strong basics she had already built through e-Conceptual over the past two years. Although she had opted for gynecological oncology, the paper turned out to be more general in nature, which worked in her favor. 

Looking Ahead: Gynae Oncology and Beyond 

When she asked about her future plans, Dr. Smita  Jugnu communicate a clear interest in gynecological oncology. However, she used to strongly believes in gaining the utmost hands-on confidence which comes before jumping into super-specialization. 

Both Dr. Raina and Dr. Smita  Jugnu agree that doing at least one year of senior residency helps sharpen clinical decision-making and surgical skills, making future fellowship or super-specialty training more meaningful and effective. 

Final Thoughts 

Dr. Smita’s journey basically a reminder that success in medicine is not just about shortcuts, it’s all about the consistency, mentorship, and believing in the process. Her story resound with thousands of postgraduate students who used to juggle in demanding clinical work while attempt to stay academically strong. 

As Dr. Raina rightly concludes, watching students grow into confident colleagues is one of the most rewarding aspects of teaching. 

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Dr. Aditya Nimbkar

Suturing in OBGYN Made Easy Suture Packets, Needles & Practical Exam Tips – Part 1 By Dr. Aditya Nimbkar

by with No Comment OBS-GYN
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Estimated reading time: 5 minutes

Suturing is one of the most fundamental yet most confusing topics for OBGYN residents—especially during exams and early OT postings. Different packets, unfamiliar markings, multiple brands, and endless viva questions often make sutures feel more complicated than they really are. 

In this first part of a two-part series, Dr. Aditya Nimbkar simplifies suturing in OBGYN by breaking down commonly used suture materials, how to read suture packets, and how to answer suturing questions confidently in exams. 

Why Sutures Matter More Than You Think?

If there is one skill that stays with you throughout residency and beyond, it is suturing. From LSCS and episiotomy repair to hysterectomies and laparoscopic vault closure, the right suture makes a significant difference to healing, infection rates, and patient comfort. 

This session focuses on the most frequently used sutures in obstetrics and gynecology, starting with Vicryl and moving on to silk and Mersilene. 

Understanding a Suture Packet: What to Read First 

Before using any suture, always understand what the packet is telling you. Every suture packet contains critical information: 

1. Suture Size (US Gauge System) 
  • 1, 2, 3 → thicker sutures 
  • 1-0, 2-0, 3-0, 4-0 → progressively thinner sutures 

Think of 1-0 as the center point: 

  • Numbers without zeros → thicker 
  • Numbers with more zeros → thinner 
2. Suture Length 
  • Usually mentioned in centimeters 
  • Common lengths: 70 cm or 90 cm 
3. Needle Details 

Each packet also mentions: 

  • Needle length (e.g., 20 mm or 30 mm) 
  • Needle shape (half circle, 3/8 circle) 
  • Needle type 
  • Round body (used for uterus, muscle) 
  • Tapered tip 
4. Absorbable vs Non-Absorbable 

Clearly mentioned on the packet and extremely important for exams. 

The Three Golden Points to Describe Any Suture in Exams 

Whenever you are shown a suture in viva, always describe it using three fixed parameters: 

  1. Natural or Synthetic 
  1. Absorbable or Non-absorbable 
  1. Monofilament or Multifilament (Braided) 

If you remember just this framework, your suturing viva will almost always go well. 

Vicryl (Polyglactin 910): The Gold Standard 

Vicryl is one of the most commonly used sutures in OBGYN. 

Key Features 
  • Synthetic 
  • Absorbable (Delayed absorbable) 
  • Multifilament (Braided) 
Strength & Absorption 
  • Loses 50% strength in ~3 weeks 
  • Loses 75% strength by 5–6 weeks 
  • Completely absorbed in 50–70 days 
  • Absorbed by hydrolysis 
Advantages 
  • Excellent tensile strength 
  • Easy handling 
  • Ideal for: 
  • Uterine closure after LSCS 
  • Episiotomy repair 
  • Vaginal tears 
  • Abdominal & vaginal hysterectomy 
  • Laparoscopic vault suturing 
  • Multilayer myomectomy closure 
Disadvantage: Wicking 

Because Vicryl is braided, it allows capillary spread of fluids and bacteria, a phenomenon known as wicking. This makes it less suitable in infected fields and unsuitable for skin closure. 

Rating: 9/10 

A reliable, versatile, and time-tested suture. 

Vicryl Plus: Added Infection Protection 

Vicryl Plus is essentially Vicryl with a key upgrade. 

Vicryl Rapid: Designed for Fast Healing Areas 

Episiotomy wounds heal quickly, so prolonged suture presence causes discomfort and dyspareunia. Vicryl Rapid was developed to address this. 

Key Features 
  • Gamma-irradiated 
  • 50% strength lost in 5–6 days 
  • Completely absorbed in 2–3 weeks 
Ideal Use 
  • Episiotomy repair 
  • Vaginal lacerations 
Not Suitable For 
  • Uterine suturing 
Rating: 8/10 

Perfect for perineal repairs, limited elsewhere. 

Silk (Mersilk): A Suture of the Past 
Characteristics 
  • Natural 
  • Multifilament 
  • Practically non-absorbable 
  • Loses 50% strength after 1–1.5 years 
Why It’s Rarely Used Now 
  • Stays in tissue for years 
  • High risk of: 
  • Foreign body granuloma 
  • Chronic inflammation 
Rating: 5/10 

Given mostly out of respect for its historical importance. 

Mersilene Tape: Still Very Relevant 

Mersilene tape is entirely different from silk, despite the similar name. 

Key Features 
  • Synthetic 
  • Permanent 
  • Multifilament 
  • Made of polyester 
  • Silicone-coated for smooth passage 
Uses 
  • Cervical cerclage (Shirodkar, abdominal cerclage) 
  • Sling surgeries 
  • Cervicopexy 
  • Sacrocolpopexy 
  • Prolapse surgery in young women 
Disadvantages 
  • Difficult handling 
  • Risk of erosion if exposed near skin or vaginal mucosa 
Rating: 7/10 

Essential in modern gynecologic surgery despite handling challenges. 

What’s Coming in Part 2? 

So, In the next session we will cover: 

  • Staplers 
  • Prolene 
  • Ethilon 
  • Catgut 
  • Linen 
  • Monocryl 
  • Barbed sutures (Stratafix) 
Final Takeaway 

Understanding sutures is not about memorizing brands—it’s about knowing why, where, and how to use them. Once you learn how to read a suture packet and apply the three-point description rule, both exams and OT work become far easier. 

Stay tuned for Part 2 of this comprehensive suturing series. 

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PDCET Exam

What is the PDCET Exam? Exam Date and Why It Matters for OBG Residents 

by with No Comment OBS-GYN
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Estimated reading time: 2 minutes

For diploma holders in Obstetrics and Gynecology, PDCET is not just another entrance exam. It is the exam that decides your next step in training, the institute where you will learn, and the kind of clinical and surgical exposure you will receive. 

After completing a post-diploma in OBG, most residents aim to move into DNB Obstetrics and Gynecology for higher specialty training. PDCET is the pathway that takes you there. A good rank gives you access to better hospitals, stronger mentorship, and wider clinical experience. 

With the PDCET 2026 scheduled for 12 April 2026, this is the ideal time to start focused preparation with proper guidance. 

What is the PDCET Exam? 

PDCET stands for Post Diploma Centralized Entrance Test. It is conducted by the National Board of Examinations (NBE) for doctors who have completed their Post Diploma and wish to pursue Post Diploma DNB courses. 

For OBG residents, this exam allows entry into DNB Obstetrics and Gynecology (Post Diploma) programmes in government and private hospitals across India. 

In simple words, 
PDCET is the exam that takes you from diploma training to advanced specialty-level OBG practice. 

PDCET 2026 Exam Date 
  • Date: Sunday, 12 April 2026 
  • Mode: Computer-based examination 
  • Centres: Conducted across multiple cities in India 
Why is PDCET Important for OBG Residents? 

PDCET is a career-defining exam. It determines: 

  • Where you will receive your higher training 
  • The quality of clinical and surgical exposure you will get 
  • The mentors who will guide your learning 
  • Your confidence as an independent obstetrician and gynecologist 

A strong rank gives you better choices and better training centres. 

Conclusion: 

PDCET is not just an entrance exam. It is the foundation of your future as an obstetrician and gynecologist. 

With the exam scheduled for 12 April 2026, this is the time to prepare with discipline, clarity, and the right mentorship. 

If your goal is to become a confident clinician, a skilled surgeon, and a dependable OBG specialist, your preparation must begin now. 

And with the guidance of Conceptual OBG, you can walk into the PDCET exam with confidence and clarity. 

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Dr. Japleen Kaur

Understanding Ovulation & Menstrual Physiology Explained in Simple Words by Dr. Japleen Kaur 

by with No Comment OBS-GYN
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Estimated reading time: 5 minutes

Dear residents, ovulation is something we all study in textbooks, but when it comes to understanding how beautifully the female body works, most books fall short. Ovulation is not just about an egg being released every month; it is a journey that starts even before a girl is born. 

In this blog, we walk through ovulation and menstrual physiology the same way Dr. Japleen Kaur explains it, step by step, logically, and with clear clinical relevance. 

The Journey of an Egg Begins Before Birth 

Most people don’t realise that a woman is born with all the eggs she will ever have. 

During early fetal life, special cells called oogonia travel from the yolk sac to the developing ovaries. By the time a baby girl is 20 weeks old inside her mother’s womb, she already has nearly 7 million eggs. 

After that, nature slowly starts reducing this number. 

  • At birth, only about 1 million eggs remain 
  • By puberty, the number drops to around 2 lakh 
  • By the age of 30, only about 26,000 eggs are left 

Out of all these, only about 400 eggs will ever be released in a woman’s lifetime. The rest slowly disappear — a natural process called atresia. 

What Happens to the Egg Before Ovulation? 

From birth till puberty, all eggs stay in a resting stage. They are paused in Meiosis I, waiting for the right time. 

When ovulation happens, the chosen egg wakes up and continues dividing: 

  • It completes its first division 
  • Releases the first polar body 
  • Becomes a secondary oocyte 
  • Then pauses again in Meiosis II 

Only after fertilisation does the final division take place and a mature ovum is formed. 

Why Oocyte Maturity Matters in IVF? 

In IVF treatment, doctors want to collect only fully mature eggs. 

An immature egg cannot be fertilised properly. A mature egg (called an M2 oocyte) has already completed its first division and is ready for fertilisation. That’s why embryologists carefully examine every egg under the microscope before proceeding. 

Any error during this stage can lead to genetic problems, which is why this step is extremely important. 

Maternal Age and Chromosomal Problems 

One very important clinical fact is the relationship between maternal age and chromosomal disorders. 

Among all chromosomal abnormalities, Down syndrome (Trisomy 21) is the one that clearly increases as maternal age increases. This is why, when counselling older pregnant women, doctors focus mainly on the risk of Down syndrome. 

How Hormones Control Ovulation?

Ovulation is controlled by a beautiful hormonal chain reaction. 

The hypothalamus in the brain releases GnRH in small pulses. This stimulates the pituitary gland to release FSH and LH. 

  • FSH acts on the granulosa cells of the ovary 
  • LH acts on the theca cells 

Theca cells produce androgens, which are converted into estrogen inside granulosa cells. 

After ovulation, the same hormones help produce progesterone, which prepares the uterus for pregnancy. 

The Feedback System That Keeps Everything in Balance 

The menstrual cycle stays regular because of a smart feedback system. 

  • Estrogen tells the brain when enough hormone has been produced 
  • Progesterone tells the brain when ovulation has already happened 

These hormones switch off further hormone production at the right time so that the cycle remains balanced. 

How a Follicle Grows Inside the Ovary?

Every month, several tiny follicles start growing inside the ovary. 

  1. Primordial follicle – a resting egg surrounded by a few cells 
  1. Primary follicle – the egg grows and forms a protective layer 
  1. Secondary follicle – a fluid-filled cavity appears (this is what we see on ultrasound) 
  1. Mature follicle – grows up to about 20 mm and is ready to release the egg 
Ovulation and Formation of Corpus Luteum 

When ovulation occurs, the mature follicle ruptures and releases the egg. The remaining follicle transforms into the corpus luteum, which produces progesterone and supports early pregnancy. 

On ultrasound, it appears like a small hemorrhagic structure with blood flow around it. 

Why Only One Egg Is Released Each Month?

Although many follicles start growing, only one usually wins the race. 

This happens because the winning follicle responds best to FSH. It produces more estrogen, which lowers FSH levels and stops the other follicles from growing. The rest slowly shrink and disappear. 

How does IVF Changes This Natural Process? 

In IVF, doctors give FSH injections from outside. This keeps FSH levels high for longer and allows multiple follicles to grow together. That’s how several eggs can be collected in one cycle. 

Role of Ovulation Induction Medicines 

Two common medicines are used to help women ovulate: 

Clomiphene citrate tricks the brain into thinking estrogen levels are low, so more FSH is released. 

Letrozole reduces estrogen production, again increasing FSH levels. 

Both help trigger ovulation in women who are not ovulating naturally. 

Conclusion: 

Ovulation is one of the most fascinating processes in the human body. It is controlled by hormones, shaped by genetics, and guided by a perfect internal clock. 

From the time an egg is formed in fetal life to the moment it is released during ovulation, every step has clinical importance, especially in fertility treatment and reproductive medicine. 

Understanding this process properly makes you a better clinician and a more confident OBG resident. 

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Obstetrics and Gynaecology Residency

Postgraduate Degrees in Obstetrics and Gynecology After MBBS in India: A Realistic Look

by with No Comment OBS-GYN
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Estimated reading time: 4 minutes

Obstetrics and Gynaecology is not a branch people usually “end up” in by accident. Most who choose it already know what they’re signing up for—late nights, sudden emergencies, emotional conversations, and decisions that can’t be postponed till morning.

It’s demanding, no doubt. But for many doctors, it’s also one of the most fulfilling specialties there is.

If you’re considering OBG after MBBS, you’re probably not looking for fancy promises. You want clarity. What degrees are available? What does the road ahead actually look like? And does it make sense in the long run? Let’s talk about that plainly.

MD (Doctor of Medicine) in Obstetrics and Gynaecology

MD – Doctor of Medicine in Obstetrics and Gynaecology is the most common postgraduate qualification in this field. It’s a three-year residency conducted in medical colleges recognised by the National Medical Commission (NMC).

Training during MD OBG is intense and unpredictable. Some days are routine OPDs and ward work. Other days—and nights—are anything but routine. Emergency caesareans, complicated labours, postpartum haemorrhage, difficult counselling sessions… you see it all.

Over time, you stop reacting and start anticipating. That’s when the real learning happens.

Your training broadly covers:

  • Labour room management and obstetric emergencies
  • High-risk pregnancy care
  • Gynaecological surgeries
  • OPD and inpatient decision-making

It’s not easy, especially in the first year. But by the end of residency, most doctors come out tougher, sharper, and far more confident than they expected.

Life and Work After MD (Doctor of Medicine) OBG

After completing MD OBG, most doctors begin working as consultant obstetricians and gynaecologists. Some join hospitals straight away, while others do senior residency first.

With experience, many choose to:

  • Open their own practice or clinic
  • Focus more on obstetrics or more on gynaecology
  • Move into teaching hospitals

OBG specialists are needed everywhere in India. That demand doesn’t disappear with time—it grows.

DNB (Diplomate of National Board) in Obstetrics and Gynaecology

DNB – Diplomate of National Board in Obstetrics and Gynaecology is awarded by the National Board of Examinations (NBE). Like MD, it is a three-year postgraduate program.

DNB training usually takes place in busy hospitals, often private ones. This means patient load is high and hands-on exposure comes early. You don’t get the luxury of watching from the sidelines for too long.

Many DNB residents end up with excellent procedural confidence simply because they’ve done so much during training.

Scope After DNB (Diplomate of National Board) OBG

After completing DNB OBG, doctors commonly:

  • Work as consultants in private hospitals
  • Join maternity centres and nursing homes
  • Enter academics after fulfilling eligibility norms
  • Pursue fellowships in specific areas

In real practice, very few patients ask whether you’re MD or DNB. They remember how you treated them—and how safe they felt under your care.

What About Diploma Courses in OBG?

Earlier, DGO (Diploma in Gynaecology and Obstetrics) was a two-year postgraduate option. Over the years, this pathway has mostly been phased out.

Doctors who already hold a DGO continue to practice, especially with experience. However, for current MBBS graduates, MD or DNB is the more secure and future-ready option.

Options After Completing Postgraduate OBG

Many OBG specialists choose to narrow their focus after PG. Some areas where doctors commonly pursue further training include:

  • Reproductive Medicine and IVF
  • Laparoscopic and Endoscopic Gynaecology
  • Maternal and Fetal Medicine
  • Gynaecologic Oncology

These paths need additional training, but they also allow you to build depth in areas you genuinely enjoy.

Career Scope of OBG in India

Obstetrics and Gynaecology will always remain essential. Women will always need care—during pregnancy, childbirth, and beyond.

OBG specialists are required in:

  • Government hospitals
  • Private maternity hospitals
  • Clinics and nursing homes

With increasing awareness around women’s health and fertility, opportunities continue to expand. The flip side is that the work can be emotionally heavy. Outcomes matter, expectations are high, and pressure is real.

Is OBG the Right Branch for You?

OBG suits doctors who:

  • Can stay composed during emergencies
  • Don’t mind long, irregular working hours
  • Are comfortable taking responsibility
  • Value patient relationships and continuity of care

It’s not a branch for shortcuts or half-hearted effort. But for those who commit fully, it offers purpose like very few others do.

Final Thoughts

Choosing between MD (Doctor of Medicine) Obstetrics and Gynaecology and DNB (Diplomate of National Board) Obstetrics and Gynaecology matters—but choosing OBG with open eyes matters more.

If you’re ready for the workload, the learning curve, and the responsibility that comes with it, OBG can be a career that challenges you—and rewards you—for decades.

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Dr Aditya Nimbkar

Must Watch Topic for NEET SS: Predictors and Future of Preeclampsia – Explained Simply By Dr. Aditya Nimbkar

by with No Comment OBS-GYN
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0

Estimated reading time: 4 minutes

Preeclampsia is something every OBG resident sees almost every day. Honestly, it’s so common that we sometimes forget how serious it actually is. In India, the numbers are worrying. Roughly one in every 10 to 20 pregnant women develops preeclampsia. That means almost every clinic or ward has multiple such patients.

What’s frustrating is this — even after so many years of research, and despite India being a high-risk population, we still struggle with predicting and preventing preeclampsia effectively. This session by Dr. Aditya Nimbkar focuses exactly on that: what we can predict today, what we can actually do, and where the future might be headed.

What Exactly Is Preeclampsia?

By definition, preeclampsia means:

  • Blood pressure more than 140/90 mmHg
  • Recorded on two occasions, at least 4 hours apart
  • After 20 weeks of pregnancy

That part is basic, and everyone knows it. But the real issue is not diagnosis.
The real issue is prediction.

Why Does Preeclampsia Happen?

The core problem starts very early in pregnancy.

Normally, trophoblasts invade the spiral arterioles. This invasion destroys the tunica layers and converts high-resistance vessels into low-resistance ones. This change is necessary because pregnancy needs more blood flow to the placenta and fetus.

When this trophoblastic invasion is faulty:

  • Blood flow to the placenta reduces
  • Placental hypoxia develops
  • The whole disease process begins
Angiogenic vs Anti-Angiogenic Factors

Placental hypoxia leads to increased anti-angiogenic factors, mainly:

  • sFlt-1
  • Soluble endoglin

At the same time, pro-angiogenic factors reduce:

  • Placental Growth Factor (PLGF)
  • VEGF

Simply put:

  • Less PLGF
  • More sFlt-1
     = higher risk of preeclampsia
PLGF Levels – Why They Matter

PLGF is one of the most useful markers we have today.

  • PLGF > 100 → risk of preeclampsia is very low
  • PLGF < 33 → very high chance of developing preeclampsia later

The lower the PLGF, the worse the placental function.

sFlt-1 / PLGF Ratio – Short-Term Prediction

This ratio helps predict what may happen in the next 1–2 weeks.

  • Before 34 weeks
    • Ratio > 85
    • High risk of severe preeclampsia, eclampsia, or abruption
  • Between 34–37 weeks
    • Ratio > 110
    • Again, there is a high risk of serious events soon

The cut-offs differ because PLGF and sFlt-1 levels behave differently as pregnancy advances.

Is This Test Really Useful?

Practically speaking, not for everyone.

The test is expensive, and even if it predicts risk, it doesn’t help us stop the disease. What it helps with is planning.

It tells us:

  • Whether delivery may be needed soon
  • Whether steroids should be given
  • Whether magnesium sulfate is required
  • Whether the patient needs admission and close monitoring

It reduces complications, but does not prevent preeclampsia.

Where Can We Actually Help the Patient?
Uterine Artery Doppler – Very Important

This is where real prevention starts.

Done along with the NT-NB scan, it tells us about placental blood flow.

  • Low resistance → good trophoblastic invasion
  • High resistance → higher risk

Key values:

  • 11–14 weeks: Mean PI > 2.4
  • 20–24 weeks: Mean PI > 1.4

Higher values mean increased risk of:

  • Preeclampsia
  • Fetal growth restriction
Aspirin – But Timing Is Everything

If the uterine artery PI is high:

  • Start low-dose aspirin
  • Ideally 150 mg
  • Before 16 weeks

After 16 weeks, trophoblastic invasion is already complete, so starting late doesn’t provide much benefit.

Aspirin doesn’t completely prevent preeclampsia, but it can delay the onset and reduce the severity.

Other Early Predictors

Better prediction comes from combining:

  • Uterine artery PI
  • PLGF
  • Mean arterial pressure (MAP)

If MAP > 90 in early pregnancy, future risk increases.

High-Risk Patients Need Extra Attention

Some women need close monitoring right from the first trimester:

  • Previous preeclampsia or eclampsia
  • History of abruption or unexplained stillbirth
  • Chronic kidney disease
  • Diabetes
  • Autoimmune disorders like SLE

These patients benefit the most from early aspirin and strict surveillance.

What About the Future?

Many new markers are being studied:

  • Placental protein 13
  • ADAM-12
  • Soluble endoglin
  • Micro-RNAs

There are also drugs under research:

  • Sildenafil
  • Statins
  • Metformin

At present, aspirin is all we have. But in the future, safer drugs may help us actually prevent, not just predict, preeclampsia.

Final Thoughts

Right now, our focus should be:

  • Early screening
  • Identifying high-risk women
  • Starting aspirin on time
  • Close maternal and fetal monitoring

Prediction helps, but prevention is the real goal. We’re not there yet — but we’re getting closer.

Subscribe to the Conceptual OBG YouTube channel for more insightful sessions.

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Dr. Aditya Nimbkar

Previous Year Recall: MCQs on Medical Disorders in Pregnancy Insights from Dr. Aditya Nimbkar

by with No Comment OBS-GYN
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0

Estimated reading time: 4 minutes

Medical disorders in pregnancy are a high-yield area for exams like NEET SS, INI-CET, and DNB, yet many questions are misunderstood because aspirants focus only on the final answer rather than the reasoning behind it. In this MCQ discussion session, Dr. Aditya Nimbkar breaks down multiple previous-year recall questions, explaining not just what the correct answer is, but why the other options are incorrect.

This blog summarises the key learning points from the session in a structured, exam-oriented format.

1. Magnesium Sulfate for Fetal Neuroprotection
What Is the Optimal Timing?

One of the most frequently asked MCQs revolves around magnesium sulfate (MgSO₄) use for fetal neuroprotection before preterm birth.

Key Concept

Magnesium sulfate is not routinely given to all women in preterm labour. Its use is selective and evidence-based.

Why Magnesium Sulfate?

Magnesium sulfate is preferred in pregnancy over other antiepileptics because of its broad neuroprotective action. It works through multiple mechanisms:

  • A – Adenosine potentiation → neuronal relaxation
  • B – GABA-B receptor activation → inhibitory neurotransmission
  • C – Calcium channel blockade
  • D – NMDA receptor inhibition
  • E – Glutamate inhibition (reduces excitotoxicity)

Together, these actions reduce neuronal excitability in both the mother and the fetus.

Why Is This Important for Preterm Babies?

Extremely preterm neonates are prone to:

  • Electrolyte imbalances
  • Germinal matrix hemorrhage
  • Neonatal seizures

Each seizure episode increases the risk of hypoxic brain injury, which magnesium sulfate helps prevent.

Exam-Oriented Answer
  • Indication: Imminent preterm birth
  • Gestational age: Up to 32 weeks (as per NICE guidelines)
  • Minimum duration: At least 4 hours before delivery
  • Maximum duration: 24 hours only

Repeat or rescue courses are not recommended.

Dose (Similar to Zuspan Regimen)
  • Loading dose: 4 g IV
  • Maintenance: 1 g/hour IV infusion
  • No intramuscular injections
Why Not Give It Repeatedly?

Excess magnesium:

  • Displaces calcium from receptors
  • Can cause fetal osteopenia
  • May lead to neonatal respiratory depression

Hence, one single course is sufficient.

2. Safest Antipsychotic Drug in Pregnancy (ACOG)

Psychiatric disorders like schizophrenia are not uncommon in pregnancy, making this a high-yield MCQ area.

Neonatal Adaptation Syndrome – A Must-Know Concept

Antipsychotic drugs can cause:

  • Poor neonatal tone
  • Poor feeding
  • Jitteriness
  • Extrapyramidal symptoms
  • Respiratory distress

This constellation is known as Neonatal Adaptation Syndrome.

Safest Antipsychotic Drugs

According to ACOG and RCOG:

Safest option:

  • Haloperidol (best safety data)

Other acceptable options:

  • Chlorpromazine
  • Olanzapine
  • Quetiapine
  • Risperidone
Important Clinical Pearl

Second-generation antipsychotics like olanzapine and quetiapine can worsen insulin resistance, increasing the risk of gestational diabetes mellitus (GDM).

What to do?
  • Perform OGTT at 24–28 weeks
  • Repeat OGTT at 32–36 weeks
Drugs to Avoid
  • Clozapine
  • Lithium
Breastfeeding Tip (Very Exam-Relevant)
  • Peak drug levels occur 1–2 hours after dosing
  • Advise mothers to avoid breastfeeding for 2–3 hours after taking the drug

This simple dose-spacing reduces neonatal side effects.

3. CNS Disorder That Worsens During Pregnancy
Trick in the Question

The worsening is not due to hormones, but due to immunological changes.

Immunological Shift in Pregnancy
  • Th1 → Th2 dominance
  • Increased humoral immunity
  • Reduced cell-mediated immunity
Correct Answer: Myasthenia Gravis
  • Antibody-mediated disease
  • Pregnancy increases antibody production
  • Leads to worsening neuromuscular weakness
Why Not the Others?
  • Multiple Sclerosis: Cell-mediated → fewer relapses in pregnancy
  • Parkinson’s Disease: Symptoms may worsen due to drug dilution but improve with dose adjustment
  • Epilepsy: Unpredictable (40% improve, 30% worsen, 30% unchanged)
4. GI Disorder That Does Not Worsen in Pregnancy

Progesterone relaxes smooth muscles and sphincters, leading to:

  • GERD (↓ LES tone)
  • Constipation (↓ peristalsis)
  • Gallstones (biliary stasis)
Correct Answer: Inflammatory Bowel Disease (IBD)
  • Ulcerative colitis
  • Crohn’s disease

These do not worsen physiologically during pregnancy.

Management of IBD in Pregnancy – High-Yield Points
Safe Drugs
  • Sulfasalazine (5-ASA)
  • Corticosteroids
  • Allopurinol
  • Anti-TNF agents (Infliximab, Adalimumab) → only till 24 weeks

Sulfasalazine causes folate trapping → Give 5 mg folic acid daily

Drugs to Avoid
  • Methotrexate
  • Tofacitinib

Methotrexate remains in tissues for months — avoid conception for at least 6 months

Crohn’s Disease and Mode of Delivery
  • Perianal Crohn’s disease → No episiotomy
  • Risk of deep perineal tears
  • Elective Caesarean Section is preferred
Key Takeaway for Exams

This session reinforces one crucial rule for medical exams:

Understanding the “why” behind an answer is more important than memorising the answer itself.

Approach MCQs conceptually, link physiology with clinical practice, and the guidelines will automatically make sense.Subscribe to Conceptual OBG for more insightful sessions to help you during your residency.

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ob gyn residency programs

Confused About Choosing OBG as Your Branch? Here’s an Honest Guide

by with No Comment OBS-GYN
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0

Estimated reading time: 5 minutes

If you’re in the middle of NEET PG counselling and staring at “MS/DNB Obstetrics & Gynaecology” on your screen with 100 doubts in your head, you’re not alone.

Students keep asking the same questions:
Is OBG the right branch for me? What about hands-on, DNB vs MS, DGO, MRCOG, superspeciality, work–life balance…?

This blog puts all of that together in one place, in simple language, straight from the real-life experiences discussed in the session.

What Makes OBG a “Beautiful” Branch?

OBG is one of those rare specialities where you make life-and-death decisions every single day – and yet, most days end with happiness.

  • You bring new life into the world.
  • You often deliver good news, not just diagnoses and reports.
  • You build long-term bonds with patients – from their first pregnancy to their second, then their sisters, cousins, mothers, and even grandmothers.
  • Over the years, entire families start trusting you as “their” doctor.

If you:

  • Enjoy talking to people
  • Like building relationships with patients
  • Are you okay with a dynamic, non-sedentary routine

…OBG can be very fulfilling.

No Two Days Are the Same

You’re constantly on the move:

  • OPD
  • Labour room
  • Wards
  • OT
  • Ultrasound room
  • Rotations in neonatology, oncology, urogynaecology, etc.

It’s an integrated branch – a mix of medicine, surgery, radiology, paediatrics, public health and social impact. You can also shape your practice later:

  • More medical, less surgical
  • More gynae, less obstetrics
  • More fertility, oncology, laparoscopy, etc.
Is OBG a Good Branch for Men?

This is one of the most frequently asked (and most misunderstood) questions.

Many male students worry:

  • “Will patients come to me?”
  • “Will I struggle more because I’m a man in OBG?”
  • “Is my future limited?”

The truth is:

  • Patients go to the doctor they trust, not just the gender they prefer.
  • If you are skilled, respectful, communicative and professional, patients stay with you.
  • There are numerous legendary male gynaecologists in India and globally who’ve shaped the branch, written standard textbooks, and led subspecialities.

Yes, in some areas (especially certain communities, rural or conservative belts), women may initially feel hesitant to consult a male gynaecologist. But:

  • Once they see good outcomes and feel comfortable, they come back and refer others.
  • Colleagues’ trust and word-of-mouth also matter a lot.

👉 Key point: Don’t let gender decide your branch. Let your interest, aptitude and willingness to learn decide.

Hands-On vs Structured Training: What Really Matters?

Another obsession:
“Will I get enough hands-on? Should I upgrade just for more hands-on?”

Of course, surgical exposure is important. But it’s not the only thing, and definitely not the first thing to judge a college by.

What actually matters more than “hands-on”?

Look for:

  • Structured academic program (seminars, tutorials, case discussions, journal clubs)
  • Motivated faculty who love teaching
  • Decent patient load (not necessarily crazy numbers)
  • Good mix of cases – obstetrics + gynae + emergencies + electives
  • Supportive environment and reasonable work culture
  • Minimal language barrier so you can communicate with patients

Plenty of residents who did thousands of caesareans still have poor technique. And others who did 30–50 well-supervised surgeries with strong theoretical understanding become excellent surgeons over time.

Surgery is a lifetime skill, not a 3-year race.

Your attitude matters a lot
  • Show up.
  • Stay back when you can.
  • Watch surgeries even if you are not scrubbed.
  • Follow up the patient whose case you assisted.
  • Be the resident who is eager, not the one who disappears at 4:59 pm.
  • FNB (fellowship of the National Board)

Then:

  • Plain DGO alone is not enough.
  • You need to complete secondary DNB to be eligible.

So, if you are very sure you want a superspeciality right from the start, keep this in mind while choosing.

What Are the Career Options After OBG Residency?

You’re not limited to “just being a general gynaecologist”. You can:

1. Practice as a General Obstetrician & Gynaecologist
  • Single-doctor clinic + attached hospitals
  • Freelancing in multiple hospitals
  • Working in a corporate hospital
  • Working in government/teaching hospitals

A general OBG practitioner is rarely out of work. Wherever there are women, there is OBG work.

2. Super-Specialise

You can go into:

  • Reproductive medicine / IVF
  • Gynae endoscopy (laparoscopy & hysteroscopy)
  • Gynae oncology
  • Urogynaecology
  • Fetal medicine
  • High-risk pregnancy & obstetric critical care

Pathways include:

  • NEET SS
  • FNB
  • Institutional fellowships
3. Non-clinical / Semi-clinical Options

Over time, some gynaecologists move towards:

  • Medical education
  • Research and writing
  • Administration/hospital management
  • Public health and policy

You can slowly reshape your career based on your interests.

Final Thoughts: Should You Choose OBG?

Ask yourself honestly:

  • Do I like the idea of dealing with pregnancy, childbirth and women’s health?
  • Am I okay with emergencies, unpredictability and responsibility?
  • Can I handle stress if I have the right support and coping tools?
  • Do I feel a pull towards this branch more than others, like medicine, paeds, radio, derma, etc.?

If the answer in your gut is yes, then:

👉 Take OBG.
👉 Accept that the first few months of residency will be hard.
👉 Surround yourself with the right people, mentors and habits.

The branch will test you – but it can also give you immense satisfaction, stability and purpose for the rest of your career.

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