Knowledge Area 6 | Maternal Medicine
(Aligned with RCOG Core Curriculum 2019)
This is one of the most clinically demanding and exam-heavy knowledge area in MRCOG Part 2.
This area focuses on: Pre-existing medical conditions in pregnancy; Medical disorders arising during pregnancy; Risk stratification and optimisation; Multidisciplinary management; Preconception counselling; Postpartum follow-up and long-term risk reduction
What the RCOG Curriculum Expects
- The modern curriculum emphasises continuity across the reproductive journey:
- Preconception → Antenatal → Intrapartum → Postpartum → Future health
- Maternal medicine is not about memorising facts — it is about safe systems-based clinical reasoning.
- The updated curriculum expects you to demonstrate:
- Risk assessment using validated tools
- MDT coordination
- Individualised birth planning
- Medication safety in pregnancy
- Thromboprophylaxis decisions
- Escalation pathways
- Postpartum long-term health counselling
Preconception Counselling (High-Yield)
- A major emphasis in the current curriculum.
- You must understand: Optimising glycaemic control in diabetes; Reviewing teratogenic medications; Folic acid dosing (high vs standard risk); Weight optimisation; Thrombosis risk assessment; Genetic counselling referral
- Preconception care reduces maternal mortality — frequently tested conceptually.
Endocrine Disorders
Diabetes in Pregnancy
- Key areas to focus on : Pre-existing vs gestational diabetes; Glycaemic targets; Insulin management; DKA in pregnancy; Intrapartum glucose control; Timing of delivery; Postpartum follow-up
- Also know: Insulin pumps; Continuous glucose monitoring; Long-term cardiovascular risk counselling
Thyroid Disease
- Understand: Overt vs subclinical disease; Trimester-specific TSH ranges; Postpartum thyroiditis; Antithyroid drugs safety
Adrenal Disorders
- Understand: Addison’s disease; Cushing’s syndrome; Stress-dose steroids
Hypertensive Disorders
- You must Know: Chronic hypertension; Gestational hypertension; Pre-eclampsia; Severe features; Magnesium sulphate indications; Antihypertensives safe in pregnancy; Aspirin prophylaxis; Postpartum BP management
- The curriculum emphasises: Long-term cardiovascular risk; Counselling for future pregnancy
Cardiac Disease
- A leading cause of indirect maternal death.
- You must understand: Risk stratification (WHO classification); Congenital vs acquired heart disease; Peripartum cardiomyopathy; Arrhythmias; Anticoagulation in mechanical valves; Multidisciplinary planning
- Exam frequently tests: Delivery planning; When to avoid vaginal birth; Anticoagulation timing
Neurological Disorders
- Epilepsy: Medication teratogenicity; Seizure control; Folic acid dosing; Breastfeeding advice
- Other topics: Stroke in pregnancy; Migraine vs pre-eclampsia; Multiple sclerosis; Idiopathic intracranial hypertension
Haematological Disorders
Anaemia
- Iron deficiency; IV iron indications; Transfusion thresholds
Haemoglobinopathies
- Sickle cell disease; Thalassaemia; Crisis management; Exchange transfusion
Thrombocytopenia
- Gestational thrombocytopenia; ITP; FNAIT
Inherited Bleeding Disorders
- Delivery planning; Epidural considerations
Venous Thromboembolism & Thrombophilia
- Although overlaps with postpartum module, maternal medicine requires: Risk assessment; LMWH dosing; Antenatal vs postnatal prophylaxis; Role of thrombophilia testing
Renal Disease
- CKD staging; AKI in pregnancy; Dialysis; Transplant recipients; Recurrent UTI
- Understand maternal–fetal implications and medication adjustments.
Gastrointestinal & Liver Disease
Intrahepatic Cholestasis of Pregnancy
- Understand: Bile acid thresholds; Timing of delivery
Other topics
- IBD in pregnancy; Acute appendicitis; Surgical abdomen
Respiratory Disease
- Asthma management; TB in pregnancy; Cystic fibrosis
- Asthma control reduces maternal morbidity — commonly tested.
Autoimmune & Connective Tissue Disorders
- Includes: Systemic lupus erythematosus; Antiphospholipid syndrome; Biologics in pregnancy
- Understand: Fetal surveillance; Thrombosis risk; Neonatal lupus
Cancer & Pregnancy
- Must know: Timing of chemotherapy; Imaging safety; MDT involvement
- Breast cancer in pregnancy
- Cervical cancer in pregnancy
Acute Medical Emergencies in Pregnancy
- Includes: DKA; Stroke; Acute severe asthma; Sepsis; Pulmonary embolism; Acute cardiac failure
- The exam tests: Immediate management; Escalation; Safe imaging decisions
How This Knowledge Area Is Tested
- Expect questions focusing on:
- Risk stratification
- Safe medication choice
- Delivery planning
- MDT coordination
- Postpartum counselling
- Prevention of maternal mortality
- Clinical judgement
- High-Yield Themes from Maternal Mortality Reports
- Recurring preventable factors: Delayed escalation; Poor communication; Failure to recognise deterioration; Inadequate risk assessment
- Keep maternal safety at the centre of every answer.
Final Words
- Maternal Medicine is best approached through: Systems-based revision; Flowcharts for emergencies; Preconception-to-postpartum framework; MDT mindset; Clear escalation triggers
- Always ask yourself:
- What is the maternal risk?
- What is the fetal risk?
- Who else should be involved?
- What is the delivery plan?
- What is the postpartum follow-up plan?
How to Structure This Knowledge Area
Create a master folder: “Maternal Medicine”
Subfolders organised by systems as follows.
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Endocrinopathies |
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Diabetes |
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NICE |
NG3 Diabetes in Pregnancy 2020 |
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TOG |
Diabetes Insipidus in pregnancy 2018 Management of diabetic ketoacidosis in pregnancy 2017 Insulin pumps & pregnancy 2016 |
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Thyroid |
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GTG |
#76 Thyroid disorders in Pregnancy 2025 |
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TOG |
Thyroid dysfunction and reproductive health 2015 |
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Others |
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TOG |
Hyperlipidaemia and severe hypertriglyceridaemia in pregnancy 2023 Adrenal disease and pregnancy 2021 Phenylketonuria in Pregnancy 2018 Hyperprolactinaemia & female reproductive function 2012 |
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Hypertension |
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NICE |
NG133 Hypertension in Pregnancy |
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TOG |
Postural tachycardia syndrome and pregnancy 2018 Blood Pressure measurement in pregnancy 2015 Low-dose aspirin and calcium supplementation for prevention of PET 2014 Management of Postpartum Hypertension 2013 New-onset hypertension in Pregnancy 2012 |
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Cardiac Disease |
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GP |
#13 Cardiac Disease & Pregnancy |
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TOG |
Acute coronary syndromes in pregnancy 2023 Peripartum cardiomyopathy 2021 Management of palpitations and cardiac arrhythmias in pregnancy 2019 The Obstetrician’s role in preventing cardio metabolic disease 2019 Myocardial Infarction and Pregnancy 2013 Cardiac Disease in Pregnancy: Congenital Heart Disease 2007 Cardiac Disease in Pregnancy: Acquired Heart Disease 2007 |
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Gastrointestinal Diseases |
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General GI |
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GTG |
#69 Management of Nausea, Vomiting of Pregnancy and Hyperemesis Gravidarum |
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TOG |
Inflammatory Bowel Disease in pregnancy 2016 Constipation in Pregnancy 2015 |
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Liver |
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GTG |
#43 Intrahepatic Cholestasis of pregnancy 2022 |
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TOG |
Acute liver disorders in 3rd trimester – AFLP, HELLP, infectious hepatitis 2025 Intrahepatic cholestasis of Pregnancy 2016 Diagnosis and Management of Liver Masses in pregnancy 2016 Skin eruptions specific to pregnancy 2013 |
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Abdominal Pain |
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TOG |
Trauma and pregnancy 2021 Acute and chronic pancreatitis in pregnancy 2021 Surgical causes of acute abdominal pain in pregnancy 2019 Management of adenexal masses in pregnancy 2017 Appendicitis in pregnancy 2015 |
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Neurological Diseases |
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Epilepsy |
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GTG |
#68 Epilepsy in Pregnancy |
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TOG |
The management of pregnant women with epilepsy 2017 |
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Others |
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TOG |
Obstetric neurological injuries 2020 Stroke in Pregnancy 2020 Multiple sclerosis and pregnancy 2019 Headaches in Pregnancy 2014 Idiopathic Intracranial Hypertension in pregnancy 2014 Pregnancy and Spinal Cord Injury 2014 |
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Hematological Disorders |
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Anaemia |
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BSCH |
UK guidelines on management of iron deficiency in pregnancy |
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TOG |
Iron deficiency and iron-deficiency anaemia in woman’s health 2017 |
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Haemoglobinopathy |
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GTG |
#61 Sickle Cell Disease in Pregnancy 2011 #66 Beta Thalassemia in Pregnancy 2014 |
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TOG |
Haemoglobinopathy: considerations for reproductive health 2018 Sickle Cell disease and b-thalassemia major in Pregnancy 2013 |
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Thrombocytopenia |
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TOG |
Thrombocytopenia in Pregnancy 2009 |
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SIP |
#61 Prenatal management of pregnancies at risk of Fetal Neonatal Alloimmune Thrombocytopenia (FNAIT 2019 |
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Inherited Bleeding Disorders |
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GTG |
#71 Inherited Bleeding disorders in Pregnancy 2017 |
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TOG |
Role of thrombophilia testing in women with adverse pregnancy outcomes 2017 |
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Renal Disease |
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TOG |
Acute Kidney Injury (AKI) in Pregnancy 2016 Solid organ transplantation in pregnancy 2016 Management of women with chronic renal disease in pregnancy 2009 UTI in Pregnancy 2008 Recurrent UTI 2020 |
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Respiratory Disease |
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TOG |
Sarcoidosis in pregnancy 2024 Tuberculosis in Pregnancy 2023 Asthma in Pregnancy 2013 Cystic Fibrosis and Pregnancy 2009 Vaccination in pregnancy 2015 |
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Connective Tissue Disease |
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TOG |
Biologics in Pregnancy— for obstetrician 2016 Maternal and fetal complications of SLE 2012 Diagnosis & management of Antiphospholipid Syndrome in pregnancy 2011 |
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Cancer & Pregnancy |
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GTG |
#12 Pregnancy & Breast Cancer 2025 |
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TOG |
The management of pregnancy after trachelectomy for early cervical cancer 2017 Management of gynaecological cancer in pregnancy 2017 Pregnancy following treatment for malignancy 2016 |