Foreword

I am delighted to be invited to write an introduction to this very important book, Ukot’s Back to Basics MCQs: Obstetrics and Gynecology, by Inyang A. Ukot. Writing a book on basics is not a surprise to those who know Ukot, as he has been a strong proponent for basics in different fields of medicine and a strong advocate for the need to impart the basics to students, resident doctors, and colleagues over the years and not merely building on knowledge without a proper foundation. Most of us agree with the author as the volume of knowledge available in any field of medicine is so vast and deep that one needs the basics to be able to work out most of the manifestations and possible complications they find in their patients. Besides, a good grasp of the basics would help the reader retain the knowledge for a long time.

The author starts this book series with Obstetrics and Gynecology, being one of the most common areas of study and practice of medicine globally. An area of medicine with the most tragic form of death on a daily basis. According to the African Health Organization Maternal Mortality Fact Sheet, every day, approximately 830 women die from preventable causes related to pregnancy and childbirth, and 99% of these deaths occur in developing countries. Skilled care before, during, and after childbirth can save the lives of women and newborn babies. The implementation of the Millennium Development Goal (MDG), which ended in 2015, only resulted in the reduction of maternal mortality worldwide by about 44%. The current Sustainable Development Goal targets the reduction of the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. To achieve this, there is a need for practitioners with a basic understanding of the subject rather than those who only memorize facts to pass examinations. We believe that the structure of this book supports this objective.Currently, there are numerous textbooks on the subject of Obstetrics and Gynecology but relatively few on MCQs alone. This is not surprising, as it is easier for specialists in the field to come together to produce voluminous textbooks on the subject than to organize textbooks in MCQs alone. Most especially the one that would be of global standard like Ukot’s Back to Basics MCQs: Obstetrics and Gynecology. This book will help students to test their level of grasp of the subjects and also what they can recall of the subjects after reading through the main textbooks. Medical practitioners and other professionals who are involved in rendering care in the field of Obstetrics and Gynecology should regularly test themselves to ensure proper transfer of knowledge to practice on patients. This is very important when one remembers that most of them are very busy and may not be able to regularly go through standard textbooks or attend conferences to update their knowledge. They are likely to benefit from a physically portable textbook (and an electronically convenient book) of this kind that addresses essentials in the subject and guides them on the practice of the discipline. Generally, the book can always allow the reader to self-test himself on the principles and practical application of Obstetrics and Gynecology. We would all agree that for us to make an effort towards attaining SDG-3 come 2030, we need medical students, physicians, and all other professionals who are involved in the medical care of women to return to the basics which is what this book emphasizes.

The questions in this book are mostly crafted to agree with Bloom’s revised taxonomy, where questions are designed for valid assessment and ensure that instructions and assessments are aligned with objectives. The reader not only remembers but understands, applies, and analyses the subjects in the questions and therefore demonstrates his reading, supporting the development of real-life or authentic skills. The MCQs are the single best answer in nature which is now agreed to be a better form for assessment than the traditional True and False type.

The book is arranged in six (6) chapters.

This chapter consists of 160 single best of four (4) options MCQs in Obstetrics. The topics under consideration are those that are very commonly encountered in our practice, present challenges to the practitioners, and cause morbidity and the death of pregnant women and their babies. A complication like postpartum hemorrhage, one of the leading causes of maternal mortality, is treated. By the time the reader goes through the questions and the detailed explanations of the answers to the questions, such is most unlikely to easily forget the subject and how to manage the complication. The author also looks at antenatal care which itself is the basic gateway for the proper management of obstetric patients. Any reader who goes through this section of the book, along with the attached explanations, would find himself competent in proper history taking, physical examination, and the right investigations to request in the care of patients. This aspect of care enables the healthcare practitioner to establish rapport with the patient and a good patient-healthcare provider relationship. This creates confidence in the patient and makes the patient easily accept care from the caregiver.

Multiple pregnancy is another topic covered in this chapter. Multiple pregnancy has been a source of fascination in many cultures and attracts all forms of obstetric complications except probably prolonged pregnancy. It is also a common cause of perinatal and neonatal mortality. Its incidence has been observed to be highest in Nigeria and is now increasing all over the world because of the use of assisted reproductive technology and ovulation induction. Addressing this topic in this book is likely to resonate with readers, helping them appreciate how much they can retain about this important subject after reading standard textbooks. The practitioner would also appreciate how much of the knowledge can be translated into practice. Hypertensive disorders of pregnancy have now taken over from obstetric hemorrhage as the leading cause of maternal mortality in some communities. Globally, it affects 5–10% of pregnancies, and the incidence is increasing. Going through the MCQs on this topic with attached explanations may likely help the reader to become well-informed with the topic and the management intricacies in this important aspect of obstetric practice. Another crucial aspect of obstetric practice that this book covers is operative vaginal delivery. This is an area where the knowledge is waning every day, particularly regarding forceps delivery. Those of us who have been involved in the practice can testify that instrumental delivery can be lifesaving for the baby and the mother. One of the major reasons why practitioners desert this mode of delivery is an inability to align theory with practice. A short handbook of this nature, which reminds the reader of the procedure on a daily basis, would encourage the doctor to practice it. Generally, we always encourage medical practitioners after reading about it and testing their understanding with a book dealing with the basics such as this, to venture out with it; The best initial attempt would be when managing the delivery of a woman with an intrauterine fetal death. After successfully performing this procedure three or four times, delivering a live baby is more likely to be successful and may spare women the trauma of undergoing a cesarean section.

This chapter contains 140 single best-of-four (4) options MCQs in Gynecological practice. It looks at the common areas in gynecology that practitioners, whether specialists or non-specialists encounter, making this book an indispensable read for all. Miscarriage is seen in our practice daily. It can present in different forms, either as spontaneous miscarriage or induced miscarriage. Miscarriage, particularly the induced variety, is one of the major causes of morbidity and death in women. It may present with complications such as hemorrhage, sepsis, cervical tears, and uterine perforation, and in the long run, result in secondary infertility and chronic pelvic pain. When the woman survives these complications, her quality of life may be adversely affected, and marital disharmony commonly results. It becomes necessary that medical practitioners (specialists or nonspecialists) be conversant with the management of miscarriages. Ukot’s Back to Basics MCQs: Obstetrics and Gynecology that can constantly remind the practitioner of the management of this common condition becomes indispensable. Ectopic pregnancy, a common cause of gynecological admissions, especially in the tropics, is also analyzed in this book. If it presents as a ruptured variety, it is usually associated with profuse intra-abdominal hemorrhage with resultant high maternal mortality. Again, a common challenge associated with ectopic pregnancy is the problem of diagnosis, and hence, the condition always calls for a high index of suspicion by the attending doctors. Another unique feature of ectopic pregnancy, which all medical practitioners must be familiar with, is that a ruptured ectopic pregnancy patient dies not because she was not offered adequate resuscitation but because she was not operated on. I cannot forget a patient with ruptured ectopic gestation who was brought to the emergency room with almost no signs of life. With very minimal resuscitative measures, we decided to operate on her using very minimal anesthesia. Signs of life only returned as we were closing the skin incision. To be conversant with the management of ectopic pregnancy, one needs a handbook that reminds a doctor of the intricacies involved in the total care of the patient; hence, the place of Ukot’s Back to Basics MCQs: Obstetrics and Gynecology. This book presents the features, not in the usual mundane manner but in a way one would hardly forget.

This chapter also considers menstrual disorders. Menstrual disorders can present in the form of varieties in the timing of the menstruation, such as polymenorrhagia or oligomenorrhea; or in the quantity of blood loss as menorrhagia or hypomenorrhea; or time of onset as precocious puberty or delayed puberty; or it may be associated with a symptom like dysmenorrhea or with premenstrual syndrome. These disorders may adversely affect the quality of life of the affected women. Any healthcare provider who is involved in the care of women needs to be familiar with the management of menstrual disorders. Ukot’s Back to Basics MCQs: Obstetrics and Gynecology will assist them to have a good grasp of the disorders and the approach to the management of the patients who consult them.

Endometriosis is a challenging condition for the clinician and the patient. Its presentation is variable, and the diagnosis is difficult even with the use of endoscopy. Determining who to treat, when to treat, and for how long to treat the patient after arriving at the diagnosis is usually challenging. A handbook that challenges one with questions and provides appropriate explanations puts the reader on their toes regarding this condition and its management. The book also handles ovarian malignancy, the third most common female genital tract cancer globally but with the highest case fatality rate. It is more prevalent in elderly women than in younger ones. Although this cancer is more common in developed nations than in developing countries, it causes more deaths in the latter due to late presentation and inadequate management. Another feature of ovarian cancer is the absence of reliable screening modalities and the absence of early symptoms.

Hence, there is a need for a high index of suspicion for this condition. Every practitioner involved in the care of gynecological patients would benefit from this handbook, which serves as a constant and uniquely presented reminder of this deadly malignancy.

This chapter contains 160 detailed comments/explanations on answers to the Obstetrics questions. It provides an in-depth analysis of why the correct answers are considered correct and why the incorrect options are deemed incorrect. With the attached explanations, it becomes difficult for the readers to forget the facts and, therefore, can easily apply the knowledge in their practice. This is different from a situation where a candidate memorizes facts to pass an examination.

This section has 140 detailed comments/explanations on answers to the gynecology questions. In this section, each question is analyzed, and the correct answers are given. The reader is made to understand why and how the correct answer is chosen and why others are wrong. With these explanations, the reader appreciates and would be able to retain facts better than reading an ordinary textbook. Practitioners would have no difficulty in applying these facts to their practice to the benefit of the patients.

These chapters deal with differential diagnoses of certain clinical conditions in the subject of Obstetrics and Gynecology. Every medical practitioner appreciates that many clinical conditions can present in such a manner that it may become difficult for the practitioner to pinpoint the exact diagnosis. When a practitioner finds themselves in this dilemma, where the symptoms of a disease match more than one condition, they need some form of detailed reasoning and ancillary investigations to arrive at an accurate diagnosis. This is important since proper management of any medical condition depends on accurate diagnosis. Working with differential diagnoses is a common encounter in Obstetrics and Gynecology. Some conditions require medical treatment, while others need a surgical approach. When a medical practitioner subjects a patient who should naturally be treated medically to surgical care, it may end in a disaster for the patient. This explains the importance of these chapters of the book as they would guide the medical practitioner on the line of reasoning and relevant investigations that would lead to an accurate diagnosis and a proper treatment of the patient. These chapters also expose the doctor to the need to keep an open mind in the management of any patient and, hence, investigate appropriately before embarking on a definitive treatment of patients.

I am convinced that this book, Ukot’s Back to Basics MCQs: Obstetrics and Gynecology, would be a valuable companion to medical students, resident doctors, general medical practitioners, and all other healthcare professionals who are involved in the practice of Obstetrics and Gynecology. With this book, the knowledge content and level of practice would certainly improve.