Maternal-Fetal Medicine and High-Risk Obstetric Care
Core concepts
High-risk care begins with risk stratification: maternal age, parity, prior obstetric history, chronic disease, and current pregnancy complications. Know the categories of hypertensive disease (chronic, gestational, preeclampsia with and without severe features, superimposed preeclampsia, eclampsia) and the criteria that define severe features (severe-range BP, thrombocytopenia, transaminase elevation, renal insufficiency, pulmonary edema, new cerebral or visual symptoms). Understand fetal growth disorders (FGR and macrosomia), their sonographic definitions (estimated fetal weight below the 10th centile with abnormal Doppler or growth trajectory), and the surveillance tools: umbilical artery Doppler, biophysical profile, and nonstress testing. Diabetic pregnancy management (A1 vs A2 gestational diabetes, target glucose ranges, fetal surveillance timing) and multifetal gestation complications (twin-twin transfusion, monoamniotic cords) are frequently tested.
Traps
Questions often conflate gestational hypertension with preeclampsia - the distinction is proteinuria or end-organ dysfunction, not BP alone. Another trap is assuming magnesium sulfate treats hypertension; it prevents and treats seizures, while antihypertensives lower BP. Timing of delivery questions reward knowing that severe features at or beyond 34 weeks generally warrant delivery, whereas uncomplicated gestational hypertension may be expectantly managed to 37 weeks.
Rule of thumb
For any hypertensive pregnant patient, ask three questions in order: (1) Is there proteinuria or end-organ dysfunction (preeclampsia)? (2) Are there severe features (delivery at 34 weeks)? (3) Is the fetus adequately grown and monitored?