Obstetric Emergencies and Critical Care
Core concepts
Obstetric emergencies require rapid recognition and team response. Know shoulder dystocia (McRoberts maneuver, suprapubic pressure, then internal maneuvers; avoid fundal pressure), umbilical cord prolapse (elevate presenting part, knee-chest or Trendelenburg, immediate delivery), placental abruption (painful bleeding, uterine tenderness, fetal distress; manage with resuscitation and delivery), placenta previa (painless bleeding; avoid digital examination), uterine rupture (sudden pain, loss of station, fetal bradycardia), and amniotic fluid embolism (sudden collapse, hypoxia, coagulopathy). Also understand maternal sepsis, massive transfusion protocols, and perimortem cesarean timing.
Traps
A classic trap is performing a digital cervical exam in suspected placenta previa. Another is applying fundal pressure in shoulder dystocia. Questions may also test that cord prolapse requires relieving pressure on the cord, not just calling for help.
Rule of thumb
For any obstetric emergency, prioritize maternal stabilization and relieving fetal compromise, then definitive delivery; know the first maneuver for each emergency.