Obstetric and Gynecologic Emergencies
Core concepts
Know the life-threatening obstetric emergencies: postpartum hemorrhage, preeclampsia/eclampsia, placental abruption, placenta previa, and ectopic pregnancy. Understand the approach to the pregnant patient with abdominal pain or bleeding, including the role of ultrasound and beta-hCG. Recognize the physiologic changes of pregnancy that alter vital signs and laboratory values.
For gynecologic emergencies, know the evaluation of pelvic pain (ectopic, ovarian torsion, PID, ruptured cyst) and the management of abnormal uterine bleeding. Understand the principles of resuscitation in pregnancy, including left uterine displacement and the importance of maternal stabilization before fetal assessment.
Traps
Questions test whether you can distinguish placenta previa (painless bleeding) from abruption (painful bleeding). Another trap is missing ectopic pregnancy in a patient with a positive pregnancy test and abdominal pain. Watch for preeclampsia presenting with headache or visual changes before hypertension is obvious.
Worked example / rule of thumb
A pregnant patient with painless vaginal bleeding in the third trimester: avoid digital examination until previa is excluded by ultrasound. Rule of thumb: "In pregnancy, stabilize the mother first - left lateral tilt, IV access, and blood products for hemorrhage."