Obstetrics and Gynecology: Antenatal Risk, Labour, and Postpartum Safety
Priority concepts
Key areas are antenatal scheduling and dating, hypertensive disorders of pregnancy, gestational diabetes, labour and its stages, postpartum haemorrhage, contraception counselling, and gynaecological screening. Accurate dating by early ultrasound underpins decisions about viability, growth restriction, and timing of delivery.
Preeclampsia is new hypertension after 20 weeks plus proteinuria or evidence of organ dysfunction such as thrombocytopenia, renal impairment, liver involvement, or neurological or pulmonary oedema. Severe features change management to magnesium sulfate for seizure prophylaxis, antihypertensives for severe ranges, and timely delivery after steroids if preterm. Postpartum haemorrhage is managed by cause using the four T's: tone, trauma, tissue, thrombin.
Traps
Blood pressure thresholds and gestational ages are where marks are lost. Do not attribute visual disturbance or right upper quadrant pain in pregnancy to indigestion. Remember that magnesium sulfate is neuroprotective against eclampsia but is not an antihypertensive. Distinguish pre-existing from gestational diabetes by timing of diagnosis.
Worked example
At 34 weeks, blood pressure 162/108 mmHg, platelets 88 × 10⁹/L, and elevated transaminases. This is preeclampsia with severe features: admit, give magnesium sulfate with monitoring for toxicity, treat severe hypertension, administer antenatal corticosteroids, and plan delivery. Proteinuria is not required when organ dysfunction is present.
Rule of thumb
Magnesium sulfate loading is typically 4 to 6 g intravenously followed by 1 to 2 g per hour; monitor deep tendon reflexes, respiratory rate, and urine output, with calcium gluconate available as the antidote. In any postpartum collapse, put haemorrhage at the top of the list.