Complications of Pregnancy, Labor, and the Puerperium
Core concepts
This domain tests emergency obstetric and newborn care (EmONC). Master the hypertensive disorders: pre-eclampsia (hypertension after 20 weeks with proteinuria or end-organ signs), eclampsia (seizures), and HELLP syndrome. Know magnesium sulfate regimens for seizure prophylaxis and treatment, plus calcium gluconate as antidote. Understand antepartum and postpartum haemorrhage, placenta praevia versus abruption (painless bleeding versus painful bleeding with a rigid uterus), cord prolapse, uterine rupture, sepsis, and obstructed labor. Also know preterm labor management (tocolysis, corticosteroids, magnesium for neuroprotection) and gestational diabetes.
Traps
Questions often blur placenta praevia and abruption presentations; never perform a digital vaginal examination when praevia is suspected. Another trap: confusing magnesium toxicity signs (loss of deep tendon reflexes, respiratory depression, oliguria) with therapeutic effect. Also watch the timing rules: corticosteroids for fetal lung maturity are most beneficial between 24 and 34 weeks.
Worked rule of thumb
For eclampsia: call for help, protect the airway, give magnesium sulfate loading dose, control blood pressure, and plan delivery. Magnesium is the anticonvulsant of choice - not diazepam - because it prevents recurrence better.
Exam strategy
In any emergency scenario, prioritize maternal stabilization and definitive treatment of the cause. For abruption with fetal distress or maternal instability, the answer is urgent delivery, not expectant management.