Obstetric and Gynaecological Emergencies
Core concepts
Cover the recognition and management of obstetric haemorrhage (antepartum: placenta praevia, abruption; postpartum: uterine atony, retained placenta, trauma), pre-eclampsia and eclampsia (magnesium sulphate, antihypertensives, delivery), and the pregnant patient in cardiac arrest (left lateral tilt, peri-mortem caesarean within 4–5 minutes). Understand ectopic pregnancy and the use of quantitative beta-hCG and ultrasound. Learn the approach to abdominal pain in early pregnancy, ovarian torsion, and pelvic inflammatory disease. Cover sepsis in pregnancy and the physiological changes of pregnancy that alter assessment (raised heart rate, lower blood pressure, dilutional anaemia).
Traps
Examiners test that magnesium sulphate treats seizures in eclampsia but does not lower blood pressure - a common distractor. In placenta praevia, a digital vaginal examination is contraindicated. In the pregnant arrest, do not delay peri-mortem caesarean while attempting prolonged resuscitation.
Rule of thumb
In any pregnant patient beyond 20 weeks with shock, think obstetric haemorrhage first. In eclampsia, magnesium prevents and treats seizures; antihypertensives control the blood pressure.
Worked example
A 32-week pregnant woman with severe headache, BP 170/110, and a seizure: give magnesium sulphate, control blood pressure, and arrange urgent delivery - do not give a fluid bolus to "improve perfusion".