Postpartum Care and Obstetric Emergencies
Core concepts
Postpartum care covers the immediate puerperium (haemorrhage, sepsis, thromboembolism, hypertensive disorders) and the delayed puerperium (infection, depression, wound complications). Postpartum haemorrhage is the highest-yield emergency: know the causes (tone, trauma, tissue, thrombin), the stepwise management (uterotonics, tranexamic acid, bimanual compression, balloon tamponade, surgical measures), and the role of massive transfusion protocols.
Other emergencies to master: uterine rupture (sudden fetal bradycardia, loss of station, abdominal pain), cord prolapse (call for help, elevate presenting part, knee-chest or Trendelenburg, immediate delivery), amniotic fluid embolism (sudden collapse, hypoxia, coagulopathy), and sepsis (early antibiotics, source control). Puerperal sepsis and endometritis require prompt broad-spectrum cover; retained products require evacuation.
Traps
- Forgetting tranexamic acid early in postpartum haemorrhage.
- Attributing postpartum collapse to haemorrhage without considering sepsis, pulmonary embolism, or amniotic fluid embolism.
- Delaying antibiotics in puerperal sepsis pending cultures.
- Missing that uterine atony can occur after a normal delivery and with a contracted uterus on palpation if the bladder is full.
Worked rule of thumb
For any postpartum emergency, run the ABCDE approach and simultaneously ask: is this haemorrhage, sepsis, thromboembolism, or hypertensive crisis? Each has a distinct first action - uterotonics and tranexamic acid for haemorrhage, antibiotics for sepsis, anticoagulation and imaging for thromboembolism, magnesium sulphate for eclampsia. The common error is treating the vital signs without naming the cause.
Exam technique
In an emergency station, verbalise your leadership, your sequence, and your escalation. Examiners score communication and prioritisation as heavily as knowledge.