Obstetrics: Antepartum Risk, Intrapartum Judgement and Postpartum Emergencies
Core concepts to master
Obstetric questions reward a structured approach: define the clinical problem, identify the gestational age, then apply the physiological changes of pregnancy to interpretation. Candidates must be fluent in hypertensive disorders (distinguishing chronic hypertension, gestational hypertension, pre-eclampsia with or without severe features, and HELLP), because management thresholds hinge on gestational age, maternal end-organ involvement and fetal status. Understand diabetes screening pathways, the pharmacology of insulin resistance in pregnancy, and the fetal consequences of poor glycaemic control. Know the causes of antepartum haemorrhage (placenta praevia, placental abruption, vasa praevia, uterine rupture) and the immediate actions each demands. Intrapartum topics include fetal surveillance interpretation (CTG categorisation, the significance of decelerations), induction indications and Bishop scoring, and the diagnosis of obstructed labour. Postpartum, be confident with the causes and sequence of management of primary postpartum haemorrhage, and recognise sepsis and pre-eclampsia as late causes of maternal deterioration.
Traps in questions
Stem wording often hides the gestational age or the blood pressure trend. Read for whether proteinuria is present and whether symptoms or biochemical abnormalities define severity. Distinguish magnesium sulfate (seizure prophylaxis) from antihypertensives (stroke prevention). Beware options offering immediate delivery when expectant management is appropriate before 34 weeks with stable disease, and vice versa. In haemorrhage questions, resuscitation precedes definitive obstetric intervention.
Worked example
A woman at 36 weeks has BP 165/110 mmHg, headache and visual disturbance, with platelets 85 and raised transaminases. This is pre-eclampsia with severe features. The rule of thumb: stabilise with antihypertensives and magnesium sulfate, then deliver - gestational age does not delay delivery once severe features are present at or beyond 34 weeks.