Obstetric, Gynecologic, and Pediatric Emergencies
Obstetric emergencies
Candidates must know that in a pregnant patient beyond about 20 weeks, the uterus compresses the inferior vena cava when supine; displace the uterus leftward and treat the mother first, because maternal resuscitation is fetal resuscitation. Recognize pregnancy-induced hypertension and preeclampsia with severe features (headache, visual changes, right upper quadrant pain, rising blood pressure) and eclampsia (seizures), treated with magnesium sulfate and blood pressure control. Postpartum hemorrhage is a leading cause of maternal death; uterine atony is the most common cause and is managed with massage, uterotonics, and volume resuscitation. Placental abruption presents with painful bleeding and a tender uterus; placenta previa with painless bleeding - no vaginal examination. Know the signs of imminent delivery and the basics of emergency delivery and newborn care.
Pediatric emergencies
Children compensate and then crash. Weight-based dosing, length-based tapes, and age-appropriate vital signs are examinable. Recognize respiratory distress in children by retractions, nasal flaring, grunting, and positioning. Dehydration severity is judged by mental status, tears, mucous membranes, capillary refill, and urine output. Fever in a young infant is a high-risk presentation requiring full evaluation.
Gynecologic emergencies
Ectopic pregnancy can present with abdominal pain, amenorrhea, and vaginal bleeding, and can bleed catastrophically; a pregnancy test is part of the workup. Sexual assault care includes safety, evidence preservation, and prophylaxis.
Traps in questions
- Do not perform a vaginal examination with suspected placenta previa.
- Magnesium toxicity presents with loss of deep tendon reflexes and respiratory depression; antidote is calcium.
- A child with normal blood pressure may still be in compensated shock.
- Do not delay delivery of a mother in arrest; perimortem cesarean delivery is considered early.
Rule of thumb
In pregnancy, maternal stabilization comes first. Worked example: a 34-week patient with a seizure and blood pressure 170/110 needs magnesium and blood pressure treatment, left uterine displacement, and fetal monitoring after maternal stabilization.