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EHPLE Midwifery study materials
EHPLE Midwifery study resources

EHPLE Midwifery: Complications of Pregnancy, Labour and the Puerperium

EHPLE Midwifery · Work through your exam, one topic at a time.

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Complications of Pregnancy, Labour and the Puerperium

This domain tests recognition and first-line management of obstetric emergencies and common complications. Questions often present a scenario with a few abnormal observations and ask for the single most important next step, so prioritisation matters more than exhaustive lists.

Core rules and concepts

  • Pre-eclampsia: BP of 140/90 or higher after 20 weeks plus proteinuria or organ dysfunction. Severe features include BP of 160/110 or higher, headache, visual disturbance, epigastric pain, HELLP syndrome and pulmonary oedema.
  • Severe pre-eclampsia: admit, give magnesium sulfate 4 g IV loading then 1 g/hour, antihypertensives such as labetalol or nifedipine, corticosteroids if preterm and plan delivery.
  • Preterm labour before 34 weeks: antenatal corticosteroids (betamethasone 12 mg intramuscularly twice, 24 hours apart); magnesium sulfate for neuroprotection before 32 weeks; tocolysis for transfer or steroid administration.
  • Preterm prelabour rupture of membranes: antibiotics (erythromycin 500 mg four times daily for 10 days), corticosteroids at 24–34+6 weeks and avoid digital examination.
  • Placenta praevia: painless bleeding with a soft uterus; no vaginal examination; delivery by caesarean.
  • Abruption: painful bleeding, woody uterus and fetal distress; concealed bleeding can underestimate loss.
  • Cord prolapse: call for help, elevate the presenting part, use knee-chest or Trendelenburg position, fill the bladder and deliver immediately.
  • Shoulder dystocia: McRoberts manoeuvre, suprapubic pressure and internal manoeuvres; never apply fundal pressure.
  • Postpartum haemorrhage: uterine massage, oxytocin, tranexamic acid 1 g IV and escalation.

Worked example

At 34 weeks a woman has BP 165/110, 3+ proteinuria, headache and visual flashes. Reasoning: this is severe pre-eclampsia, not gestational hypertension. She needs admission, magnesium sulfate, antihypertensive treatment, corticosteroids and delivery planning. Headache and visual symptoms indicate cerebral involvement and raise seizure risk.

Traps

  • Giving magnesium sulfate only after a seizure rather than for severe pre-eclampsia.
  • Performing a vaginal examination in suspected placenta praevia.
  • Treating abruption as placenta praevia because both cause bleeding.
  • Applying fundal pressure in shoulder dystocia.
  • Delaying antibiotics in preterm prelabour rupture of membranes.

Key points

  • Severe pre-eclampsia: magnesium sulfate 4 g load then 1 g/hour; control BP and deliver.
  • Give corticosteroids before 34 weeks; magnesium sulfate neuroprotection before 32 weeks.
  • Placenta praevia causes painless bleeding; avoid vaginal examination.
  • Abruption causes painful bleeding with a woody uterus and possible concealed loss.
  • Cord prolapse: elevate the presenting part and deliver immediately.