Emergency Obstetrics and Critical Care
Domain 10 - Emergency Obstetrics and Critical Care
This domain tests resuscitation, eclampsia, massive obstetric haemorrhage, sepsis and maternal cardiac arrest. It is scored on sequence and speed - the first three actions matter more than the complete list.
Core rules
- Eclampsia: protect the airway, left lateral position, magnesium sulfate 4 g IV over 20 minutes then 1 g/hour, control BP to <160/110 with nifedipine or labetalol, deliver after stabilisation. Magnesium toxicity presents as loss of reflexes, respiratory depression and oliguria - give calcium gluconate 1 g IV.
- Massive PPH: activate the team, two large-bore lines, blood products in a 1:1:1 ratio, tranexamic acid 1 g within 3 hours, keep fibrinogen >2 g/L, then balloon, B-Lynch or hysterectomy.
- Amniotic fluid embolism: sudden hypoxia, hypotension and coagulopathy - supportive care, early intubation, blood products; no specific antidote.
- Maternal sepsis: antibiotics within one hour, fluids, source control (evacuate the uterus, drain the abscess).
- Cardiac arrest in pregnancy: continuous chest compressions with left uterine displacement, no aortocaval compression, and perimortem caesarean section by 4–5 minutes if there is no return of circulation.
- Uterine rupture: fetal bradycardia, loss of station, tearing pain - immediate laparotomy.
- Placenta accreta spectrum: plan caesarean hysterectomy; do not attempt placental removal.
Worked example
A woman at 36 weeks has a generalised seizure on the ward. Call for help, protect her from injury, place her left lateral, give oxygen and magnesium sulfate 4 g IV over 20 minutes followed by 1 g/hour, then nifedipine for BP 170/110. Delivery follows once she is stable; the seizure itself is not an indication for immediate caesarean.
Traps
Using diazepam as first-line for eclampsia; delaying perimortem caesarean beyond 5 minutes; aggressive fluid loading in preeclampsia; removing an accreta placenta; forgetting tranexamic acid.