Obstetric and Gynaecological Emergencies
This domain tests eclampsia, pre-eclampsia, postpartum haemorrhage, ectopic pregnancy, abruption, and pregnancy-related sepsis. The exam expects simultaneous maternal stabilisation and fetal assessment.
Core rules
- Eclampsia: give magnesium sulfate, control blood pressure, and protect the airway. Magnesium toxicity causes loss of reflexes and respiratory depression; calcium gluconate is the antidote.
- Postpartum haemorrhage: assess tone, trauma, tissue, and thrombin; give uterotonics, tranexamic acid, fluids/blood, and escalate to balloon or surgery.
- Ectopic pregnancy: unstable patient with positive pregnancy test needs urgent resuscitation and surgery; do not delay for ultrasound.
- Pregnancy CPR: perform standard chest compressions, displace the uterus manually after 20 weeks, and prepare perimortem caesarean delivery if no response.
Worked example
A 34-week pregnant woman has a seizure and BP 170/110. Give magnesium sulfate and treat hypertension. Delivery is the definitive treatment, but stabilise the mother first.
Traps
- Do not give nitrates or ACE inhibitors in pregnancy for hypertension.
- Do not miss occult abruption with fundal tenderness and fetal distress.
- Do not delay surgery for an unstable ectopic pregnancy to obtain serial hCG levels.
- Do not overlook sepsis in postpartum fever.