Obstetric and Gynecologic Emergencies
Domain focus
The Obstetric and Gynecologic Emergencies domain tests pregnancy-specific causes of shock, hypertension, bleeding, and abdominal pain. The exam expects you to stabilize two patients and know when delivery is the treatment.
Core rules
- Preeclampsia with severe features: BP ≥160/110, platelets <100,000, elevated liver enzymes, renal insufficiency, pulmonary edema, visual symptoms. Treat with labetalol, hydralazine, or nifedipine.
- Eclampsia: magnesium sulfate 4–6 g IV load, then 1–2 g/h; recurrent seizures need additional bolus.
- Postpartum hemorrhage: uterine atony most common; massage, oxytocin, then carboprost, misoprostol, tranexamic acid; balloon or surgery.
- Ectopic pregnancy: unstable + positive hCG + free fluid → operating room; methotrexate only if stable.
- Abruption: painful bleeding, uterine tenderness, fetal distress; resuscitate and deliver.
Worked example
A 34-week pregnant woman has a seizure and BP 170/110. Give magnesium sulfate 6 g IV over 15–20 minutes, then infusion; control BP with labetalol; call obstetrics for delivery. Reasoning: eclampsia is treated with magnesium, not phenytoin, and delivery is definitive.
Traps
Missing pregnancy in a woman of childbearing age with abdominal pain, giving NSAIDs in late pregnancy without caution, and treating eclampsia with diazepam instead of magnesium are common.