Midwifery Emergencies and Obstetric Complications
What this domain tests
Midwifery Emergencies and Obstetric Complications tests structured recognition and first-line management - the ordered actions in postpartum haemorrhage, eclampsia, shoulder dystocia, cord prolapse and fetal compromise - before medical help arrives.
Core rules
- PPH definition. Blood loss ≥500 mL after vaginal birth or ≥1000 mL after caesarean, or any loss causing haemodynamic compromise. Causes are the four T's: tone (about 70%), trauma, tissue, thrombin.
- PPH bundle. Call for help; empty the bladder and massage the uterus bimanually; oxytocin 10 IU IM followed by infusion; tranexamic acid 1 g IV within 3 hours of birth; then carboprost 250 µg IM every 15 minutes (maximum 2 mg; avoid in asthma) or misoprostol 800 µg sublingual; balloon tamponade or surgery if refractory. Two large-bore IV lines, warmed fluids, keep her warm, cross-match.
- Eclampsia. Magnesium sulfate is the drug of choice. Pritchard: 4 g IV over 10–20 minutes plus 10 g IM, then 5 g IM every 4 hours. Zuspan: 4 g IV load then 1–2 g/hour. Monitor deep tendon reflexes, respiratory rate ≥16, urine output ≥30 mL/hour and saturation.
- Shoulder dystocia. Call for help, McRoberts, suprapubic pressure, then internal manoeuvres. Never fundal pressure or head traction.
- Cord prolapse. Knee-chest or Trendelenburg, elevate the presenting part, fill the bladder if transfer is needed, prepare for immediate caesarean.
Worked example
Two hours after birth: 700 mL loss, pulse 118, BP 90/55, soft uterus. Order of action - call for help and activate the PPH bundle; catheterise and massage; oxytocin 10 IU IM; tranexamic acid 1 g IV; two IV lines with crystalloid; cross-match; inspect for tears and retained placenta; escalate to carboprost if bleeding continues.
Traps that cost marks
Waiting for the placenta before treating atony; giving tranexamic acid beyond 3 hours; continuing magnesium when reflexes are absent; fundal pressure in shoulder dystocia; not re-documenting estimated loss after each intervention.