Obstetrics and Gynaecology: Safe Motherhood Priorities
What you must know
The exam expects structured thinking about antenatal care, the partograph, hypertensive disease of pregnancy, eclampsia, obstructed labour, postpartum haemorrhage, puerperal sepsis and abortion care. Know the components of focused antenatal care, the danger signs, and the partograph action line. Distinguish gestational hypertension, chronic hypertension, pre-eclampsia and eclampsia.
Classic traps
- Blood pressure alone does not define pre-eclampsia; check urine protein and warning symptoms such as headache, visual disturbance and epigastric pain.
- Magnesium sulphate is the drug of choice for eclampsia and severe pre-eclampsia, not diazepam or phenytoin. Watch for loss of tendon reflexes, respiratory depression and oliguria; the antidote is calcium gluconate.
- Postpartum haemorrhage: the commonest cause is uterine atony. Work through the four Ts: tone, trauma, tissue, thrombin.
- Do not give ergometrine to a woman with hypertension or cardiac disease.
Rule of thumb
In active management of the third stage give oxytocin 10 IU intramuscularly, controlled cord traction and uterine massage. In postpartum haemorrhage, rub the fundus, empty the bladder, give uterotonics and intravenous fluids while identifying the cause; always inspect the placenta for completeness. For obstructed labour, resuscitate, catheterise, give antibiotics and deliver by caesarean section; never apply fundal pressure.