Obstetric Emergencies and Referral
This domain tests recognition, immediate stabilisation and safe transfer for the conditions that kill quickly: haemorrhage, eclampsia, obstructed labour, sepsis and cord prolapse.
Core rules
- PPH: massage, oxytocin, tranexamic acid 1 g IV within 3 hours, misoprostol, bimanual compression and IV fluids; refer if bleeding persists.
- Eclampsia: protect the airway, lie left lateral, give magnesium sulfate (loading 4 g IV plus 10 g IM, then maintenance), control BP and refer after the first dose, not before.
- Shoulder dystocia: call for help, McRoberts manoeuvre, suprapubic pressure, then internal manoeuvres; never fundal pressure.
- Cord prolapse: knee-chest or exaggerated lithotomy, elevate the presenting part, keep the cord warm and moist, and arrange immediate caesarean.
- Obstructed labour: stop oxytocin, give IV fluids and antibiotics, and refer; do not attempt vaginal delivery.
Worked example
A woman at 38 weeks has a seizure at a health centre. BP is 160/110. Reasoning: this is eclampsia until proven otherwise. Give magnesium sulfate immediately, protect her from injury, keep her left lateral, start oxygen and IV access, then refer with a note stating the time and dose of magnesium. Referral without magnesium is a critical error because another seizure can occur in transit.
Traps
- Giving diazepam instead of magnesium sulfate for eclampsia.
- Continuing oxytocin in obstructed labour.
- Using fundal pressure for a stuck shoulder.
- Sending a woman without calling the receiving hospital.