Complications of Pregnancy, Labour, and the Puerperium
What this domain tests
This domain tests recognition and initial management of hypertensive disease, diabetes, preterm labour, placental problems, malpresentation, and postpartum complications. The exam expects safe referral and avoidance of harmful interventions.
Core rules
- Hypertension in pregnancy is blood pressure of 140/90 mmHg or higher. Pre-eclampsia is hypertension after 20 weeks with proteinuria or maternal organ dysfunction. Severe features include 160/110 mmHg, headache, visual changes, epigastric pain, raised liver enzymes, low platelets, or renal impairment.
- Screen for gestational diabetes at 24–28 weeks with an oral glucose tolerance test. Treat with diet, exercise, and medicines when targets are not met.
- Placenta praevia causes painless vaginal bleeding; placental abruption causes painful bleeding with a tender, hard uterus. Never perform a digital vaginal examination when placenta praevia is suspected.
- Preterm labour before 37 weeks needs assessment, fetal fibronectin or cervical length where available, steroids, and magnesium sulfate for neuroprotection when indicated.
- Puerperal sepsis presents with fever, offensive lochia, uterine tenderness, and tachycardia; take cultures and start antibiotics promptly.
Worked example
A woman at 34 weeks has blood pressure 160/110 mmHg, headache, proteinuria 2+, and platelets of 90. This is severe pre-eclampsia. Admit, start magnesium sulfate for seizure prophylaxis, give antihypertensives, administer corticosteroids for fetal lung maturity, and plan delivery with the obstetric team. Do not give ACE inhibitors or diuretics for routine treatment.
Traps that cost marks
Hypertension before 20 weeks is usually chronic, not pre-eclampsia. Do not diagnose pre-eclampsia without checking blood pressure correctly and confirming proteinuria or organ dysfunction. Do not perform a vaginal examination in suspected placenta praevia. Do not treat gestational diabetes with oral agents without local protocol guidance.
Key points
- Pre-eclampsia occurs after 20 weeks with hypertension plus proteinuria or organ dysfunction.
- Severe hypertension is 160/110 mmHg or higher.
- Painless bleeding suggests placenta praevia; painful bleeding suggests abruption.
- Avoid digital vaginal examination in suspected placenta praevia.
- Magnesium sulfate prevents and treats eclamptic seizures.
- Puerperal sepsis requires cultures and prompt antibiotics.