Midwifery Emergencies and Obstetric Life Support
What this domain tests
This domain tests immediate action in postpartum haemorrhage, eclampsia, shoulder dystocia, cord prolapse, uterine rupture, and maternal collapse. Answers must show sequence, teamwork, and escalation.
Core rules
- Postpartum haemorrhage is blood loss of more than 500 mL after vaginal birth or more than 1000 mL after caesarean birth, or any loss causing haemodynamic compromise. Use the four Ts: tone, trauma, tissue, thrombin.
- For uterine atony: call for help, rub the fundus, empty the bladder, give oxytocin, and give tranexamic acid 1 g intravenously within 3 hours of birth. Escalate for further uterotonics, blood products, and surgery.
- Eclampsia: protect the airway, give oxygen, position safely, and give magnesium sulfate. Control severe hypertension. Deliver after stabilisation.
- Shoulder dystocia: call for help, use the HELPERR sequence, and avoid fundal pressure and excessive traction.
- Cord prolapse: call for help, elevate the presenting part, place the woman in knee-chest or Trendelenburg position, and prepare for immediate delivery.
Worked example
Ten minutes after a normal birth, the uterus is boggy and blood loss is 700 mL. Call for help, massage the fundus, empty the bladder, give oxytocin per protocol, and give tranexamic acid 1 g IV. Record vital signs, start a second intravenous line, take bloods, and prepare for escalation. Tranexamic acid is an adjunct, not a substitute for uterotonics or source control.
Traps that cost marks
Do not give ergometrine to a woman with hypertension or pre-eclampsia. Do not use fundal pressure for shoulder dystocia. Do not wait for a second dose of a uterotonic before calling for help. Magnesium toxicity presents with loss of reflexes, respiratory depression, and oliguria; calcium gluconate is the antidote.
Key points
- Postpartum haemorrhage is over 500 mL after vaginal birth or over 1000 mL after caesarean birth.
- The four Ts are tone, trauma, tissue, and thrombin.
- Tranexamic acid 1 g IV is given within 3 hours of birth.
- Magnesium sulfate is first-line for eclamptic seizures.
- Cord prolapse requires elevation of the presenting part and immediate delivery.
- Avoid fundal pressure in shoulder dystocia.