Obstetrics and Gynecology
Obstetrics and gynecology tests recognition of time-critical emergencies in pregnancy and safe gynecologic decision-making.
Core rules
- Pre-eclampsia: BP ≥140/90 after 20 weeks plus proteinuria or organ dysfunction. Severe features: BP ≥160/110, platelets <100,000, transaminases >2× normal, creatinine >1.1 mg/dL, pulmonary edema, cerebral or visual symptoms.
- Treatment: magnesium sulfate (4 g IV load, 1 g/h), antihypertensives (labetalol, hydralazine, nifedipine), then delivery.
- Postpartum hemorrhage: uterine atony is commonest - massage, oxytocin, then ergometrine, carboprost, misoprostol, tranexamic acid 1 g within 3 hours, then balloon or surgery.
- Ectopic: any woman of reproductive age with pain and bleeding gets a pregnancy test; if unstable, operate.
- Gestational diabetes: 75 g OGTT at 24–28 weeks; fasting ≥92, 1 h ≥180, 2 h ≥153 mg/dL.
Worked example
A 34-week primigravida with BP 168/112, headache, platelets 88,000, creatinine 1.3. This is pre-eclampsia with severe features. Give magnesium sulfate, lower BP to <160/110, and plan delivery, giving corticosteroids if time permits. Avoid fluid loading and diuretics; restrict fluids to about 80 mL/h and monitor reflexes and urine output for magnesium toxicity.
Traps
- Treating hypertension without magnesium in severe disease - eclampsia is the avoidable harm.
- Missing pregnancy in a woman with abdominal pain.
- Omitting uterotonic prophylaxis in the third stage.
- Misreading cardiotocography: late decelerations suggest placental insufficiency, variable decelerations suggest cord compression.