Obstetrics and Gynaecology: Maternal Emergencies and Reproductive Care
Obstetrics and Gynaecology in the Myanmar MMLE tests antenatal risk assessment, intrapartum emergencies, postpartum care, and reproductive health. The exam emphasizes preventable causes of maternal death: haemorrhage, hypertensive disorders, sepsis, obstructed labour, and unsafe abortion. Answers should show triage, referral thresholds, and drug regimens that are safe in pregnancy.
Core rules
- Severe pre-eclampsia: BP at least 160/110 with symptoms or proteinuria; give magnesium sulfate for seizure prophylaxis, control BP, and plan delivery.
- Postpartum haemorrhage: uterine atony is most common; massage the uterus, give oxytocin first, add tranexamic acid within 3 hours, resuscitate, and escalate.
- Obstructed labour: use the partograph, drain the bladder, and refer; avoid oxytocin when obstruction is suspected.
- Postpartum sepsis and endometritis need broad-spectrum antibiotics and source control.
Worked example
A woman at 32 weeks has BP 160/110, 3+ proteinuria, headache, and visual flashes. Reasoning: severe pre-eclampsia with symptoms. Admit, start magnesium sulfate loading and maintenance per protocol, control BP with hydralazine or labetalol, give antenatal corticosteroids if appropriate, and plan delivery. Monitor reflexes, respiratory rate, and urine output to detect magnesium toxicity.
Traps
Using diazepam instead of magnesium sulfate for eclampsia prophylaxis; missing HELLP syndrome; failing to check platelets and liver enzymes; causing fluid overload; and giving oxytocin in suspected obstruction.