Complications of Pregnancy, Labour and Postpartum
This is the largest clinical domain and often decides the result. It tests recognition, first-line treatment and the decision to refer.
Hypertensive disorders
Classify as chronic, gestational, pre-eclampsia (with or without severe features) and eclampsia. Severe features: BP ≥160/110, platelets <100 ×10⁹/L, creatinine >1.1 mg/dL or doubling, transaminases doubled, pulmonary oedema, or cerebral and visual symptoms. Treat with labetalol, hydralazine or nifedipine; give magnesium sulfate for eclampsia prevention in severe disease; deliver, after dexamethasone 6 mg 12-hourly for four doses between 24 and 34 weeks.
Haemorrhage and sepsis
Antepartum bleeding: no digital or speculum examination until placenta praevia is excluded by ultrasound. Postpartum haemorrhage: rub the fundus, give oxytocin, then tranexamic acid 1 g intravenously within three hours, followed by misoprostol or carboprost, balloon tamponade and surgery. Sepsis: cultures, broad-spectrum antibiotics within one hour, source control.
Preterm labour
Tocolysis to buy time for steroids, magnesium sulfate for fetal neuroprotection before 32 weeks, and erythromycin for preterm prelabour rupture of membranes.
Worked example
At 33 weeks: BP 168/110, 3+ proteinuria, headache and visual disturbance. Reasoning: severe pre-eclampsia. Admit, start magnesium sulfate, control blood pressure, give dexamethasone and plan delivery where neonatal care exists - 33 weeks is well beyond expectant management in a soum hospital.
Traps
ACE inhibitors in pregnancy; waiting for proteinuria before diagnosing pre-eclampsia in a woman with organ dysfunction; stopping magnesium sulfate as soon as the blood pressure falls; and rapid fluid loading.