Complicated Pregnancy, Labour, and Postpartum
Complicated Pregnancy, Labour, and Postpartum
This domain tests early recognition, first-line management, and referral for pre-eclampsia, haemorrhage, sepsis, obstructed labour, malpresentation, preterm labour, and fetal compromise. The exam rewards a structured ABC approach and safe transfer, not heroics at a basic facility.
Core rules
- Severe pre-eclampsia: BP ≥160/110 with symptoms or abnormal labs is an emergency. Give magnesium sulfate, control BP with labetalol, hydralazine, or nifedipine, and refer. Magnesium sulfate Pritchard regimen: 4 g IV plus 10 g IM loading, then 5 g IM every 4 hours; monitor respirations, reflexes, urine output; calcium gluconate is the antidote.
- Postpartum haemorrhage: massage, oxytocin, tranexamic acid within 3 hours, IV fluids, bimanual compression, and referral.
- Obstructed labour: do not give oxytocin; catheterise, assess for rupture, and refer for operative delivery.
- Shoulder dystocia: McRoberts manoeuvre, suprapubic pressure, episiotomy if needed, then internal manoeuvres.
Worked example
A 34-week woman has BP 165/110, headache, and 3+ proteinuria. Reasoning: severe pre-eclampsia. Stabilise with magnesium sulfate and antihypertensive, monitor fetal heart, arrange urgent referral with a skilled team; corticosteroids may be considered for fetal lung maturity if delivery is expected, but maternal stabilisation comes first.
Traps
Giving ACE inhibitors or diuretics; missing proteinuria; using oxytocin in obstruction; delaying referral for "observation"; and forgetting to monitor magnesium toxicity.