Recognising and responding to complexity, emergencies and referral/consultation pathways
This domain tests timely recognition, structured communication and safe escalation. The exam often presents a deteriorating woman or baby and asks what you do first and whom you call.
Recognition
- Red flags: maternal collapse, postpartum haemorrhage, hypertension, sepsis, reduced fetal movements, abnormal CTG.
- Use ISBAR: Identify, Situation, Background, Assessment, Recommendation.
- Recognise your own limits and call early.
Escalation
- Consult: discuss with obstetric or medical staff.
- Refer: hand over responsibility.
- Transfer: move the woman or baby to secondary or tertiary care.
- Know local pathways and retrieval services.
- Structured handover includes allergies, bloods, medicines and observations.
Emergencies
- PPH: uterotonics, bimanual compression, tranexamic acid 1 g within 3 hours, fluids, theatre.
- Eclampsia: magnesium sulfate 4 g IV loading, then 1 g/hour; prevent injury.
- Sepsis: cultures and antibiotics within 1 hour.
- Neonatal resuscitation: dry, stimulate, airway, breathing, compressions.
- Document times, response and who was called; debrief and report incidents.
- Keep the woman and whānau informed during transfer and obtain consent where possible.
Worked example
A homebirth is followed by heavy bleeding. Call an ambulance, give uterotonics and tranexamic acid, keep the woman warm, transfer and give an ISBAR handover.
Traps
Delaying transfer to "see if it settles"; poor handover; having no backup plan.