OG35.{3,19},OG36.1 | Emergency Recognition and Initial Management — Summary & Reflection

KEY TAKEAWAYS

Emergency recognition and initial management in obstetrics follows the sequence: Recognise → Stabilise (ABCDE) → Communicate → Transfer. The shock index (pulse/SBP >1) is a rapid bedside tool for identifying significant haemorrhage. Eclampsia management requires MgSO₄ loading dose (Pritchard IM: 4 g IV + 10 g IM; Zuspan IV: 4 g then 1 g/h) with mandatory monitoring of knee jerks (first sign of toxicity), respiratory rate ≥12/min, and urine output ≥30 mL/h; antidote = calcium gluconate 1 g IV. Antihypertensive for severe BP (≥160/110) = labetalol, hydralazine, or oral nifedipine. APH differentiation: placenta praevia = painless, soft uterus — never perform vaginal examination; abruptio placentae = painful, rigid uterus, possible DIC risk. PPH management uses the 4 Ts (Tone = atony 80%, Trauma, Tissue, Thrombin); first-line = oxytocin 10 IU IM; contraindications: ergometrine in hypertension/pre-eclampsia; carboprost in asthma. OG36.1 requires need-based, cost-effective treatment matched to disease severity, patient context, and institutional capability — always use NHM first-line protocols before escalating. Emergency simulation drills (PPH drill, eclampsia drill) build the muscle memory needed for real emergencies.

REFLECT

Reflect on an obstetric emergency you have observed during your clinical posting. Was the team's initial response structured (ABCDE) or reactive? Was the uterotonic given correctly — right drug, right dose, right route, right contraindication check? Was the referral decision made promptly, and was the documentation complete before the patient left? Use these observations as a checklist for your own competency — not to criticise the team, but to identify the gaps between what you observed and what the protocol requires, and to use your remaining posting time to close those gaps.