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Common Obstetrical Complications Flashcards

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  1. A 36-year-old G2P1 at 32 weeks presents with sudden onset dyspnea, hypoxia (SpO2 82%), hypotension, and cardiovascular collapse immediately after an amniotomy. She develops DIC. What is the most likely diagnosis?

    Answer: Amniotic fluid embolism

    Amniotic fluid embolism (AFE) is characterized by sudden cardiovascular collapse, hypoxia, and DIC following amniotic fluid entry into maternal circulation, classically triggered by amniotomy or delivery.

  2. A 25-year-old primigravida at 10 weeks with hyperemesis gravidarum is found to have thyroid-stimulating hormone (TSH) of 0.02 mIU/L and free T4 elevated. She has no goiter and no personal history of thyroid disease. What is the most appropriate management?

    Answer: Reassure that this is gestational transient hyperthyroidism; treat hyperemesis

    Gestational transient thyrotoxicosis (GTT) is caused by TSH receptor stimulation by hCG in early pregnancy; it resolves spontaneously and antithyroid drugs are not indicated.

  3. A 28-year-old G1P0 at 26 weeks is found to have a 1-hour 50g GCT of 8.9 mmol/L. A 2-hour 75g OGTT shows fasting 5.4, 1-hour 11.2, and 2-hour 9.0 mmol/L. What is the most appropriate initial management?

    Answer: Medical nutrition therapy (MNT) and lifestyle modification for 2 weeks before pharmacotherapy

    Newly diagnosed gestational diabetes mellitus (GDM) is initially managed with medical nutrition therapy and lifestyle modification; pharmacotherapy is added if targets are not met within 1-2 weeks.

  4. A 33-year-old G2P1 with a previous low transverse caesarean section is labouring at 39 weeks. At 8 cm dilation, she reports severe sudden abdominal pain and the CTG shows prolonged bradycardia. Her previous scar is tender on palpation. What is the most feared complication?

    Answer: Complete uterine rupture

    Uterine rupture during trial of labour after caesarean (TOLAC) presents with sudden pain, scar tenderness, and acute fetal distress, requiring immediate emergency caesarean.

  5. A 30-year-old primigravida at 37 weeks has BP 148/96 on two readings 4 hours apart, with no proteinuria, but complains of new-onset headache and has elevated creatinine (110 µmol/L). How is this best classified?

    Answer: Preeclampsia with severe features

    Hypertension in pregnancy with severe headache and elevated creatinine meets criteria for preeclampsia with severe features (organ involvement), even without proteinuria.

  6. A 34-year-old woman at 39 weeks undergoes caesarean section. During closure, brisk bleeding is noted from the uterine incision edges that does not stop with suture. She receives oxytocin, ergometrine, and carboprost without effect. Estimated blood loss is 3 L. What is the next surgical step?

    Answer: B-Lynch compression suture

    B-Lynch compression suture is a uterine-preserving surgical option for refractory uterine atony after medical management fails, compressing the uterus to reduce bleeding.

  7. A 26-year-old G1P0 at 30 weeks is admitted with threatened preterm labour and intact membranes. Cervical length is 22 mm and fetal fibronectin is positive. What is the most evidence-based intervention to reduce neonatal morbidity if delivery occurs?

    Answer: Antenatal corticosteroids (betamethasone) to accelerate fetal lung maturity

    Antenatal corticosteroids (betamethasone 12 mg IM x2 doses) are the most impactful intervention for reducing neonatal RDS, IVH, and mortality when preterm birth is anticipated between 24-34 weeks.