The obstetric emergency is the heart of the O&G selection interview, because it tests the things the specialty demands: calling for help at once, knowing the protocol cold, making decisions while the clock runs, leading a team of midwives and anaesthetists, and talking to a frightened woman and her partner at the same time. This guide covers the emergencies that recur and the specifics the panels listen for.
The structure for every emergency
Call for help first and say so. The emergency bell, the senior midwife, the consultant, the anaesthetist, the paediatric team if the baby is involved. Then the protocol with the specifics. Then the decision. Then the woman and her partner. Then the aftermath: the documentation, the debrief, the incident report if needed, and the follow up conversation.
Postpartum haemorrhage
A woman is bleeding heavily after delivery and the loss is now 1.5 litres. Call for help, two large bore cannulas, bloods including crossmatch and coagulation, fluids then blood, the massive transfusion protocol if the loss continues. Then the four causes in order: tone, trauma, tissue, thrombin. Uterine massage and the uterotonics in sequence with their doses, bimanual compression, the examination for trauma, the check for retained tissue, and the coagulation results. Say the drugs you would give and in what order.
When the uterus is contracted and she is still bleeding, the panel is pushing you past tone: look for a tear, retained placenta or membranes, or a coagulopathy, and escalate to theatre for examination under anaesthesia, balloon tamponade, and the surgical options with the consultant. Say what you would tell the partner while this happens.
Severe pre eclampsia
A woman at 36 weeks with a blood pressure of 170 over 110, a headache and brisk reflexes. This is severe pre eclampsia with a risk of eclampsia. Call for help, intravenous antihypertensives to a target, magnesium sulphate for seizure prophylaxis with its loading and maintenance doses and its monitoring, fluid restriction, bloods for the platelets, liver function and renal function, and the plan for delivery, which is the treatment. The consultant, the anaesthetist and the paediatric team. Say what you would do if she had a seizure.
Shoulder dystocia
The manoeuvres in order, with the help called at once: the position changes, suprapubic pressure, the internal manoeuvres, delivery of the posterior arm, and the further options if these fail. Know the time pressure and the documentation afterwards. Say what you would tell the woman during and after, and that the baby's team would be present.
Cord prolapse
Call for help, relieve the pressure on the cord by position and by elevating the presenting part, stop the oxytocin, and an immediate caesarean unless delivery is imminent. Say how you would explain this to the woman in the seconds available.
Antepartum haemorrhage
A woman at 32 weeks with painless vaginal bleeding is placenta praevia until proven otherwise. Resuscitate, no vaginal examination until the placental site is known, the ultrasound, the bloods and crossmatch, steroids for the baby, the consultant, and the plan depending on the bleeding and the baby's condition.
The ectopic pregnancy
Severe lower abdominal pain, a positive pregnancy test and a blood pressure of 85 is a ruptured ectopic until proven otherwise. Resuscitate, crossmatch, the bedside ultrasound, the consultant and the anaesthetist, and theatre now. Say what you would tell the woman and that you would not delay for a formal scan.
The abnormal trace
Late decelerations: assess the whole trace, the clinical context, the woman's position, the oxytocin, the maternal observations, and the fetal blood sample or the decision for delivery. Involve the consultant and say how you would explain the plan to the woman.
Sepsis in labour
A temperature of 38.5 in labour: the sepsis screen, intravenous antibiotics within the hour, fluids, the fetal monitoring, the consultant, and the plan for delivery.
What the panels score
Help called first, the protocol with its specifics, the decision made, the team led, the woman and her partner spoken to, and the aftermath. The common failures are starting treatment before calling for help, not knowing the drug doses, and forgetting the woman is awake and listening.
Preparing
Learn your hospital's protocols for each emergency with the doses until they are automatic. Talk each one through aloud in four minutes, calling for help first every time, with the conversation with the woman at the end. Then have someone worsen each scenario, because the panel will.