Obstetric emergencies
Haemorrhage, hypertensive disorders, ectopic pregnancy and intrapartum emergencies. These are classic AMC stations with time pressure.
High-yield points
Postpartum haemorrhage (500 mL or more after vaginal birth): think of the 4 Ts (tone, trauma, tissue, thrombin); uterine massage, oxytocin, then ergometrine (avoid in hypertension), carboprost and tranexamic acid.
Pre-eclampsia: new hypertension (140/90 or more) after 20 weeks with maternal organ or fetal involvement; proteinuria is not required.
Severe pre-eclampsia: control BP (labetalol, nifedipine, hydralazine) and give magnesium sulfate to prevent or treat eclampsia; delivery is the cure.
Magnesium toxicity: loss of reflexes, then respiratory depression; antidote is calcium gluconate.
Ectopic pregnancy: positive beta-hCG with no intrauterine pregnancy on ultrasound; unstable patients go to theatre.
Placental abruption: painful bleeding with a tense uterus; placenta praevia: painless bleeding, never do a digital vaginal exam.
Shoulder dystocia: call for help, McRoberts manoeuvre and suprapubic pressure first.
Cord prolapse: relieve pressure on the cord (knee-chest or fill the bladder) and arrange urgent delivery.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Postpartum haemorrhage | Oxytocin, misoprostol, uterotonics; blood availability can be a limit. | Largely the same approach: oxytocin, tranexamic acid, stepwise escalation, early senior help and massive transfusion protocol. |
| Magnesium sulfate for eclampsia | Pritchard (IM) regimen is widely taught. | IV regimen: 4 g loading dose then 1 g per hour, with monitoring of reflexes, respiration and urine output. |
| Rh-negative women | Anti-D often only after delivery or sensitising events. | Routine antenatal anti-D prophylaxis at 28 and 34 weeks, plus after birth and sensitising events. |
| Rural emergencies | Referral to a higher centre. | Stabilise and arrange retrieval (e.g. RFDS); small hospitals may not have obstetric or theatre cover. |
Postpartum haemorrhage
India (MBBS)
Oxytocin, misoprostol, uterotonics; blood availability can be a limit.
Australia (AMC): what the exam expects
Largely the same approach: oxytocin, tranexamic acid, stepwise escalation, early senior help and massive transfusion protocol.
Magnesium sulfate for eclampsia
India (MBBS)
Pritchard (IM) regimen is widely taught.
Australia (AMC): what the exam expects
IV regimen: 4 g loading dose then 1 g per hour, with monitoring of reflexes, respiration and urine output.
Rh-negative women
India (MBBS)
Anti-D often only after delivery or sensitising events.
Australia (AMC): what the exam expects
Routine antenatal anti-D prophylaxis at 28 and 34 weeks, plus after birth and sensitising events.
Rural emergencies
India (MBBS)
Referral to a higher centre.
Australia (AMC): what the exam expects
Stabilise and arrange retrieval (e.g. RFDS); small hospitals may not have obstetric or theatre cover.