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OG35.{3,19},OG36.1 | Emergency Recognition and Initial Management — SDL Guide (Part 3)
Applied Practice: Simulation and Supervised Emergency Drills
Emergency management skills are built exclusively through practice — reading about a PPH drill is not the same as performing one. The NMC competency framework places OG35.19 at the DOAP level (demonstration, observation, assistance, performance), meaning you are expected to participate in structured simulation exercises during your OG clinical posting. OG35.3 and OG36.1 are assessed at the SH (should help) level under faculty supervision.
The standard PPH drill practised in clinical skills laboratories and high-fidelity simulation centres follows a structured sequence: identify the patient (postpartum woman with excess bleeding); assess uterine tone (massage the fundus — describe what you feel); administer the correct first-line uterotonic (call out the drug, dose, and route before drawing it up); perform bimanual uterine compression (demonstrate correct hand placement: vaginal hand balled in anterior fornix, abdominal hand pressing posterior uterine wall toward vaginal hand; compress rhythmically); establish IV access and initiate fluid resuscitation; complete the referral letter; and brief the receiving team by telephone. Debrief with faculty after each drill: what was the correct order? Which drug did you almost reach for incorrectly (common error: carboprost in a patient with known asthma, or ergometrine in a hypertensive patient)?
The eclampsia drill covers: position the patient in the left lateral position; protect the airway; high-flow oxygen; draw up and administer the correct MgSO₄ loading dose (Pritchard IM regimen: 4 g IV + 10 g IM in correct preparation and dilution); set up the monitoring chart (knee jerks, RR, UO); identify the calcium gluconate antidote and state when to use it; administer labetalol or nifedipine for severe BP; and initiate the referral process.
In the labour ward, observe at minimum two APH cases and two PPH cases during your posting, focusing specifically on: the sequence of actions taken by the resident; the timing of the decision to refer; the completeness of the referral documentation; and any deviation from the protocol that you noticed. Discuss these observations with the resident in the post-emergency debrief. Emergency competency is built from carefully observed real cases, not only simulation — use every case as a learning opportunity.
Self-Assessment
The scenarios below test your ability to apply emergency recognition, first-line management, and need-based treatment planning across the obstetric emergency presentations covered in this module. Each scenario represents a situation you are likely to encounter in your internship, where you may be the first — and only — clinician available for the critical initial minutes. For each scenario, write out your management plan in the sequence: recognise (what emergency constellation do the clinical features represent?) → stabilise (ABCDE: what are your first three actions?) → drug choice (name, dose, route, and any contraindication to check first) → communicate (who do you call, and what do you say?) → transfer (what must accompany the patient?). This structured sequence is exactly the format expected in DOAP skill assessments and OSCE emergency stations at the final MBBS level.
- A 28-year-old woman, 36 weeks pregnant, is brought to a PHC at 2 AM. Her BP is 160/110. She had a convulsion at home lasting 2 minutes. On arrival she is drowsy and her knee jerks are brisk. There is no MgSO₄ available at the PHC — only IV fluids and antihypertensives. Outline your immediate management and referral plan.
- A multigravida delivers at a district hospital. Thirty minutes after delivery the placenta has not been expelled. BP and pulse are normal. What is the immediate management of retained placenta, and at what point would you give oxytocin?
- A patient at 28 weeks presents with sudden onset painless bright-red vaginal bleeding — soaking two pads in 30 minutes. Her BP and pulse are normal and the uterus is soft and non-tender. The fetal heart is audible. How do you manage her, and what is the single most important examination you must NOT perform at this stage?