OB/GYN - LABOR / DELIVERY + OBSTETRIC EMERGENCIES

YEAR 3 | PAGE 30F - STABILIZE -> MATERNAL / FETAL STATUS -> TIME-CRITICAL NEXT STEP

C. LABOR + DELIVERY REASONING FRAME

Decision	What to integrate	Shelf / ward logic
Is this labor?	Contractions, cervical change, membrane status, gestational age and presentation.	Distinguish true labor from symptoms without progressive cervical change; preterm context changes the entire pathway.
Is labor progressing?	Stage of labor, dilation/effacement/station, contraction pattern, fetal position and adequacy of time.	Do not diagnose arrest from one snapshot. Use the current labor framework and ask whether augmentation, observation or operative delivery is appropriate.
How is the fetus tolerating labor?	Baseline, variability, accelerations/decelerations, contraction timing and maternal context.	Interpret the tracing as a pattern. Correct reversible causes and escalate when persistent abnormalities imply fetal compromise.
What delivery route?	Presentation, prior uterine surgery, placental location, fetal/maternal status, labor progress and contraindications.	The exam often gives several technically possible routes but asks for the safest route now.
What changed postpartum?	Bleeding, uterine tone, retained tissue, laceration, infection, blood pressure, pain, cardiopulmonary symptoms and mental health.	Delivery does not end risk. Postpartum hemorrhage, hypertension, infection and thromboembolism remain time-sensitive.

D. OBSTETRIC EMERGENCIES - RECOGNIZE THE TRIGGER

Threat	Clues to prioritize	Immediate reasoning sequence
Severe preeclampsia / eclampsia / HELLP	Severe-range pressure or end-organ symptoms, seizure, hemolysis/liver/platelet abnormalities, fetal/placental compromise.	Stabilize maternal airway/circulation, prevent/treat seizure as indicated, control severe hypertension and determine delivery timing with the supervised obstetric team.
Third-trimester bleeding	Painful vs painless bleeding, uterine tone/tenderness, fetal status, placental location, hemodynamics.	Stabilize first; avoid unsafe examination when placenta previa is possible; use ultrasound/obstetric evaluation to distinguish placental causes and urgency.
Cord prolapse / uterine rupture / shoulder dystocia	Sudden fetal bradycardia after membrane rupture, prior uterine scar + acute pain/loss of station, or impacted shoulder after head delivery.	These are action-before-complete-diagnosis scenarios: call for help, perform the immediate maneuver/pathway and expedite definitive delivery as appropriate.
Postpartum hemorrhage	Excessive bleeding with atony, retained tissue, trauma or coagulopathy; tachycardia/hypotension may lag.	Resuscitate while identifying the cause. Use the 4 Ts framework (Tone, Trauma, Tissue, Thrombin) and escalate rapidly if bleeding persists.
Preterm labor / PPROM	Gestational age, contractions/cervical change, membrane rupture, infection, fetal status and contraindication to expectant management.	Balance prematurity benefit against infection, bleeding, fetal compromise or maternal instability; gestational age drives medications and delivery decisions.

E. FETAL MONITORING: DO NOT NAME THE CATEGORY AND STOP

Baseline + variability first: ask whether fetal autonomic function appears preserved before chasing individual decelerations.
Match deceleration to contractions: timing and shape suggest different mechanisms; the management question is whether the pattern is reassuring, needs reversible-cause correction, or requires escalation.
Reassess after intervention: maternal position, blood pressure, uterine tachysystole, medications and fluid status can change the tracing; response is new data.

E. FETAL MONITORING: DO NOT NAME THE CATEGORY AND STOP — Direct video repair

APGO - Topic 11: Intrapartum Care	APGO - Topic 26: Intrapartum Fetal Surveillance
APGO - Topic 22: Abnormal Labor APGO - Topic 27: Postpartum Hemorrhage 2026/27 clerkship-expanded edition - verify school and official exam updates before testing	APGO - Topic 18: Preeclampsia-Eclampsia APGO - Topic 23: Third Trimester Bleeding