Obstetrics Emergencies

Placental Abruption

• Clinical Presentation:
  • Sudden onset of painful vaginal bleeding.
  • Tender, rigid uterus.
  • Signs of fetal distress or maternal shock in severe cases.
• Diagnostic Tests:
  • Clinical diagnosis based on symptoms.
  • Ultrasound may show retroplacental hematoma but can miss the diagnosis.
  • Fetal monitoring to assess distress.
• Treatment:
  • Immediate delivery if fetal distress or significant maternal hemorrhage is present, usually by caesarean section.
  • Stabilization with IV fluids and blood products.
  • Continuous monitoring of both mother and fetus.

Placenta Previa

• Clinical Presentation:
  • Painless bright red vaginal bleeding, usually in the third trimester.
  • Soft, non-tender uterus.
  • Possible preterm labour.
• Diagnostic Tests:
  • Ultrasound to confirm placental location.
  • Fetal monitoring for signs of distress.
• Treatment:
  • Bed rest and monitoring if mild bleeding and preterm.
  • Immediate caesarean section if significant bleeding or fetal distress.

Uterine Rupture

• Clinical Presentation:
  • Sudden, severe abdominal pain and vaginal bleeding.
  • Loss of fetal station or abnormal fetal heart rate patterns.
  • Signs of maternal shock (hypotension, tachycardia).
• Diagnostic Tests:
  • Clinical diagnosis based on symptoms and history (e.g., previous caesarean section).
  • Ultrasound may help, but often the diagnosis is made during surgery.
• Treatment:
  • Immediate emergency caesarean section.
  • Surgical repair of the uterus or hysterectomy if necessary.
  • Stabilization with IV fluids and blood transfusion.

Amniotic Fluid Embolism

• Clinical Presentation:
  • Sudden onset of respiratory distress and hypotension during labour or immediately postpartum.
  • Severe coagulopathy and disseminated intravascular coagulation (DIC).
  • Altered mental status and seizures may occur.
• Diagnostic Tests:
  • Clinical diagnosis; no specific test confirms the diagnosis.
  • Blood tests showing DIC (elevated D-dimer, prolonged PT/PTT, low platelets).
  • Chest X-ray may show pulmonary edema.
• Treatment:
  • Immediate supportive care in an ICU setting.
  • Oxygen therapy, mechanical ventilation if necessary.
  • IV fluids, vasopressors, and blood products to manage shock and DIC.
  • Prompt delivery of the baby to improve maternal and fetal outcomes.

Shoulder Dystocia

• Clinical Presentation:
  • Difficulty delivering the baby's shoulders after the head has emerged.
  • Turtle sign (head retracts against the perineum).
  • Prolonged labour and fetal distress.
• Diagnostic Tests:
  • Clinical diagnosis based on difficulty in delivery.
  • Fetal monitoring for distress.
• Treatment:
  • McRoberts maneuver (maternal legs flexed onto abdomen).
  • Suprapubic pressure to dislodge the shoulder.
  • Possible episiotomy or other maneuvers to facilitate delivery.

Postpartum Haemorrhage (PPH)

• Clinical Presentation:
  • Excessive vaginal bleeding after delivery (>500 mL after vaginal birth or >1000 mL after caesarean).
  • Signs of hypovolemic shock (hypotension, tachycardia, pallor).
  • Uterine atony (soft and boggy uterus) is a common finding.
• Diagnostic Tests:
  • Clinical diagnosis based on visible blood loss and vital signs.
  • Ultrasound may be used to identify retained products of conception.
  • Laboratory tests: CBC, coagulation profile.
• Treatment:
  • Uterotonic agents (oxytocin, misoprostol) to promote uterine contraction.
  • Manual uterine massage.
  • Surgical intervention (e.g., uterine tamponade, D&C, hysterectomy) if bleeding persists.
  • IV fluids and blood transfusion to stabilize the patient.

Eclampsia

• Clinical Presentation:
  • Seizures in a pregnant woman with preeclampsia (hypertension, proteinuria, edema).
  • Severe headache, visual disturbances, and epigastric pain may precede seizures.
  • Signs of severe hypertension.
• Diagnostic Tests:
  • Blood pressure monitoring.
  • Urine analysis for proteinuria.
  • Blood tests: liver function, kidney function, platelets.
• Treatment:
  • Magnesium sulfate for seizure control.
  • Antihypertensive medications (e.g., labetalol, hydralazine).
  • Immediate delivery of the baby, regardless of gestational age.
  • Intensive monitoring of both mother and fetus.

Umbilical Cord Prolapse

• Clinical Presentation:
  • Visible or palpable cord in the vagina ahead of the presenting part.
  • Fetal bradycardia or variable decelerations on monitoring.
  • Sudden onset of fetal distress.
• Diagnostic Tests:
  • Clinical diagnosis based on visualization or palpation of the cord.
  • Fetal heart rate monitoring to assess distress.
• Treatment:
  • Immediate repositioning of the mother to relieve cord pressure (e.g., knee-chest position).
  • Emergency caesarean section to deliver the baby.
  • Oxygen administration to the mother and continuous fetal monitoring.

HELLP Syndrome

• Clinical Presentation:
  • Right upper quadrant or epigastric pain.
  • Nausea, vomiting, and malaise.
  • Signs of preeclampsia (hypertension, proteinuria).
• Diagnostic Tests:
  • Blood tests: haemolysis (LDH, bilirubin), elevated liver enzymes (AST, ALT), low platelets.
  • Urine analysis for proteinuria.
  • Fetal monitoring for distress.
• Treatment:
  • Stabilization of the mother with IV fluids, blood products if needed.
  • Antihypertensive therapy and magnesium sulfate to prevent seizures.
  • Immediate delivery of the baby, usually via caesarean section.