Obstetric Emergencies

There are a number of potential complications associated with pregnancy that can threaten the well-being of both mother and child.

Several complications can arise throughout pregnancy. In the first trimester, the two major potential problems are miscarriage and ectopic pregnancy.

"Miscarriage" (up to 24 wks) is the lay term for the natural or accidental termination of a pregnancy at a stage where the foetus is incapable of surviving. The medical term for it is "abortion"; when the abortion is not deliberately induced, it is termed a "spontaneous abortion".
- Threatened Miscarriage - Light bleeding with little or no pain
- Inevitable Miscarriage - Increased pain with bleeding. (Dilated cervix)
- Incomplete Miscarriage - When some of the placenta is retained. Severe bleeding and infection are common
In a normal pregnancy, the fertilized egg enters the uterus and settles into the uterine lining where it has plenty of room to divide and grow. In a typical ectopic pregnancy, the egg does not reach the uterus, but instead adheres to the wall of the Fallopian tube. As the embryo grows, the tube becomes stretched and inflamed, causing extreme pain in the pregnant woman. If left untreated, the affected Fallopian tube will likely burst.
- The most common symptoms and signs of ectopic pregnancy include:
  - Patient of child bearing age
  - Sharp pain in the abdomen or pelvis
  - Signs of early pregnancy
  - Vaginal bleeding
  - Tender abdomen
  - Dizziness or fainting and generally not feeling well
Just because a woman is experiencing these pains it doesn't mean they have an ectopic pregnancy but bear in mind the possibility.

Management of Miscarriage/Possible Ectopic event

GO DR SHAVPU ACBC

Reassurance, rest and gentle treatment, Entonox for pain relief, treatment for shock if necessary.

ASHICE (Consider)

Transport to Hospital (Bring all of patients pregnancy notes if available)

Professional Handover

Antepartum Haemorrhage (after 24 weeks)

Placenta praevia is characterised by the implantation of the placenta over or near the top of the cervix. Bright red blood is lost

Abruptio Placenta is separation of the placenta (the organ that nourishes the foetus) from the site of uterine implantation before delivery of the foetus. Blood is darker in colour and patient is likely to be in severe pain.

Management of Antepartum Haemorrhage

GO DR SHAVPU ACBC

Reassurance, rest and gentle treatment, Entonox, treatment for shock if necessary.

ASHICE (Consider)

Transport to Hospital (Bring all of patients pregnancy notes if available)

Professional Handover

Eclampsia

It describes one or more convulsions occurring during or immediately after pregnancy as a complication of pre-eclampsia.

Before they suffer an eclamptic convulsion, most women have signs of pre-eclampsia, most notably high blood pressure and/or protein in the urine, Swollen hands and feet. Often there are one or more warning symptoms - such as restlessness, shakiness, intense headache, upper abdominal pain or visual disturbances - before the fit occurs, although these are very common, non-specific symptoms which are usually perfectly benign

Management

GO DR SHAVPU ACBC

Reassurance, High concentrations of O₂,Monitoring vital signs. Loosen tight clothing, Do not attempt to restrain patient, Do not put anything in patients mouth, Deal with any injuries sustained during attack. Consider paramedic backup

Secondary Survey

ASHICE (Consider)

Transport to Hospital

Professional Handover