Obstetric Emergencies

Obstetric emergencies are sudden, life-threatening conditions that occur during pregnancy, labor, or the postpartum period. Prompt recognition and management are essential to save the lives of both mother and baby. Major emergencies include shoulder dystocia, cord prolapse, eclampsia, and amniotic fluid embolism.

 
1. Shoulder Dystocia
Shoulder dystocia occurs when, after delivery of the baby’s head, the anterior shoulder becomes impacted behind the maternal pubic symphysis, preventing delivery.
Risk Factors:
• Macrosomia (large baby)
• Maternal diabetes
• Prolonged second stage of labor
Management:
• Call for help immediately
• Perform McRoberts maneuver (flexing the mother’s thighs onto her abdomen)
• Apply suprapubic pressure to dislodge the shoulder
• If unsuccessful, perform internal rotational maneuvers (e.g., Woods screw maneuver)
• Avoid excessive traction to prevent brachial plexus injury

2. Cord Prolapse
Cord prolapse is the descent of the umbilical cord through the cervix alongside or past the presenting fetal part after rupture of membranes. It compromises fetal oxygen supply.
Management:
• Immediate action required — this is an obstetric emergency.
• Call for help and relieve pressure on the cord by:
o Placing the mother in knee-chest or Trendelenburg position
o Manually elevating the presenting part from the cord
• Avoid handling the cord excessively.
• Cover the exposed cord with warm saline-soaked gauze.
• Immediate cesarean delivery is usually indicated.

3. Eclampsia
Eclampsia is the occurrence of seizures in a woman with preeclampsia (high blood pressure and proteinuria during pregnancy).
Signs and Symptoms:
• Severe headache, blurred vision, convulsions, and loss of consciousness
Management:
• Ensure airway, breathing, and circulation (ABC)
• Place the woman in left lateral position to prevent aspiration
• Administer Magnesium sulfate (drug of choice) to control seizures
• Control blood pressure with labetalol or hydralazine
• Plan for delivery once the mother is stabilized

4. Amniotic Fluid Embolism (AFE)
Amniotic Fluid Embolism is a rare but fatal condition caused by entry of amniotic fluid into the maternal circulation, triggering a severe allergic-type reaction.
Symptoms:
• Sudden collapse with dyspnea, hypotension, cyanosis, and cardiac arrest
• May be followed by disseminated intravascular coagulation (DIC)
Management:
• Immediate resuscitation (oxygen, fluids, CPR if needed)
• Maintain oxygenation and blood pressure
• Correct coagulopathy with blood products
• Multidisciplinary critical care support is essential

Conclusion
Early recognition and rapid management of obstetric emergencies such as shoulder dystocia, cord prolapse, eclampsia, and amniotic fluid embolism are vital to prevent maternal and neonatal mortality.