Clinical Review

ABC of labour care

Obstetric emergencies

BMJ 1999; 318 doi: 10.1136/bmj.318.7194.1342 (Published 15 May 1999)
Cite this as: BMJ 1999;318:1342

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  1. Geoffrey Chamberlain,
  2. Philip Steer

    The management of emergencies is usually the responsibility of hospital obstetricians. As more maternity care is now given in the community, however, midwives, general practitioners, and paramedics may be involved and must know the outlines of management of emergencies and the possible side effects. If such a situation occurs outside the hospital then arrangements must be made to transport the woman to the obstetric unit safely and promptly.

    The first principles of dealing with obstetric emergencies are the same as for any emergency (see to the airway, breathing, and circulation), but remember that in obstetrics there are two patients; the fetus is very vulnerable to maternal hypoxia

    Clinical features of abruption of the placenta

    Symptoms

    • Abdominal pain

    • evere shock with symptoms beyond vaginal blood loss

    • Vaginal bleeding—usually old blood

    Signs

    • Shock

    • Spasm of uterus—described as woody

    • Tender uterus

    • Fetal parts hard to feel

    • Often no fetal heart is heard

    All emergency protocols should have been considered beforehand and mutually agreed by obstetricians, midwives, general practitioners, and paramedics. Everybody then knows their immediate priority, and hazards to the woman can be minimised.

    Abruption of the placenta

    An abruption is a death threat to the fetus and a hazard to the mother. When the placenta separates from its bed (probably because of the rupture of a malformed blood vessel), the damage to the fetus follows not just because of the barrier that the clot makes between the placental bed and villi but also because the release of prostaglandins causes a major degree of uterine spasm. This interferes with perfusion of the placenta, which remains attached. Blood tracking into the myometrium often goes as far as the peritoneum over the uterus, causing much pain and shock, with spasm of the uterine muscle.

    Emergency treatment of abruption

    Treat the shock

    • Give oxygen

    • Insert intravenous lines

    • Arrange a cross match of 6 units of blood

    • Give morphine (if fetus dead) …

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