Obstetrical Emergencies Definition Obstetrical emergencies are life-threatening medical conditions that occur in pregnancy pregnancy or or during or after labor anddelivery.
Description There are a number of illnesses and disorders of pregnancy that can threaten the well-being of both mother and child.Obstetrical emergencies may also occur during active labor, and after delivery (postpartum).
Obstetrical emergencies of pregnancy ECTOPIC PREGNANCY.. An ectopic, or tubal, pregnancy occurs when the fertilied egg implants itself in the fallopiantube PREGNANCY rather than the uterine wall. !f the pregnancy is not terminated at an early stage, the fallopian tube will rupture,ca using internal hemorrhaging and potentially resulting in permanent infertility. PLACENTAL ABRPTION.. Also called abruptio placenta , placental abruption occurs when the placenta separates fromthe ut ABRPTION erus prematurely, causing bleeding and contractions. !f over "#$ of the placenta separates, both the fetus andm other are at ris%. PLACENTA PRE!IA. &hen the placenta attaches to the mouth of the uterus and partially or completely bloc%s thecervi', the PRE!IA. position is termed placen placenta ta previa (or low-lying placenta). Placenta pre"ia can result in premature bleedingand possible postpartum hemorrhage. pre"ia can EE*+A!AE*+A!A. reeclampsia (to'emia), or pregnancy-induced high blood pressure, causes se vereedema (swelling due to water retention) and can impair %idney and liver function. The condition occurs in ap pro'imately"$ of all /nited tates pregnancies. !f it progresses to eclampsia, to'emia is potentially fatal for mot her and child. EAT/E /T/E O0 E1A2E (O). remature rupture of membranes is the brea%ing of the b ag ofwaters (amniotic fluid) before contractions or labor begins. The situation is only considered an emergency if the brea%occurs before thirty-seven wee%s and results in significant lea%age of amniotic fluid andor infection of t he amniotic sac.
Obstetrical emergencies #$ring labor an# #eli"ery A2!OT!* 0+/!3 E1O+!. A rare but fre4uently fatal complication of labor, labor, this condition occurs when amni otic fluidembolies from the amniotic sac and through the veins of the uterus and into the circulatory system of t he mother. Thefetal cells present in the fluid then bloc% or clog the pulmonary artery, resulting in %eart attac&. This complication canalso happen during pregnancy, but usually occurs in the presence of strong contra attac&. ctions. !25E!O2 O /T/E O0 /TE/. 3uring labor, a wea% spot in the uterus (such as a scar or a uterine w all that isthinned by a multiple pregnancy) may tear, resulting in a uterine rupture. !n certain circumstances, a po
rtion of theplacenta may stay attached to the wall and will pull the uterus out with it during delivery. This is called uterine inversion. +A*E2TA A**ETA. Placenta accreta occurs when the placenta is implanted too deeply into the uterine wall, and willnot detach during the late stages of c%il#birt%, resulting in uncontrolled bleeding. O+AE3 /1!+!*A+ *O3. A prolapse of the umbilical cord occurs when the cord is pushed down into th e cervi'or vagina. !f the cord becomes compressed, the o'ygen supply to the fetus could be diminished, resultin g in braindamage or possible #eat%. 6O/+3E 37TO*!A. houlder dystocia occurs when the baby8s shoulder(s) becomes wedged in the birth c anal afterthe head has been delivered.
Obstetrical emergencies postpart$m OTAT/ 6EO6A9E O !20E*T!O2. evere bleeding or uterine infection occurring after delivery is aserious, potentially fatal situation.
Ca$ses an# symptoms Obstetrical emergencies can be caused by a number of factors, including stress, trauma, genetics, and other va riables.!n some cases, past medical history, including previous pregnancies and deliveries, may help an obstetri cian anticipatethe possibility of complications. igns and symptoms of an obstetrical emergency include, but are not limited to: •
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3iminished fetal activity. !n the late third trimester, fewer than ten movements in a two hour period may indicate t hatthe fetus is in distress. Abnormal bleeding. 3uring pregnancy, brown or white to pin% vaginal discharge is normal, bright red blood or bl
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oodcontaining large clots is not. After delivery, continual blood loss of over "## ml indicates hemorrhage. +ea%ing amniotic fluid. Amniotic fluid is straw-colored and may easily be confused with urine lea%age, but can be
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differentiated by its slightly sweet odor. evere abdominal pain. tomach or lower bac% pain can indicate preeclampsia or an undiagnosed ectopicpreg
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nancy. ostpartum stomach pain can be a sign of infection or hemorrhage. *ontractions. egular contractions before ;< wee%s of gestation can signal the onset of preterm labor due toobs
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tetrical complications. Abrupt and rapid increase in blood pressure. 6ypertension is one of the first signs of to'emia.
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Edema. udden and significant swelling of hands and feet caused by fluid retention from to'emia.
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/npleasant smelling vaginal discharge. A thic%, malodorous discharge from the vagina can indicate a postpartu
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minfection. 'e"er . 0ever may indicate an active infection.
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+oss of consciousness. (%oc& due to blood loss (hemorrhage) or amniotic embolism can precipitate a loss ofc
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onsciousness in the mother. 1lurred vision and headaches. 5ision problems and %ea#ac%e are possible symptoms of preeclampsia.
Diagnosis 3iagnosis of an obstetrical emergency typically ta%es place in a hospital or other urgent care facility. A specialist willta%e the patient8s medical history and perform a pelvic and general physical e'amination. The mother8s vital s igns areta%en, and if preeclampsia is suspected, blood pressure may be monitored over a period of time. The fet al heartbeat isassessed with a doppler stethoscope, and diagnostic blood and urine tests of the mother may als
o be performed,including laboratory analysis for protein andor bacterial infection. An ab#ominal $ltraso$n# may aid in the diagnosis ofany condition that involves a malpositioned placenta, such as placenta pr evia or placenta abruption. !n cases where an obstetrical complication is suspected, a fetal heart monitor is positioned e'ternally on the mot her8sabdomen. !f the fetal heart rate is erratic or wea%, or if it does not respond to movement, the fetus may be i n distress. Abiophysical profile (1) may also be performed to evaluate the health of the fetus. The 1 uses data from anultrasound e'amination to analye the fetus sie, movement, heart rate, and surrounding amniotic fl uid. !f the mother8s membranes have ruptured and her cervi' is partially dilated, an internal fetal scalp electrode can beinserted through the vagina to assess heart rate. A fetal o'imetry monitor that measures the o'ygen saturatio n levels ofthe fetus may also be attached to the scalp.
Treatment Obstetrical emergencies of pregnancy ECTOPIC PREGNANCY. Treatment of an ectopic pregnancy is laparoscopic surgical removal of the fertilied ovum. !fthe fallopian tube has burst or been damag ed, further surgery will be necessary. PLACENTAL ABRPTION. !n mild cases of placental abr$ption, bed rest may prevent further separation of theplacenta and stem bleeding. !f a significant abruption ( over "#$) occurs, the fetus may have to be delivered immediatelyand a blood transf$sion may be re4uired. PLACENTA PRE!IA. 6ospitaliation or highly restricted athome bed rest is usually recommended if placenta previa isdiagnosed after the twentieth wee% of pregnancy. !f t he fetus is at least ;= wee%s old and the lungs are mature, acesarean section is performed to deliver the baby. EE*+A!AE*+A!A. Treatment of preeclampsia depends upon the age of the fetus and the acutenes s of thecondition. A woman near full term who has only mild to'emia may have labor induced to deliver the child as soon aspossible. evere preeclampsia in a woman near term also calls for immediate delivery of the child, as this is the only%nown cure for the condition. 6owever, if the fetus is under >? wee%s, the mother may be hospitali ed and steroids maybe administered to try to hasten lung development in the fetus. !f the life of the mother or fe tus appears to be in danger,the baby is delivered immediately, usually by cesarean section. EAT/E /T/E O0 E1A2E (O). !f O occurs before ;< wee%s andor results in signific antlea%age of amniotic fluid, a course of intravenous antibiotics is started. A culture of the cervi' may be ta%en to analyefor the presence of bacterial infection. !f the fetus is close to term, labor is typically induced if contracti ons do not startwithin >@ hours of rupture.
Obstetrical emergencies #$ring labor an# #eli"ery A2!OT!* 0+/!3 E1O+!. The stress of contractions can cause this complication, which has a high mortali ty rate.Administering steroids to the mother and delivering the fetus as soon as possible is the standard treatme nt. !25E!O2 O /T/E O0 /TE/. An inverted uterus is either manually or surgical replaced to the prop erposition. A ruptured uterus is repaired if possible, although if the damage is e'treme, a %ysterectomy (remov al of theuterus) may be performed. A blood transfusion may be re4uired in either case if hemorrhaging occurs.
+A*E2TA A**ETA. &omen who e'perience placenta accreta will typically need to have their placenta surgi callyremoved after delivery. 6ysterectomy is necessary in some cases. O+AE3 /1!+!*A+ *O3. aline may be infused into the vagina to relieve the compression. !f the cord hasprolapsed out the vaginal opening, it may be replaced, but immediate delivery by cesarean section is usually indicated.
Obstetrical emergencies postpart$m OTAT/ 6EO6A9E O !20E*T!O2. The source of the hemorrhage is determined, and blood trans fusionand !5 fluids are given as necessary. O'ytocic drugs may be administered to encourage contraction of the uterus.etained placenta is a fre4uent cause of persistent bleeding, and surgical removal of the remaining frag ments (curettage)may be re4uired. urgical repair of lacerations to the birth canal or uterus may be re4uired. 3r ugs that encouragecoagulation (clotting) of the blood may be administered to stem the bleeding. !nfre4uently, hy sterectomy is re4uired. !n cases of infection, a course of intravenous antibiotics is prescribed. ost postpartum infections occur in theen dometrium, or lining of the uterus, and may be also caused by a piece of retained placenta. !f this is the case, it willalso re4uire surgical removal. 6O/+3E 37TO*!A. The mother is usually positioned with her %nees to her chest, %nown as the coberts maneuver, in an effort to free the child8s shoulder. An episiotomy is also performed to widen the vaginal openin g. !f theshoulder cannot be dislodged from the pelvis, the baby8s clavicle (collarbone) may have to be bro%en to complete thedelivery before a lac% of o'ygen causes brain damage to the infant.
Prognosis !f a fetus is close to full-term (;< wee%s) and the complication is detected early enough, the prognosis is usually good formother and child. &ith advances in neonatal care, appro'imately ?"$ of infants weighing less than ; lb s " o survive,and these infants are being delivered at >? wee%s and younger. 6owever, preterm infants have a greater chance ofserious medical problems, and developmental disabilities occur in >"-"#$. They also have a h igher incidence of learningdisorders, and are four to si' times more li%ely to be diagnosed with attention-deficit h yperactivity disorder (A363).
Pre"ention roper prenatal care is the best prevention for obstetrical emergencies. &hen complications of pregnancy do ari se,pregnant women who see their O1972 on a regular basis are more li%ely to get an early diagnosis, and with it, the bestchance for fast and effective treatment. !n addition, eating right and ta%ing prenatal "itamins and sup plements asrecommended by a physician will also contribute to the health of both mother and child.
Reso$rces Perio#icals *hamberlain, 9eoffrey, and hillip teer. Obstetric Emergencies. British Medical Journal . ;B?, no..
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.ey terms Amniotic fl$i# D The li4uid in the placental sac that cushions the fetus and regulates temperature in the placentalenviron ment. Amniotic fluid also contains fetal cells. Cesarean section D The surgical delivery of a fetus through an incision in the uterus. Embolism D 1lood vessel obstruction by a blood clot or other substance (i.e., air, cell matter). Episiotomy D !ncision of the perineum, the area between the vulva and the anus, to assist delivery and avoid s everetearing of the perineum. Laparoscopic D A minimally-invasive surgical or diagnostic procedure that uses a fle'ible endoscope (laparos cope) toview and operate on structures in the abdomen. Postpart$m D After childbirth.