An obstetrical emergency is a situation where the life of the mother or baby is in danger, requiring immediate action to save lives. Midwives must act quickly, providing emergency treatment and ensuring proper referral when necessary.

List of Obstetrical Emergencies

1. Antepartum Hemorrhage (APH)

2. Postpartum Hemorrhage (PPH)

3. Cord Prolapse

4. Ruptured Uterus

5. Fetal Distress

6. Vasa Previa

7. Intrapartum Hemorrhage

8. Obstructed Labor

9. Retained Placenta

10. Severe Preeclampsia and Eclampsia

11. Pulmonary Embolism

12. Severe Anemia

13. Inversion of the Uterus

14. Impending Rupture of the Uterus

15. Obstetric Shock

Roles of a Nurse/Midwife in Obstetrical Emergencies

1. At The Community Level

• Health Education: Educate the community about obstetrical emergencies, including their roles in management and prevention.

• TBA Supervision: Educate, supervise, and evaluate Traditional Birth Attendants (TBAs) in the care given to mothers during pregnancy, labor, and the puerperium.

• Awareness of Facilities: Raise awareness of available health facilities (dispensaries, clinics, maternity centers, hospitals).

• Clinic Attendance: Encourage attendance at antenatal, intranatal, postnatal, young child, and family planning clinics.

• Self-Help Projects: Advise women to start self-help projects to minimize over-dependence on their husbands.

• Nutrition: Emphasize the importance of a well-balanced diet.

• Harmful Practices: Discourage harmful traditional practices and beliefs that expose girls to early marriage and limit their education.

• Husband’s Role: Encourage husbands to take over physically tiring tasks from their pregnant wives.

• Emergency Transport: Encourage the community to assist with transportation in case of emergencies.

2. During Pregnancy

• Identify High-Risk Cases: Identify high-risk pregnancies that may result in emergencies and refer them in a timely manner.

• Thorough Assessment: Conduct thorough history taking, physical examinations, and early investigations for every pregnant woman.

• Labor Preparation: Prepare mothers for labor and successful lactation.

• Treat Minor Conditions: Provide prompt treatment for minor conditions like morning sickness.

• Early Referral: Refer mothers with serious conditions early for further management.

• Proper Referrals: Ensure proper referral systems are in place.

3. During Labor

• Welcoming Admission: Provide a warm welcome, reassurance, and counseling to mothers in labor.

• Thorough Assessment: Conduct thorough history taking, physical examinations, and investigations for every woman in labor.

• Monitoring: Monitor mothers in labor closely, using a partograph.

• Early Detection of Danger Signs: Detect danger signs early and summon help promptly.

• Avoid Prolonged Labor: Prevent prolonged and exhausting labor by administering analgesics, providing reassurance, avoiding early pushing, and ensuring rehydration with IV fluids or oral intake.

• Timely Episiotomy: Provide a timely episiotomy when indicated (e.g., assisted deliveries, malpresentation, malposition) to prevent extended tears and hemorrhage.

• Infection Prevention: Use aseptic techniques throughout labor to prevent infection.

• Proper Third Stage Management: Ensure proper management of the third stage of labor to prevent postpartum hemorrhage.

4. After Delivery

• Close Observation: Observe the mother and baby closely, especially in the first 2 hours, to prevent complications.

• Health Education: Educate mothers about:

  • The importance of a well-balanced diet.

  • Breastfeeding on demand.

  • Postnatal exercises.

  • Maintaining personal and environmental hygiene.

  • Returning for a postnatal checkup after 6 weeks.

  • Attending family planning clinics.

  • Bringing the baby to the Young Child Clinic (YCC) for immunization.

General Management Principles

1. Readiness: Ensure everything needed for managing high-risk pregnancies is readily available, including:

   • Emergency Tray: Equipped with drugs (ergometrine, hydrocortisone, diazepam, dexamethasone, mannitol, digoxin, Lasix, dextrose 5%, 50%, vitamin K, aminophylline, atropine, pethidine, morphine, Pitocin, magnesium sulfate, adrenaline), oxygen cylinder, solutions (normal saline), needles and syringes, adequate staff, Ambu bags, and any other resuscitation equipment.

2. Competent Staff: The midwife/nurse should be calm, quick, knowledgeable, and able to summon help when needed.

3. Prioritize: Address the most urgent need first (e.g., arresting hemorrhage, rehydration, or delivery of the baby).

4. Assessment: Perform a quick but thorough history, physical examination, and investigations.

5. Systematic Care: Apply essential care systematically according to the emergency (e.g., delivery, manual removal of the placenta, resuscitation), using the nursing process.

6. Reassurance: Reassure the mother and her relatives.

7. Referral: Some mothers with high-risk pregnancies are cared for in the maternity center during pregnancy and referred at full term for delivery in the hospital. Others are referred on the first contact.

8. Early Detection and Referral: Emphasize the importance of early detection and referral.

9. Transport: Prepare for transport if necessary.

10. Referral Notes: Write detailed referral notes, including:

    • Time of arrival

    • Personal history of the mother

    • General condition on arrival

    • Findings on examination and admission

    • Treatment given, plus obstetrical management

    • Reasons for referral

    • Condition at referral

Complications

To the Mother:

Obstetrical emergencies increase the risk of maternal morbidity and mortality, especially if management is delayed or inappropriate. Lack of facilities or inadequate knowledge can worsen outcomes. Potential complications include:

• Hemorrhage (due to APH, PPH, or intrapartum hemorrhage)

• Shock (resulting from severe bleeding)

• Infections (following prolonged second stage or manual removal of the placenta)

• General ill health

• Anemia

• Puerperal psychosis

• Venous thrombosis

• Poor lactation

• Sterility

• Need for assisted deliveries

• Premature labor

• Low resistance to infections

• ABO incompatibility

• Amniotic fluid embolism

• Infertility (resulting from infections and damage to the reproductive system)

To the Baby:

• High neonatal and infant morbidity and mortality

• Failure to thrive

• Cerebral damage leading to mental retardation

• Complications associated with premature deliveries

• Pregnancy wastage (abortions)

• Complications associated with assisted deliveries

• Intrauterine fetal growth retardation

• Low resistance to infections

Prevention of Obstetric Emergencies

• Midwife’s Role: Emphasize the crucial role of the midwife in managing obstetric emergencies.

• Knowledge and Skills: The nurse/midwife should be knowledgeable and skilled in handling obstetric emergencies.

• Continuing Education: The nurse/midwife should regularly update their knowledge of obstetrical conditions.

• Equipped Maternity Center: The midwife should ensure her maternity center is well-equipped to deal with emergencies efficiently.

• Prompt Transfer: Ensure the ability to transfer the mother to the hospital immediately when necessary

Pediatric Emergencies

Pediatric Emergencies are conditions where the life of the baby is in danger of death or complications.
They are considered right from birth up to 5 years of age.