Quick Chart
  • While most pregnancies and births are uneventful, all pregnancies are at risk. Around 15% of all pregnant women develop a potentially life-threatening complication.

Read the complete article; Obstetrics in the Medical Library > Pathophysiology.

 Clinical Presentation
  • Obstetric emergencies should be considered for any female of child bearing age presenting with abdominal pain and/or PV bleeding. 
  • Obstetric patients are able to compensate well due to the increase in maternal blood volume and may deteriorate rapidly. Observations are not a reliable indicator whether or not the patient is time critical. If the patient experiences any complications, priority transport should be considered.
 Exclusion Criteria
Exclusion Criteria
 Risk Assessment
  • Early Pregnancy Bleeding
  • Late pregnancy / APH ≥20 weeks
    • Placenta abruption / praevia
    • Gestational HTN and pre-eclampsia
  • Multiple Births
  • Pre-term Delivery
  • Malpresentation
  • Cord Prolapse
  • Post-partum haemorrhage
  • Supine Hypotension Syndrome
  • Thromboembolic Disease
  • amniotic fluid embolism

Complications can occur up to 6 weeks postpartum, including:

  • post-partum haemorrhage
  • post-partum preeclampsia
  • sepsis
  • amniotic fluid embolism (up to 48 hours post-partum)
Primary Care
  • Primary Survey
  • Vital Sign Survey
  • Consider Oxygen if indicated as per CPG
  • Post Birth:
    • Apply direct pressure to any visible bleed, such as tear of perineum
    • Apply management principles as indicated in clinical skill Postpartum Haemorrhage
      • Encourage breast feeding (which triggers uterine contraction)
      • Consider fundus (uterine) massage
      • In life threatening conditions, consider aortic/suprapubic compression.
  • Secondary / CNS Survey (as required)
Intermediate Care
  • Apply cardiac monitor if trained and authorised
  • Consider pain relief
  • Consider anti-emetic
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility and informing them especially if patient is pregnant
Advanced Care
  • Apply cardiac monitor
  • Establish vascular access
  • Fluid therapy as per CPG
  • Consider pain relief
  • Consider anti-emetic
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport patient in left lateral tilt
  • Transport Priority 1 if patient time critical as per transport decision guidelines, pre-notifying receiving facility
Transport Decision
  • < 20 weeks – nearest/allocated ED
  • ≥ 20 weeks – obstetric unit
  • ALL pregnant patients suffering major trauma, follow Major Trauma Guideline
Critical & Extended Care
  • As per Advanced Care guidelines
 Additional Information
  • Amount of vaginal bleeding is difficult to estimate.
  • Vaginal examination by SJA staff is never indicated, and is not to be performed.
  • May call for second vehicle to assist when dealing with two unwell patients post birth, the momentum of getting to hospital should always remain a priority, a rendezvous can be arranged en-route.
Key Terms & Links
Extended Care:
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