UNCONTROLLED WHEN PRINTED
Quick Chart
Introduction
- 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.
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
Management
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.
- Apply direct pressure to any visible bleed, such as tear of perineum
- Secondary / CNS Survey (as required)
Intermediate Care (EMT / Level 2)
- 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 (AP)
- 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 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 (CCP, PSO)
- As per Advanced Care (AP) 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.
References
References
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Responsible Manager
Head of Clinical Services
Published Date
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