Management of Obstetrical Emergencies in Community

 Definition of Obstetric Emergency
* It Is a life –threatening medical condition (s) that occur in pregnancy or during or after labour and delivery

Common Obstetric Emergencies 
 1.Antepartum Hemorrhage (APH)
 Means bleeding from the genital tract in late pregnancy, after the 24th week of gestation and before the onset of labour
This can occur as a result of local lesions of the genital tract, placental praevia and abrupt-ion

 Signs and symptoms may include the following
        o Pain
        o Pallor
        o Breathlessness which may indicate shock
        o Low blood pressure and rapid pulse
        o Tenderness of abdomen
 Action
        o Refer immediately for further management

2.Postpartum Hemorrhage (PPH)
 Is defined as excessive bleeding from the genital tract at any time following the baby‘s birth up to 6 weeks after delivery
 If it occurs immediately after delivery or within 24 hours of delivery it is termed Primary PPH
 If it occurs after 24hours following birth up to 6th week it is termed as ―secondary PPH

 Signs of PPH include:
         o Visible vaginal bleeding
         o Maternal collapse/shock
         o Pallor
         o Rising pulse rate
         o Falling blood pressure
         o Altered level of consciousness
         o Restlessness
         o Boggy uterus on palpation
 Action
         o Call for help
         o Immediately refer the woman to a health facility

3.Premature Rupture of Membranes
 Premature rupture of membranes is the rupture of membranes before the onset of labour before 37 weeks‘ gestation
 The condition is characterized by leaking or a gush of watery fluid from the vagina and constant wetness in underwear
 Action
           o Refer the woman to health facility for further management

4.Eclampsia
 Is the onset of convulsions in a pregnancy characterized by rolling of eyes and twitching of muscles and muscle spasms
 The most common sign of eclampsia is ―eclamptic fits‖
 Action
           o Refer immediately

5.Ruptured Uterus
Can be
    o Complete which involve a tear in the wall of the uterus with or without expulsion of the foetus
    o Incomplete involving a tear of the uterine wall but the foetal membrane remain intact.
 Ruptured uterus is accompanied by;
        o Severe abdominal pain released when contractions stop
        o Vaginal bleeding
        o Palpable foetal parts in the abdomen
        o Uterine tenderness and cessation of uterine contractions
        o Loss of foetal movements
        o Signs of shock

 Management of ruptured uterus
       o Once uterine rupture is diagnosed, the woman should be referred immediately to a health  facility

6.Retained Placenta
 This diagnosis is reached when the placenta remain undelivered after a specified period of time (usually half to one hour following the baby‘s
 Action
         o Stop bleeding and refer the woman to the nearest facility

7.Shoulder Dystosia
Failure of the shoulder to spontaneously transverse the pelvis after birth of the head
 This can be manifested through failure of advancing foetal head and rotation of shoulders
 Action
           o The health care provider should summon help immediately and
           o Refer the woman immediately to a health facility

8.Acute Abdominal Pain
 Abdominal pain is a common presenting symptom for miscarriage and ectopic pregnancy in early pregnancy
 It can also be due to retroversion of the uterus, fibroid and ovarian cyst.
 This requires special attention from healthcare providers
 The woman should be referred immediately for further management

9.Prolapsed Umbilical Cord
 The cord lies in front of the presenting part and the foetal membranes are ruptured
 The cord can be felt in the vagina, or in the cervical os or a loop of cord may be visible at the vulva
 Action
       o Once diagnosis of cord prolapsed is made, the health care provider should call for assistance
       o The woman should raise her pelvis and buttocks or adopt ‗Knee-Chest, position to relieve   pressure on the umbilical cord.
       o Elevation of the bed may also relieve compression to the umbilical cord
       o The woman should be referred immediately to the nearest health facility

Equipment and Supplies Needed for Obstetric Emergencies Referral

1.  Pair of sterile gloves
2.  Enough clean clothes
3.  Transport to the health facilities
4.  Companion to escort the women

Management of Obstetric Emergency
 Priorities for obstetric emergency in any setting are;

1.  Shout for help or call her partner to call for help
2.  Inform responsible people (husband, mother, ant or in-laws)
3.  Consult/inform the health facility
4.  Call for ambulance/transport
5.  Collect belongs of the mother
6.  Escort the mother to the health facility
7.  Remain with the client to monitor condition
8.  Stay calm to reduce the couple‘s anxiety
9. Put on gloves to prevent contact with blood and other secretions

Summary

•   Obstetric Emergency is a life –threatening medical condition (s) that occur in pregnancy or during or after labour and delivery
•  The common obstetric emergencies include antepartum and postpartum haemorrhage, premature rupture of membranes, eclampsia, ruptured uterus, retained placenta, shoulder dystocia, acute abdominal pain and prolapsed umbilical cord.