Women's lives are routinely saved on a daily basis throughout the UK. However, when vigilance is relaxed, women die. Complications of childbirth can often not be prevented but they can be treated promptly and effectively, and it is imperative that professionals that provide care to pregnant women follow a structured approach to emergencies. This can be achieved by regular attendance at obstetric drills where practical training, often incorporating mannequins, has been demonstrated to improve management in real life.
For any obstetric emergency, there is an emphasis on team-working. This is usually multidisciplinary and involves anaesthetic, paediatric, haematology and blood-bank colleagues.It is important that teams that work together train together to achieve maximum effectiveness from training. It is vital to have a scribe to record timings and procedures. Effective communication is essential and the role of a team leader should allocated early. This often falls to the most senior obstetrician, but if that person becomes tasked focused they may not be the right person to lead the team, and the role of team leader should then be allocated to someone else. The team should aim to work effectively together and remain calm. More help should be called for if needed. It can be very useful for the team involved to have a debrief session after the event to retrospectively assess the management of the case and discuss good points, as well as how things could have been improved.
This tutorial will cover three obstetric emergencies – maternal collapse and resuscitation, shoulder dystocia and cord prolapse. Other emergencies such as eclampsia and haemorrhage are covered in their own module and hence not repeated here.
When you have completed this tutorial you will be able to:
- describe the physiological changes in pregnancy and the effect on resuscitation
- describe resuscitation of pregnant women and modifications to CPR
- have knowledge of the causes of maternal collapse and their management
- identify shoulder dystocia and describe the manouveres to overcome shoulder dystocia
- appreciate the risk factors for cord prolapse and its management
Last updated April 2020.