Obstetrical Emergencies Health Article

Causes and symptoms

Obstetrical emergencies can be caused by a number of factors, including stress, trauma, genetics, and other variables. In some cases, past medical history, including previous pregnancies and deliveries, may help an obstetrician anticipate the possibility of complications.

Signs and symptoms of an obstetrical emergency include, but are not limited to:

• Diminished fetal activity. In the late third trimester, fewer than ten movements in a two hour period may indicate that the fetus is in distress.
• Abnormal bleeding. During pregnancy, brown or white to pink vaginal discharge is normal, bright red blood or blood containing large clots is not. After delivery, continual blood loss of over 500 ml indicates hemorrhage.
• Leaking amniotic fluid. Amniotic fluid is straw-colored and may easily be confused with urine leakage, but can be differentiated by its slightly sweet odor.
• Severe abdominal pain. Stomach or lower back pain can indicate preeclampsia or an undiagnosed ectopic pregnancy. Postpartum stomach pain can be a sign of infection or hemorrhage.
• Contractions. Regular contractions before 37 weeks of gestation can signal the onset of preterm labor due to obstetrical complications.
• Abrupt and rapid increase in blood pressure. Hypertension is one of the first signs of toxemia.
• Edema. Sudden and significant swelling of hands and feet caused by fluid retention from toxemia.
• Unpleasant smelling vaginal discharge. A thick, malodorous discharge from the vagina can indicate a postpartum infection.
• Fever. Fever may indicate an active infection.
• Loss of consciousness. Shock due to blood loss (hemorrhage) or amniotic embolism can precipitate a loss of consciousness in the mother.
• Blurred vision and headaches. Vision problems and headache are a possible symptom of preeclampsia.

Diagnosis

Diagnosis of an obstetrical emergency typically takes place in a hospital or other urgent care facility. A specialist will take the patient's medical history and perform a pelvic and general physical examination. The mother's vital signs are taken, and if preeclampsia is suspected, blood pressure may be monitored over a period of time. The fetal heartbeat is assessed with a doppler stethoscope, and diagnostic blood and urine tests of the mother may also be performed, including laboratory analysis for protein and/or bacterial infection. An abdominal ultrasound may aid in the diagnosis of any condition that involves a malpositioned placenta, such as placenta previa or placenta abruption.

In cases where an obstetrical complication is suspected, a fetal heart monitor is positioned externally on the mother's abdomen. If the fetal heart rate is erratic or weak, or if it does not respond to movement, the fetus may be in distress. A biophysical profile (BPP) may also be performed to evaluate the health of the fetus. The BPP uses data from an ultrasound examination to analyze the fetus size, movement, heart rate, and surrounding amniotic fluid.

If the mother's membranes have ruptured and her cervix is partially dilated, an internal fetal scalp electrode can be inserted through the vagina to assess heart rate. A fetal oximetry monitor that measures the oxygen saturation levels of the fetus may also be attached to the scalp.

Prognosis

If a fetus is close to full-term (37 weeks) and the complication is detected early enough, the prognosis is usually good for mother and child. With advances in neonatal care, approximately 85% of infants weighing less than 3 lbs 5 oz survive, and these infants are being delivered at 28 weeks and younger. However, preterm infants have a greater chance of serious medical problems, and developmental disabilities occur in 25–50%. They also have a higher incidence of learning disorders, and are four to six times more likely to be diagnosed with attention-deficit hyperactivity disorder (ADHD).

Prevention

Proper prenatal care is the best prevention for obstetrical emergencies. When complications of pregnancy do arise, pregnant women who see their OB/GYN on a regular basis are more likely to get an early diagnosis, and with it, the best chance for fast and effective treatment. In addition, eating right and taking prenatal vitamins and supplements as recommended by a physician will also contribute to the health of both mother and child.

BOOKS

Pearlman, Mark D and Judith Tintinalli, eds. Emergency Care of the Woman. New York: McGraw-Hill, 1998.

PERIODICALS

Chamberlain, Geoffrey and Phillip Steer. "Obstetric Emergencies." British Medical Journal. 318, no. 7194 (May 1999):1342.

"Women's Lives at Risk: Preventable Deaths, Avoidable Injuries." Population Reports. 25, no. 1 (Sept 1997):3.

ORGANIZATIONS

National Institute of Child Health and Human Development (NICHD) Clearinghouse. Bldg 31, Room 2A32, MSC 2425, 31 Center Drive, Bethesda, MD 20892-2425. (800) 370-2943. <http://www.nichd.nih.gov/publications/health.htm>.