Comprehensive List of Obstetrical Emergencies

1. Severe Pre-eclampsia/Eclampsia 2. Postpartum Hemorrhage 3. Shoulder Dystocia 4. Umbilical Cord Prolapse 5. Placental Abruption 6. Uterine Rupture 7. Amniotic Fluid Embolism 8. HELLP Syndrome 9. Prolonged or Arrested Labor 10. Fetal Bradycardia 11. Chorioamnionitis 12. Preterm Labor 13. Severe Hypertension 14. Sepsis in Pregnancy 15. Retained Placenta 16. Uterine Inversion 17. Acute Pulmonary Edema 18. Oligohydramnios/Polyhydramnios

Template Script for Each Emergency

Severe Pre-eclampsia/Eclampsia

00:00:02 - 00:00:37 “In cases of severe pre-eclampsia or eclampsia, I begin by assessing the patient’s condition. This includes checking vitals, particularly blood pressure, assessing fetal status via fetal heart rate monitoring, and obtaining relevant labs like liver function tests and platelets. I ensure the patient has IV access for potential medication administration.”

00:00:37 - 00:01:13 “Next, I inform the patient of the situation and explain the potential need for delivery if the condition worsens. If a magnesium sulfate infusion or antihypertensive is needed, I will explain the reasons and obtain consent.”

00:01:13 - 00:01:49 “I alert the nursing staff, ensure anesthesiology is aware and prepared, and make sure all necessary medications, such as magnesium sulfate, hydralazine, and labetalol, are available. I review the checklist for severe pre-eclampsia to ensure we’re prepared for any possible complications.”

Postpartum Hemorrhage

00:00:02 - 00:00:37 “In postpartum hemorrhage cases, I start by assessing the patient’s vitals, estimating blood loss, and performing a uterine exam to evaluate for uterine atony or retained products of conception.”

00:00:37 - 00:01:13 “I inform the patient of the situation and the possible interventions, including uterine massage, medications like oxytocin, and potentially surgical intervention if the bleeding doesn’t stop.”

00:01:13 - 00:01:49 “Next, I alert the team, ensure that the necessary personnel, including anesthesia and additional OB help, are present. I also ensure that medications such as oxytocin, methergine, and hemabate are available.”

Shoulder Dystocia

00:00:02 - 00:00:37 “When shoulder dystocia occurs, I first assess the fetal head and try to confirm the diagnosis based on difficulty delivering the shoulders after the head is born. I immediately initiate the HELPERR mnemonic, including positioning and maneuvers to relieve the shoulder dystocia.”

00:00:37 - 00:01:13 “I inform the patient about the need for additional maneuvers and explain what to expect. I ensure that I have consent to proceed with these maneuvers, emphasizing the urgency.”

00:01:13 - 00:01:49 “I call for immediate assistance from the nursing staff, anesthesia, and pediatric support to manage the newborn after delivery. The necessary equipment, including step stools and McRoberts positioning, is quickly prepared.”

Umbilical Cord Prolapse

00:00:02 - 00:00:37 “In the case of umbilical cord prolapse, I assess the fetal heart rate and perform an immediate vaginal exam to confirm the prolapsed cord. I keep my hand in place to elevate the presenting part and relieve pressure on the cord.”

00:00:37 - 00:01:13 “I explain to the patient the need for an emergency cesarean section and obtain consent for the procedure.”

00:01:13 - 00:01:49 “I activate the emergency team, ensure anesthesia and nursing are ready for an immediate c-section, and prepare the OR. Equipment for emergent surgery is brought into the room, and fetal monitoring continues closely.”

For each additional obstetrical emergency, this template can be adapted based on the specific steps involved, with an emphasis on clear communication, prompt action, and ensuring the availability of all necessary resources.

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