1. Postpartum Hemorrhage (PPH) – Excessive Bleeding After Delivery
Definition:
PPH is blood loss >500 mL (Vaginal Delivery) or >1000 mL (C-section).
Causes (4 T’s):
- Tone (Atony – Most Common): Uterus fails to contract.
- Tissue (Retained Placenta): Placental fragments remain.
- Trauma (Tears, Uterine Rupture): Genital tract injury.
- Thrombin (Coagulopathy): Clotting disorders (DIC, HELLP).
Management:
- Uterine Massage → First-line.
- IV Oxytocin 10 IU + Tranexamic Acid (TXA) 1g IV.
- If Bleeding Persists:
- Additional Uterotonics: Misoprostol, Ergometrine.
- Bakri Balloon Tamponade (If uterine atony).
- B-Lynch Suture / Uterine Artery Ligation (Surgical).
- Hysterectomy (Last Resort).
Monitor for Shock (BP, HR, Urine Output).
2. Eclampsia – Seizures in Pregnancy
Definition:
Eclampsia is preeclampsia (HTN + Proteinuria) + Seizures.
Management:
Prevent Further Seizures:
- Magnesium Sulfate (Loading 4g IV over 10
min, then 1g/hr IV).
Control BP: - Labetalol IV or Hydralazine
IV.
Immediate Delivery of Baby (Once Stable).
Complications: Stroke, HELLP, Pulmonary Edema.
3. Cord Prolapse – Umbilical Cord Below Presenting Part
Definition:
Umbilical cord slips out before the baby, leading to fetal hypoxia.
Signs:
- Fetal bradycardia (<110 bpm).
- Palpable cord in vagina.
Management:
- Immediate Knee-Chest or Trendelenburg Position.
- Manually Elevate Presenting Part (Relieve Compression).
- Emergency Cesarean Section.
4. Uterine Rupture – Complete Tearing of Uterus
Definition:
Uterus ruptures completely, leading to fetal distress & maternal hemorrhage.
Risk Factors:
- Previous C-section scar.
- Prolonged obstructed labor.
Signs:
- Sudden severe abdominal pain.
- Loss of fetal station.
- Fetal distress (Bradycardia, Late Decelerations).
Management:
- Immediate Laparotomy.
- Uterine Repair or Hysterectomy (If Severe).
- Blood Transfusion as Needed.
5. Amniotic Fluid Embolism (AFE) – Rare, Fatal Emergency
Definition:
Amniotic fluid enters maternal circulation, causing anaphylactic shock.
Signs:
- Sudden Hypoxia (Dyspnea, Cyanosis).
- Hypotension, DIC, Cardiac Arrest.
Management:
- High-Flow Oxygen + Intubation.
- Aggressive IV Fluids & Vasopressors.
- Correct Coagulopathy (Fresh Frozen Plasma, Platelets).
High Mortality – Requires ICU Care.
6. Shoulder Dystocia – Fetal Shoulder Stuck Behind Pubic Bone
Definition:
After head delivers, shoulders fail to pass through pelvis.
Risk Factors:
- Macrosomia (>4 kg).
- Gestational Diabetes.
- Post-term pregnancy.
Management (HELPERR Mnemonic):
- H – Call for Help.
- E – Episiotomy if needed.
- L – Legs in McRoberts Maneuver (Flex thighs onto abdomen).
- P – Pressure (Suprapubic).
- E – Enter Vaginal Maneuvers (Rubin, Woods Screw).
- R – Remove Posterior Arm.
- R – Roll to All-Fours (Gaskin Maneuver).
If all fail → Zavanelli Maneuver (Push Head Back & Do C-section).
7. Summary Table: Obstetric Emergencies & Management
|
Condition |
Signs |
Management |
|
PPH |
Excessive bleeding |
Uterotonics, TXA, Surgery if needed |
|
Eclampsia |
Seizures + HTN + Proteinuria |
Magnesium Sulfate, BP Control, Deliver Baby |
|
Cord Prolapse |
Fetal bradycardia, Palpable cord |
Elevate Presenting Part, Emergency C-section |
|
Uterine Rupture |
Sudden pain, Fetal distress |
Laparotomy, Uterine Repair or Hysterectomy |
|
AFE |
Sudden collapse, DIC |
Oxygen, Fluids, ICU Care |
|
Shoulder Dystocia |
Head delivers, Shoulders stuck |
McRoberts Maneuver, Suprapubic Pressure |
8. Key Takeaways
- PPH is managed with Oxytocin, TXA, and surgical interventions if needed.
- Eclampsia requires Magnesium Sulfate & immediate delivery.
- Cord prolapse & uterine rupture need emergency C-section.
- AFE is a critical condition with high mortality, needing ICU care.
- Shoulder dystocia is managed with McRoberts Maneuver & Suprapubic Pressure.
