Question

2. Define emergency obstetrics and obstetric complications with examples of each?

Answer 1

Obstetrical Emergencies:

Obstetrical emergencies are life-threatening medical conditions that occur in pregnancy or during or after labor and delivery. There are a number of illnesses and disorders of pregnancy that can threaten the well-being of both mother and child. Obstetrical emergencies may also occur during active labor, and after delivery (postpartum).

Obstetrical emergencies of pregnancy

• ECTOPIC PREGNANCY: An ectopic, or tubal, pregnancy occurs when the fertilized egg implants itself in the fallopian tube rather than the uterine wall. If the pregnancy is not terminated at an early stage, the fallopian tube will rupture, causing internal hemorrhaging and potentially resulting in permanent infertility.
• PLACENTAL ABRUPTION: Also called abruptio placenta, placental abruption occurs when the placenta separates from the uterus prematurely, causing bleeding and contractions. If over 50% of the placenta separates, both the fetus and mother are at risk.
• PLACENTA PREVIA: When the placenta attaches to the mouth of the uterus and partially or completely blocks the cervix, the position is termed placenta previa (or low-lying placenta). Placenta previa can result in premature bleeding and possible postpartum hemorrhage.
• PREECLAMPSIA/ECLAMPSIA: Preeclampsia (toxemia), or pregnancy-induced high blood pressure, causes severe edema (swelling due to water retention) and can impair kidney and liver function.If it progresses to eclampsia, toxemia is potentially fatal for mother and child.
• PREMATURE RUPTURE OF MEMBRANES (PROM): Premature rupture of membranes is the breaking of the bag of waters (amniotic fluid) before contractions or labor begins. The situation is only considered an emergency if the break occurs before thirty-seven weeks and results in significant leakage of amniotic fluid and/or infection of the amniotic sac.

Obstetrical emergencies during labor and delivery

• AMNIOTIC FLUID EMBOLISM: A rare but frequently fatal complication of labor, this condition occurs when amniotic fluid embolizes from the amniotic sac and through the veins of the uterus and into the circulatory system of the mother. The fetal cells present in the fluid then block or clog the pulmonary artery, resulting in heart attack. This complication can also happen during pregnancy, but usually occurs in the presence of strong contractions.
• INVERSION OR RUPTURE OF UTERUS: During labor, a weak spot in the uterus (such as a scar or a uterine wall that is thinned by a multiple pregnancy) may tear, resulting in a uterine rupture. In certain circumstances, a portion of the placenta may stay attached to the wall and will pull the uterus out with it during delivery. This is called uterine inversion.
• PLACENTA ACCRETA: Placenta accreta occurs when the placenta is implanted too deeply into the uterine wall, and will not detach during the late stages of childbirth, resulting in uncontrolled bleeding.
• PROLAPSED UMBILICAL CORD: A prolapse of the umbilical cord occurs when the cord is pushed down into the cervix or vagina. If the cord becomes compressed, the oxygen supply to the fetus could be diminished, resulting in brain damage or possible death.
• SHOULDER DYSTOCIA: Shoulder dystocia occurs when the baby's shoulder(s) becomes wedged in the birth canal after the head has been delivered.

Obstetrical emergencies postpartum

• POSTPARTUM HEMORRHAGE OR INFECTION: Severe bleeding or uterine infection occurring after delivery is a serious, potentially fatal situation.