OBSTETRIC EMERGENCIES

6/23/2022




 Recognition of the problem and the instigation of emergency
measures may determine the outcome for the mother or the fetus.



 The midwife should remain calm and attempt to keep the woman
and her partner fully informed to obtain her consent and
cooperation for procedures that may be needed.
OBSTETRIC EMERGENCIES
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 All midwifery and medical staff must be updated on the signs
and symptoms of critical illness from both obstetric and non-
obstetric causes.
 pregnancy and labour are normal physiological events, however  Regular drills should be held to maintain and improve these skills.
regular routine observations of vital signs must be an  All staff should be trained in basic life support to a nationally
integral part of midwifery care. recognized level and emergency drills for maternal resuscitation
should be regularly practiced in all maternity units (CMACE 2011;
 There is potential for pregnant women and those who have  National Health Service Litigation Authority [NHSLA] 2011).
recently given birth to be at risk of physiological deterioration that  Furthermore, effective communication between members of
is not always predicted or recognized the multiprofessional team is essential to ensure the optimum
outcome for the childbearing woman who becomes unwell and her
 To improve recognition of women who are unwell before they baby (National Health Service [NHS] Institute for Innovation an
become critically ill the modified early obstetric warning score Improvement 2008).
(MEOWS) chart should now be used (CMACE 2011).




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, 6/23/2022




COMMUNICATION

 There are very few instruments that specifically focus on how to  Use of the SBAR tool
improve verbal communication.
 The SBAR:  The tool consists of standardized prompt questions about the
 Situation, condition of an individual in four stages:
 Background  • Situation
 Assessment and
 • Background
 Recommendations tool developed by the NHS Institute for Innovations
and Improvements (2008) is a framework that midwives can use to  • Assessment
develop critical clinical conversations that require immediate attention  • Recommendation.
and action.




 These prompts can assist the midwife to assertively and effectively
share concise and focused information about a woman’s condition,
reducing repetition. CORD PROLAPSE &
CORD PRESENTATION
 The SBAR tool can be used in all clinical conversations: face-to
face, by telephone or through collaborative multiprofessional team
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meetings.

 In each of the following midwifery and obstetric emergencies, the
use of the SBAR tool should be paramount in facilitating
appropriate action that is always in the best interest of the woman
and her baby.




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DEFINITIONS
 Umbilical cord presentation: Presence of cord in front of
presenting part before the rupture of membranes.

 Umbilical cord prolapse:
 Descent of umbilical cord following rupture of the
membranes, through the cervix so that it lies either along
side the fetal part or in front of presenting part into the
cervix/ and into or out of vagina.




TYPES OF CORD PROLAPSE ETIOLOGY OR RISK FACTORS - 1
 Occult prolapse –
Cord lies adjacent to the presenting part, but not
beyond the presenting part in the presence of intact or without Non engagement of fetal head:
1.Unengaged or poorly applied presenting part
intact membranes.
2. High parity - weak muscles
 Overt prolapse – cord which is visible or palpable with
3. Unstable lie – weak muscles
naked eyes following rupture of membranes.
4. Malpresentations=Breech presentations




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