Obstetric Emergencies Requiring Immediate Intervention

Primary Life-Threatening Emergencies

The American College of Obstetricians and Gynecologists recommends that postpartum hemorrhage is the leading preventable cause of maternal mortality worldwide and requires immediate recognition and treatment 3.
Administer oxytocin 5-10 IU via slow IV or intramuscular injection immediately at shoulder release or postpartum to prevent hemorrhage, as recommended by the American College of Obstetricians and Gynecologists 3, 4.
If bleeding occurs despite oxytocin, administer tranexamic acid 1 gram IV within 1-3 hours of bleeding onset (number needed to treat: 276 to prevent one maternal death), according to the American College of Obstetricians and Gynecologists 3.
Have large-bore IV catheters, fluid warmers, forced-air body warmers, and rapid infusion devices immediately available, as recommended by the American Society of Anesthesiologists 5.
Severe pre-eclampsia and eclampsia represent acute neurological and cardiovascular emergencies requiring immediate blood pressure control and seizure prophylaxis, according to the American College of Obstetricians and Gynecologists 1, 2, 3.
Coordinate immediately with emergency services to initiate antihypertensive treatment and magnesium sulfate administration, as recommended by the American College of Obstetricians and Gynecologists 3.
Administer magnesium sulfate as first-line therapy for eclamptic seizures, according to the American College of Obstetricians and Gynecologists 4.

Systematically assess for multiparity, history of previous rapid or non-hospital delivery, regular painful uterine contractions, and urge to push, as recommended by the American College of Obstetricians and Gynecologists 3.
Perform cervical examination before contacting the receiving obstetric team to optimize triage, according to the American College of Obstetricians and Gynecologists 3.
Position patient for McRoberts maneuver if shoulder dystocia is anticipated, as recommended by the American College of Obstetricians and Gynecologists 3.
Assess for cephalopelvic disproportion before proceeding with augmentation, which occurs in 25-30% of active phase arrest cases, according to the American College of Obstetricians and Gynecologists 3, 6.
Oxytocin augmentation is first-line treatment with 92% success rate for vaginal delivery when cephalopelvic disproportion is absent, as recommended by the American College of Obstetricians and Gynecologists 3, 6.

Use cognitive aid checklist focusing on "ABC" principle: airway, breathing, and circulation support, as recommended by the American College of Obstetricians and Gynecologists 3.
Secure airway immediately if respiratory distress and seizure activity occur to prevent aspiration, according to the American College of Obstetricians and Gynecologists 4.
Transfer to ICU immediately given multi-system involvement with respiratory failure, neurological compromise, and coagulopathy, as recommended by the American College of Obstetricians and Gynecologists 4.
Avoid prostaglandin F2α and ergometrine in patients with respiratory distress, according to the American College of Obstetricians and Gynecologists 4.

Failure to recognize the 4-minute window for perimortem cesarean delivery during maternal cardiac arrest leads to poor maternal and fetal outcomes, as noted by the American College of Obstetricians and Gynecologists 3.
Delaying tranexamic acid administration beyond 3 hours of bleeding onset reduces its effectiveness, according to the American College of Obstetricians and Gynecologists 3.
Underestimating physiological changes of pregnancy complicates airway management during emergency cesarean delivery, as noted by the American College of Obstetricians and Gynecologists 6.
Failing to maintain left uterine displacement during resuscitation perpetuates aortocaval compression, according to the American College of Obstetricians and Gynecologists 3.
Not having hemorrhage management resources immediately available (large-bore IVs, rapid infusion devices, blood products) delays critical interventions, as recommended by the American Society of Anesthesiologists 5.

Establish direct contact between on-call obstetrician and emergency medical services for all potential obstetric emergencies, as recommended by the American College of Obstetricians and Gynecologists 3.
Ensure immediate availability of basic and advanced life-support equipment in labor and delivery units, according to the American College of Obstetricians and Gynecologists 6.
Lack of standardized approaches to emergency obstetric care contributes to poor maternal outcomes, as noted by the American College of Physicians 7.
Emergency obstetric training for all personnel managing deliveries is essential, as recommended by the American Society of Anesthesiologists 1, 2.