Obstetrical Emergencies: Treatment

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ECTOPIC PREGNANCY. Treatment of an ectopic pregnancy is laparoscopic surgical removal of the fertilized ovum. If the fallopian tube has burst or been damaged, further surgery will be necessary.

PLACENTAL ABRUPTION. In mild cases of placental abruption, bed rest may prevent further separation of the placenta and stem bleeding. If a significant abruption (over 50%) occurs, the fetus may have to be delivered immediately and a blood transfusion may be required.

PLACENTA PREVIA. Hospitalization or highly restricted at-home bed rest is usually recommended if placenta previa is diagnosed after the twentieth week of pregnancy. If the fetus is at least 36 weeks old and the lungs are mature, a cesarean section is performed to deliver the baby.

PREECLAMPSIA/ECLAMPSIA. Treatment of preeclampsia depends upon the age of the fetus and the acuteness of the condition. A woman near full term who has only mild toxemia may have labor induced to deliver the child as soon as possible. Severe preeclampsia in a woman near term also calls for immediate delivery of the child, as this is the only known cure for the condition. However, if the fetus is under 28 weeks, the mother may be hospitalized and steroids may be administered to try to hasten lung development in the fetus. If the life of the mother or fetus appears to be in danger, the baby is delivered immediately, usually by cesarean section.

PREMATURE RUPTURE OF MEMBRANES (PROM). If PROM occurs before 37 weeks and/or results in significant leakage of amniotic fluid, a course of intravenous antibiotics is started. A culture of the cervix may be taken to analyze for the presence of bacterial infection. If the fetus is close to term, labor is typically induced if contractions do not start within 24 hours of rupture.

AMNIOTIC FLUID EMBOLISM. The stress of contractions can cause this complication, which has a high mortality rate. Administering steroids to the mother and delivering the fetus as soon as possible is the standard treatment.

INVERSION OR RUPTURE OF UTERUS. An inverted uterus is either manually or surgical replaced to the proper position. A ruptured uterus is repaired if possible, although if the damage is extreme, a hysterectomy (removal of the uterus) may be performed. A blood transfusion may be required in either case if hemorrhaging occurs.

PLACENTA ACCRETA. Women who experience placenta accreta will typically need to have their placenta surgically removed after delivery. Hysterectomy is necessary in some cases.

PROLAPSED UMBILICAL CORD. Saline may be infused into the vagina to relieve the compression. If the cord has prolapsed out the vaginal opening, it may be replaced, but immediate delivery by cesarean section is usually indicated.

POSTPARTUM HEMORRHAGE OR INFECTION. The source of the hemorrhage is determined, and blood transfusion and IV fluids are given as necessary. Oxytocic drugs may be administered to encourage contraction of the uterus. Retained placenta is a frequent cause of persistent bleeding, and surgical removal of the remaining fragments (curettage) may be required. Surgical repair of lacerations to the birth canal or uterus may be required. Drugs that encourage coagulation (clotting) of the blood may be administered to stem the bleeding. Infrequently, hysterectomy is required.

In cases of infection, a course of intravenous antibiotics is prescribed. Most postpartum infections occur in the endometrium, or lining of the uterus, and may be also caused by a piece of retained placenta. If this is the case, it will also require surgical removal.

SHOULDER DYSTOCIA. The mother is usually positioned with her knees to her chest, known as the McRoberts maneuver, in an effort to free the child's shoulder. An episiotomy is also performed to widen the vaginal opening. If the shoulder cannot be dislodged from the pelvis, the baby's clavicle (collarbone) may have to be broken to complete the delivery before a lack of oxygen causes brain damage to the infant.

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