---
title: Obstetric Emergency Protocols
description: A comprehensive guide to the recognition and management of obstetric emergencies, including hemorrhage, hypertensive disorders, and fetal distress.
keywords: [obstetric, emergency, hemorrhage, preeclampsia, fetal distress]
category: clinical
---

## Introduction

Obstetric emergencies are life-threatening conditions that require prompt recognition and intervention to ensure the safety of the mother and fetus. These situations can arise during pregnancy, labor, and the postpartum period, and can have significant consequences if not managed appropriately. This clinical reference document outlines the key protocols for the diagnosis and management of common obstetric emergencies, with a focus on evidence-based practices and established clinical guidelines.

## Obstetric Hemorrhage

Obstetric hemorrhage is a leading cause of maternal morbidity and mortality worldwide. It is defined as blood loss of 500 mL or more following a vaginal delivery or 1000 mL or more following a cesarean section. The most common causes of obstetric hemorrhage include uterine atony, placental abnormalities, genital tract trauma, and coagulopathy.

### Diagnosis
- Assess vital signs, including blood pressure, heart rate, and respiratory rate
- Estimate blood loss through direct measurement and visual assessment
- Obtain laboratory tests, including complete blood count, coagulation studies, and fibrinogen level

### Treatment
1. Uterine atony:
   - Administer uterotonic medications, such as oxytocin (10 IU IV/IM), methylergonovine (0.2 mg IM), or misoprostol (800-1000 mcg rectally)
   - Perform uterine massage and bimanual compression
   - Consider balloon tamponade or uterine artery embolization
2. Placental abnormalities:
   - Manage placenta previa or accreta according to clinical guidelines
   - Perform manual removal of the placenta if indicated
3. Genital tract trauma:
   - Identify and repair lacerations, cervical tears, or uterine rupture
   - Consider pelvic arterial embolization or hysterectomy for uncontrolled bleeding
4. Coagulopathy:
   - Administer appropriate blood products, such as packed red blood cells, fresh frozen plasma, and platelets
   - Correct underlying coagulopathy with factor replacement or reversal agents

## Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy, including preeclampsia, eclampsia, and gestational hypertension, are leading causes of maternal and fetal morbidity and mortality. Prompt recognition and management are essential to prevent complications such as seizures, stroke, and organ dysfunction.

### Diagnosis
- Measure blood pressure and assess for signs of end-organ damage (e.g., headache, visual disturbances, epigastric pain)
- Evaluate laboratory tests, including complete blood count, liver function tests, and renal function
- Assess fetal well-being through non-stress testing, biophysical profile, or Doppler ultrasound

### Treatment
1. Preeclampsia without severe features:
   - Administer oral antihypertensive medications, such as labetalol (200-400 mg every 12 hours) or nifedipine (immediate-release 10-20 mg every 6-8 hours)
   - Monitor maternal and fetal status closely
   - Consider delivery if gestational age is ≥37 weeks or if there are signs of maternal or fetal compromise
2. Preeclampsia with severe features:
   - Administer intravenous antihypertensive medications, such as labetalol (20-80 mg every 10 minutes) or hydralazine (5-10 mg IV every 20 minutes)
   - Administer magnesium sulfate for seizure prophylaxis (loading dose of 4-6 g IV, followed by 1-2 g/hour maintenance infusion)
   - Deliver the fetus if gestational age is ≥34 weeks or if there are signs of maternal or fetal compromise
3. Eclampsia:
   - Administer magnesium sulfate for seizure control (loading dose of 4-6 g IV, followed by 1-2 g/hour maintenance infusion)
   - Administer intravenous antihypertensive medications to control blood pressure
   - Deliver the fetus as soon as possible, regardless of gestational age

## Fetal Distress

Fetal distress is a condition in which the fetus experiences hypoxia or acidosis, which can lead to significant morbidity and mortality if not recognized and managed promptly. Common causes include placental abruption, umbilical cord complications, and maternal hypertensive disorders.

### Diagnosis
- Monitor fetal heart rate patterns using cardiotocography (CTG)
- Assess fetal oxygenation through fetal scalp blood sampling or fetal pulse oximetry
- Evaluate fetal well-being using the modified biophysical profile score

### Management
1. Mild fetal distress:
   - Provide maternal oxygen supplementation
   - Reposition the mother to improve uteroplacental perfusion
   - Consider tocolytic medications to suppress uterine contractions
2. Severe fetal distress:
   - Prepare for immediate delivery, either by cesarean section or instrumental vaginal delivery
   - Administer maternal corticosteroids if delivery is not imminent and gestational age is <34 weeks
   - Consider fetal scalp stimulation or intrauterine resuscitation techniques

## Amniotic Fluid Embolism

Amniotic fluid embolism is a rare but life-threatening obstetric emergency characterized by the sudden onset of maternal cardiorespiratory collapse, coagulopathy, and seizures. Prompt recognition and management are crucial to improve maternal and fetal outcomes.

### Diagnosis
- Sudden onset of hypotension, respiratory distress, and coagulopathy during or after delivery
- Consider amniotic fluid embolism in the differential diagnosis if the clinical presentation is consistent

### Management
1. Resuscitation:
   - Provide immediate advanced life support, including chest compressions, ventilation, and administration of vasopressors and inotropes
   - Correct coagulopathy with blood products, such as packed red blood cells, fresh frozen plasma, and platelets
2. Supportive care:
   - Maintain oxygenation and ventilation
   - Treat seizures with anticonvulsants, such as benzodiazepines
   - Provide volume resuscitation and support for organ dysfunction
3. Delivery:
   - If the fetus is still in utero, consider urgent cesarean delivery to improve maternal and fetal outcomes

## Conclusion

Obstetric emergencies require a multidisciplinary approach and prompt recognition and management to ensure the best possible outcomes for the mother and fetus. This clinical reference document outlines the key protocols for the diagnosis and management of common obstetric emergencies, with a focus on evidence-based practices and established clinical guidelines. Healthcare providers should be familiar with these protocols and be prepared to implement them in emergency situations.