Obstetrical Emergencies
Key Points
- Obstetrical emergencies can occur suddenly in routine labor and require immediate coordinated response.
- Key emergencies include shoulder dystocia, cord prolapse, uterine rupture, and severe fetal compromise patterns.
- Nursing actions are algorithmic: recognize fast, call for help, initiate first-line maneuvers, and prepare definitive delivery.
Pathophysiology
Obstetrical emergencies involve abrupt interruption of fetal oxygen transfer, severe maternal hemorrhage risk, or catastrophic maternal-fetal instability. Without rapid intervention, compromise can progress within minutes to permanent injury or death.
Emergency patterns vary in mechanism but share a common response requirement: immediate recognition, coordinated team activation, and protocolized intervention with continuous reassessment.
Classification
- Mechanical emergencies: Shoulder dystocia and umbilical cord prolapse.
- Uterine integrity emergency: Uterine rupture with rapid hemorrhage/fetal compromise risk.
- Maternal-fetal oxygenation emergency: Severe fetal distress and nonreassuring tracing progression.
- Hemostatic/systemic emergencies: DIC and severe obstetric hemorrhage syndromes.
Nursing Assessment
NCLEX Focus
Priority questions focus on the first bedside action before definitive provider intervention is completed.
- Identify emergency cues immediately from tracing, exam findings, and maternal symptoms.
- Assess for cord prolapse when prolonged deceleration follows membrane rupture.
- Monitor for uterine rupture warning patterns, including abrupt tracing loss and maternal instability.
- Track hemorrhage and coagulation-related signs that suggest evolving DIC or shock.
Nursing Interventions
- Activate emergency team support at the first high-risk trigger.
- For cord prolapse, relieve presenting-part compression and maintain manual elevation until delivery.
- For shoulder dystocia, execute team maneuver sequence rapidly and document timing/actions.
- Prepare emergent cesarean pathway and blood-product support when rupture or severe instability is suspected.
Minutes-Matter Emergencies
Delayed emergency recognition or delayed team activation in obstetrical crises can cause irreversible maternal-fetal harm.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| uterotonics | Hemorrhage/atony contexts | Used rapidly when postpartum bleeding mechanisms are involved. |
| blood-products | Massive-bleeding context | Early preparation and protocol activation improve survival in hemorrhagic emergencies. |
Clinical Judgment Application
Clinical Scenario
After spontaneous membrane rupture, fetal heart tracing shows prolonged deceleration and cord prolapse is palpated.
Recognize Cues: Acute prolonged deceleration with confirmed cord compression. Analyze Cues: Immediate fetal oxygen interruption requires urgent decompression and expedited delivery. Prioritize Hypotheses: Highest priority is restoring perfusion while preparing definitive birth. Generate Solutions: Call emergency team, elevate presenting part, optimize maternal position, and prep OR. Take Action: Maintain decompression continuously until delivery. Evaluate Outcomes: Fetal status improves or immediate operative birth proceeds without delay.
Related Concepts
- intrauterine-resuscitation - First-line corrective framework for nonreassuring fetal patterns.
- cesarean-section - Definitive emergency pathway for many unresolved obstetrical crises.
- complications-of-the-second-stage-of-labor - Shoulder dystocia and prolonged pushing risks intersect.
- complications-in-the-third-stage-of-labor - Hemorrhage emergencies often continue into postpartum period.
- fhr-and-uc-intervention-framework - Rapid interpretation supports early emergency recognition.
Self-Check
- Which immediate nursing action is critical when cord prolapse is suspected?
- How can uterine rupture present differently from routine labor pain progression?
- Why do emergency drills improve obstetrical outcomes?