OB Emergencies

Assessment

History:Signs & Symptoms: Differential: 
□ Past medical history 
□ Hypertension meds 
□ Prenatal care 
□ Prior pregnancies / births 
□ Gravida / Para  		□ Vaginal bleeding 
□ Abdominal pain 
□ Severe headache 
□ Visual changes		□ Pre-eclampsia / Eclampsia 
□ Placenta previa 
□ Placenta abruptio 
□ Spontaneous abortion 

Clinical Management Options

EMT-B
• Oxygen, target SpO2 to 92-96% 
• If post-partum hemorrhage, then fundal massage and encourage infant to breast feed 
Paramedic
• Vascular access 
• Isotonic bolus for hypotension
Consult Online Medical Control as Needed

Pearls

  • Any pregnant patient involved in a MVC should be seen immediately by a physician for evaluation and fetal monitoring in a Trauma Center.  
  • Small trauma can cause placental abruption in patients who are >20 weeks pregnant. Transport to OB capable hospitals if complaining of any abdominal pain after even minor falls/injuries
  • Post-partum hemorrhage defined as blood loss > 1000mL or greater than 500mL with signs/symptoms of hypotension. 500mL blood loss is commonly seen in uncomplicated vaginal deliveries without signs or symptoms. The perineum should be checked for bleeding from vaginal tears which may be mistaken for uterine bleeding. Bleeding should be controlled by direct pressure over the laceration. 
  • The most common cause of post-partum hemorrhage is uterine atony due to prolonged labor or multiple gestations 
  • If > 20 weeks consider left lateral position. 
  • If >20 weeks pregnant OR the uterus is above the umbilicus in a cardiac arrest patient, consider immediate transport for peri-mortem C-section.