Top 10 Life-Threatening OB-GYN Emergencies Every Resident Must Know

OB-GYN emergencies are some of the most high-stakes cases in medicine. A single decision can mean the difference between life and death for both mother and baby. For residents, managing these emergencies requires quick thinking, sharp clinical skills, and the ability to remain calm under extreme pressure.

From postpartum hemorrhage to eclampsia and uterine rupture, OB-GYN emergencies demand immediate recognition and intervention. This article outlines the most critical OB-GYN emergencies that every resident should be prepared for, along with essential management strategies to improve patient outcomes.

1. Postpartum Hemorrhage (PPH): The Leading Cause of Maternal Mortality
A. Recognizing Postpartum Hemorrhage

• Defined as >500 mL blood loss after vaginal delivery or >1000 mL after C-section.
• The most common cause is uterine atony, but other causes include retained placental tissue, trauma, and coagulopathy.
• Risk factors include prolonged labor, multiple gestations, and high parity.

B. Emergency Management

• Fundal Massage: The first step to stimulate uterine contraction.
• Medications: Administer oxytocin, misoprostol, or carboprost to control bleeding.
• Bimanual Compression: If fundal massage and medications fail, apply manual pressure to the uterus.
• Surgical Interventions: If bleeding continues, consider Bakri balloon, B-Lynch sutures, uterine artery embolization, or hysterectomy as a last resort.
• Massive Transfusion Protocol: Be prepared for rapid blood loss replacement if necessary.

2. Eclampsia and Severe Preeclampsia: When Hypertension Becomes Life-Threatening
A. Recognizing Eclampsia

• Preeclampsia: BP ≥140/90 with proteinuria or signs of organ damage.
• Eclampsia: Seizures in a preeclamptic patient.
• Additional symptoms may include severe headache, visual disturbances, and right upper quadrant pain.

B. Emergency Management

• Magnesium Sulfate: First-line treatment for preventing and managing seizures.
• Antihypertensives: Labetalol, hydralazine, or nifedipine to control blood pressure.
• Immediate Delivery: If the patient is unstable, proceed with an urgent C-section.
• ICU Monitoring: High-risk patients require continuous hemodynamic monitoring.

3. Uterine Rupture: A Devastating Obstetric Emergency
A. Recognizing Uterine Rupture

• Sudden severe abdominal pain during labor.
• Loss of fetal station on pelvic exam.
• Fetal distress (bradycardia, decelerations).
• High-risk factors include previous C-sections or uterine surgeries.

B. Emergency Management

• Immediate C-section: The only way to save mother and baby.
• Massive Transfusion Protocol (MTP): Prepare for significant hemorrhage.
• Hysterectomy May Be Required: If the uterus cannot be repaired, removal may be the only option.

4. Shoulder Dystocia: A True Obstetric Emergency
A. Recognizing Shoulder Dystocia

• "Turtle Sign" – the fetal head retracts after delivery of the head.
• Prolonged second stage of labor.
• Risk factors include fetal macrosomia, maternal obesity, and gestational diabetes.

B. Emergency Management

• McRoberts Maneuver: Hyperflexing maternal legs to widen the pelvis.
• Suprapubic Pressure: Helps dislodge the anterior shoulder.
• Delivery Techniques: If needed, use Wood’s screw maneuver or posterior arm delivery.
• Zavanelli Maneuver and C-section: In extreme cases, reinsert the fetal head and proceed to an emergency C-section.

5. Cord Prolapse: When Every Second Counts
A. Recognizing Cord Prolapse

• Sudden fetal bradycardia or variable decelerations.
• Palpable cord in the vagina or outside the cervix.

B. Emergency Management

• Manually Elevate the Presenting Part: Prevents cord compression.
• Trendelenburg or Knee-Chest Position: Relieves pressure on the cord.
• Emergency C-section: Immediate surgical delivery is required to prevent fetal hypoxia.
• Oxygen and IV Fluids: Optimize maternal hemodynamics.

6. Amniotic Fluid Embolism: A Rare but Catastrophic Condition
A. Recognizing Amniotic Fluid Embolism (AFE)

• Sudden hypotension, hypoxia, and DIC following labor or C-section.
• Severe respiratory distress and cardiovascular collapse.

B. Emergency Management

• Rapid Intubation and Mechanical Ventilation.
• Aggressive Fluid Resuscitation.
• Massive Transfusion Protocol (MTP).
• ICU Care: Patients often require prolonged intensive care.

7. HELLP Syndrome: A Silent Killer in Pregnancy
A. Recognizing HELLP Syndrome

• Hemolysis, Elevated Liver Enzymes, Low Platelets.
• Right upper quadrant pain, severe hypertension, and nausea.
• Can progress to hepatic rupture and multi-organ failure if untreated.

B. Emergency Management

• Immediate Delivery: The only definitive treatment.
• Magnesium Sulfate: Prevents seizures.
• Blood Pressure Control: Labetalol, hydralazine, or nifedipine.
• Blood Product Transfusion: If platelet count is dangerously low.

8. Septic Abortion: A Life-Threatening Infection
A. Recognizing Septic Abortion

• Fever, chills, foul-smelling discharge, and uterine tenderness after an abortion.
• Severe cases may progress to sepsis and multi-organ failure.

B. Emergency Management

• IV Broad-Spectrum Antibiotics: Clindamycin + gentamicin.
• Immediate Uterine Evacuation: Dilation & curettage (D&C) or hysterectomy if needed.
• Hemodynamic Support: IV fluids, vasopressors, and ICU admission if unstable.

9. Ruptured Ectopic Pregnancy: A Leading Cause of Maternal Death in Early Pregnancy
A. Recognizing Ruptured Ectopic Pregnancy

• Sudden severe lower abdominal pain and dizziness.
• Hemodynamic instability (tachycardia, hypotension, syncope).

B. Emergency Management

• Immediate Surgical Intervention: Laparoscopic salpingectomy or salpingostomy.
• Massive Transfusion Protocol: Prepare for rapid blood loss.
• Methotrexate for Non-Ruptured Cases: In stable, early-diagnosed ectopic pregnancies.

10. Inversion of the Uterus: A Rare but Deadly Emergency
A. Recognizing Uterine Inversion

• Sudden severe postpartum hemorrhage.
• "Bluish mass" protruding from the cervix or vagina.

B. Emergency Management

• Immediate Manual Replacement: Attempt to push the uterus back in place.
• Uterine Relaxants: Nitroglycerin or terbutaline may be needed to facilitate repositioning.
• Surgical Intervention: If manual attempts fail.

Conclusion
OB-GYN emergencies are unpredictable, rapid, and require immediate action. For residents, mastering these critical cases is essential to ensuring safe maternal and fetal outcomes. While each case presents unique challenges, the key to success lies in preparation, confidence, and the ability to remain calm under pressure.

Being an OB-GYN resident means facing life-and-death situations regularly. But with the right training, quick decision-making, and a strong team, these emergencies can be managed effectively—saving lives and making a lasting impact in women’s healthcare.