Top 20 Obstetric and Gynecology Emergencies And How To Deal With It

Here we share 20 emergencies in obstetrics and gynaecology for doctors and how to deal with it.

1. Ectopic Pregnancy

• Presentation: Abdominal pain, vaginal bleeding, amenorrhea, shoulder tip pain.
• Diagnosis:
  • Positive pregnancy test.
  • Transvaginal ultrasound shows absence of intrauterine pregnancy.
  • Serum beta-hCG levels.
• Management:
  • Hemodynamically stable: Methotrexate therapy.
  • Hemodynamically unstable or ruptured ectopic: Emergency surgical intervention (laparoscopy or laparotomy).

2. Placental Abruption

• Presentation: Sudden onset abdominal pain, vaginal bleeding, uterine tenderness, fetal distress.
• Diagnosis:
  • Clinical examination.
  • Ultrasound (may not always be definitive).
  • Monitoring fetal heart rate.
• Management:
  • Stabilize mother with IV fluids and blood products.
  • Continuous fetal monitoring.
  • Immediate delivery if fetal distress or maternal instability (cesarean section often required).

3. Pre-eclampsia/Eclampsia

• Presentation: Hypertension, proteinuria, headache, visual disturbances, epigastric pain, seizures (eclampsia).
• Diagnosis:
  • Blood pressure measurement.
  • Urine dipstick or 24-hour urine collection for protein.
  • Blood tests for liver function, platelets, and renal function.
• Management:
  • Control blood pressure with antihypertensives (labetalol, hydralazine).
  • Magnesium sulfate for seizure prophylaxis.
  • Delivery of the baby is definitive treatment, timing based on gestational age and severity.

4. Postpartum Hemorrhage (PPH)

• Presentation: Heavy vaginal bleeding after delivery, signs of hypovolemic shock.
• Diagnosis:
  • Clinical assessment of blood loss.
  • Vital signs monitoring.
  • Hemoglobin/hematocrit levels.
• Management:
  • Uterine massage.
  • Administer uterotonic drugs (oxytocin, misoprostol).
  • IV fluids and blood transfusions.
  • Surgical interventions (uterine artery ligation, hysterectomy) if conservative measures fail.

5. Uterine Rupture

• Presentation: Sudden severe abdominal pain, vaginal bleeding, cessation of contractions, fetal distress.
• Diagnosis:
  • Clinical suspicion based on symptoms.
  • Fetal heart rate monitoring.
  • Ultrasound may show free fluid in the abdomen.
• Management:
  • Immediate surgical intervention (laparotomy) to repair the rupture and deliver the baby.
  • Resuscitation with IV fluids and blood products.

6. Shoulder Dystocia

• Presentation: Difficulty delivering the baby's shoulders after the head has emerged.
• Diagnosis:
  • Clinical diagnosis during delivery.
• Management:
  • McRoberts maneuver (hyperflexion of mother’s legs).
  • Suprapubic pressure.
  • Delivery of posterior arm.
  • Episiotomy if needed for additional room.
  • Consider Zavanelli maneuver (repositioning head back into uterus) for severe cases.

7. Cord Prolapse

• Presentation: Visualization or palpation of the umbilical cord in the vagina, variable decelerations on fetal heart monitor.
• Diagnosis:
  • Clinical examination.
  • Fetal heart rate monitoring.
• Management:
  • Immediate manual elevation of the presenting part to relieve pressure on the cord.
  • Emergency cesarean section.
  • Maintain cord moisture with saline-soaked gauze.

8. Amniotic Fluid Embolism

• Presentation: Sudden respiratory distress, hypotension, coagulopathy, seizures, cardiac arrest.
• Diagnosis:
  • Clinical diagnosis based on rapid onset of symptoms.
  • Exclusion of other causes.
• Management:
  • Immediate resuscitation (CPR if necessary).
  • Supportive care with oxygen, fluids, and blood products.
  • Intensive care unit admission.

9. Severe Preterm Labor

• Presentation: Regular contractions leading to cervical changes before 37 weeks gestation.
• Diagnosis:
  • Clinical examination and monitoring of contractions.
  • Cervical assessment via ultrasound.
  • Fetal fibronectin test.
• Management:
  • Tocolytics to delay labor (nifedipine, indomethacin).
  • Corticosteroids for fetal lung maturity.
  • Magnesium sulfate for neuroprotection.
  • Prepare for possible preterm delivery with neonatal intensive care involvement.

10. Ovarian Torsion

• Presentation: Sudden onset severe pelvic pain, nausea, vomiting, adnexal mass.
• Diagnosis:
  • Pelvic ultrasound with Doppler to assess blood flow.
  • Clinical suspicion.
• Management:
  • Surgical intervention (laparoscopy or laparotomy) to untwist or remove the ovary.
  • Pain management and stabilization.

11. Hyperemesis Gravidarum

• Presentation: Severe nausea and vomiting, dehydration, weight loss.
• Diagnosis:
  • Clinical diagnosis based on symptoms.
  • Electrolyte panel and urinalysis for dehydration.
• Management:
  • IV fluids and electrolyte replacement.
  • Antiemetic medications (ondansetron, metoclopramide).
  • Nutritional support, possibly including total parenteral nutrition.

12. HELLP Syndrome

• Presentation: Hemolysis, elevated liver enzymes, low platelet count, right upper quadrant pain, nausea, vomiting.
• Diagnosis:
  • Blood tests showing hemolysis (elevated LDH), elevated liver enzymes (AST, ALT), and low platelets.
• Management:
  • Stabilization with IV fluids and blood products as needed.
  • Magnesium sulfate for seizure prophylaxis.
  • Immediate delivery, usually via cesarean section.

13. Uterine Inversion

• Presentation: Sudden onset of vaginal bleeding, severe pelvic pain, visible or palpable uterine fundus at the introitus, signs of shock.
• Diagnosis:
  • Clinical examination showing the inverted uterus.
  • Often occurs postpartum during or immediately after placental delivery.
• Management:
  • Immediate manual replacement of the uterus into the pelvic cavity.
  • Use of uterine relaxants (e.g., nitroglycerin, terbutaline) may be necessary.
  • Administer uterotonic agents (e.g., oxytocin) once the uterus is repositioned to prevent recurrence.
  • IV fluids and blood transfusions for stabilization.

14. Vaginal Bleeding in Early Pregnancy

• Presentation: Vaginal bleeding with or without abdominal pain in the first trimester.
• Diagnosis:
  • Pelvic examination.
  • Ultrasound to assess for intrauterine pregnancy and viability.
  • Serial beta-hCG levels.
• Management:
  • Expectant management for threatened miscarriage.
  • Dilation and curettage (D&C) for incomplete or missed miscarriage.
  • Methotrexate or surgical management for ectopic pregnancy.

15. Intrauterine Fetal Demise

• Presentation: Absence of fetal movements, absence of fetal heart tones.
• Diagnosis:
  • Ultrasound confirmation of absence of fetal heartbeat.
• Management:
  • Psychological support for the patient.
  • Induction of labor for delivery.
  • Post-delivery investigation to determine cause (placental examination, autopsy).

16. Gestational Diabetes Mellitus (GDM) Complications

• Presentation: Polyhydramnios, macrosomia, neonatal hypoglycemia.
• Diagnosis:
  • Oral glucose tolerance test (OGTT).
  • Ultrasound for fetal growth and amniotic fluid assessment.
• Management:
  • Blood glucose monitoring and dietary management.
  • Insulin therapy if required.
  • Close fetal monitoring for complications.

17. Chorioamnionitis

• Presentation: Fever, uterine tenderness, foul-smelling amniotic fluid, maternal tachycardia, fetal tachycardia.
• Diagnosis:
  • Clinical signs and symptoms.
  • Laboratory tests (elevated white blood cell count, positive amniotic fluid culture).
• Management:
  • Broad-spectrum antibiotics.
  • Delivery of the baby, regardless of gestational age.
  • Supportive care for mother and neonate.

18. Vasa Previa

• Presentation: Painless vaginal bleeding, fetal heart rate abnormalities.
• Diagnosis:
  • Ultrasound with color Doppler.
  • Clinical suspicion during labor.
• Management:
  • Emergency cesarean section if diagnosed during labor.
  • Planned cesarean section before labor if diagnosed antenatally.

19. Molar Pregnancy (Hydatidiform Mole)

• Presentation: Vaginal bleeding, hyperemesis, rapid uterine enlargement, preeclampsia before 20 weeks.
• Diagnosis:
  • Ultrasound showing "snowstorm" pattern.
  • Elevated beta-hCG levels.
• Management:
  • Suction curettage to evacuate molar tissue.
  • Serial beta-hCG monitoring to ensure resolution.
  • Avoid pregnancy for 6-12 months and use reliable contraception.

20. Pelvic Inflammatory Disease (PID)

• Presentation: Lower abdominal pain, fever, abnormal vaginal discharge, cervical motion tenderness.
• Diagnosis:
  • Clinical examination.
  • Pelvic ultrasound if abscess suspected.
  • Laboratory tests (positive chlamydia or gonorrhea tests).
• Management:
  • Broad-spectrum antibiotics (ceftriaxone, doxycycline, metronidazole).
  • Hospitalization for severe cases or if abscess is present.
  • Follow-up to ensure resolution and prevent complications.