Obstetric Emergencies

These four emergencies create different immediate threats, but they share one bedside demand: recognize the pattern and act before a definitive diagnosis is complete. Cord prolapse and shoulder dystocia are mechanical emergencies that interrupt fetal oxygenation. Uterine rupture causes abrupt fetal compromise and potentially concealed maternal hemorrhage. Amniotic fluid embolism can produce sudden maternal cardiopulmonary collapse followed by coagulopathy. The first question is not simply What is the diagnosis? Ask what is harming the mother or fetus right now, which action can reverse that mechanism, and which team must be activated immediately. A sudden fetal heart rate change after rupture of membranes calls for relief of cord compression. A fetal head that delivers but retracts and cannot be followed by the shoulders calls for HELPERR. Sudden pain with fetal bradycardia and maternal instability calls for preparation for laparotomy, even when vaginal bleeding is slight. Sudden maternal hypoxia, hypotension, and bleeding from coagulopathy call for resuscitation and blood-component support. The RPN initiates the emergency response, performs immediate measures within education, competence, and employer policy, communicates time-critical findings clearly, and continues to...