Obstetric Emergencies: What You Need to Know

Obstetric emergencies are medical emergencies that occur during pregnancy, childbirth, or during the postpartum period. These emergencies can range from minor complications to life-threatening situations that require immediate medical attention. In this post, we will focus on three of the most common obstetric emergencies: pre-eclampsia and eclampsia, HELLP syndrome, and postpartum hemorrhage. However, there are other emergencies, such as amniotic fluid embolism, that I have covered and that we’ll explore in a future post.

Preeclampsia is a condition that occurs during pregnancy and is characterized by high blood pressure and protein in the urine, or other signs of organ dysfunction. Some symptoms a patient may experience include headache, visual problems, vomiting, epigastric (upper abdominal, region around the stomach) or back pain, and sudden swelling of the face, hands, and feet. If left untreated, pregnant women with preeclampsia may develop seizures, in which case the condition is then called eclampsia. The exact cause of preeclampsia and eclampsia is unknown. However, some researchers think that the cause may be related to insufficient blood perfusion of the placenta. Such insufficient perfusion leads to the release of chemicals called vasoconstrictors from the fetus. These vasoconstrictors cause widespread vasoconstriction (blood vessels narrow) and hypertension (high blood pressure) in the mother. The only definitive treatment for preeclampsia is delivery of the baby and the placenta. Consequently, if you develop preeclampsia, your obstetrician must prepare the fetus for delivery by give you corticosteroid medication to accelerate the development of the fetal lungs.

Risk factors for developing preeclampsia include first pregnancy, multiple gestation, obesity, advanced maternal age, diabetes mellitus, and a family or personal history of preeclampsia. Advanced maternal age means that you are over the age of 35 and especially if you are over the age of 40, even though 40 is still very young when it comes to life outside of pregnancy. Preeclampsia can be prevented by starting patients with risk factors on a daily dose of aspirin from 12 weeks of gestation until the birth of the baby. Hypertension is managed with medications, such as labetalol, nifedipine, or hydralazine. Labetalol and other drugs of its class (which are called beta blockers) should be avoided by women with asthma. Certain blood pressure medications are absolutely contraindicated in all pregnant women. Such medications include ACE inhibitors, so if you are taking such drugs for high blood pressure prior to pregnancy, they must be stopped and your doctor will replace them with different drugs.

Preeclamptic women in labor or within 24 hours of labor are given intravenous magnesium sulfate to treat and prevent seizures. “Mag”, as you may hear it called, also may be given to postpartum women who remain preeclamptic, as well as in women with severe hypertension. Magnesium sulfate can depress your breathing, so the respiratory rate and oxygen saturation is monitored during treatment. If respiratory depression occurs, treatment with calcium gluconate may be necessary. It is important to avoid fluid overload in women with severe preeclampsia or eclampsia. Thus, urine output is monitored and doctors file fluid balance charts. Women with preeclampsia are closely monitored to prevent complications. This includes regularly checking blood pressure levels, protein in the urine, and blood tests for liver enzymes and platelet count. Fetal development should also be closely monitored.

Some maternal complications of preeclampsia include pulmonary edema, seizures, HELLP syndrome, and hemorrhage. Pulmonary edema is a condition in which fluid accumulates in the lungs, causing difficulty breathing. Seizures can be a serious complication of preeclampsia, meaning that the condition has become eclampsia. If seizures are not stopped, they can lead to coma or death. Hemorrhage, or heavy bleeding, can also be a complication of preeclampsia and can lead to serious complications if not treated promptly. Fetal complications of preeclampsia may include intrauterine growth restriction, prematurity, and perinatal death.

HELLP syndrome is a rare but serious complication of preeclampsia that affects the liver, platelets, and red blood cells. It is characterized by Hemolysis (H breakage of red blood cells), Elevated Liver enzymes (EL), and Low Platelets (LP, low concentration of platelets, the cell fragments needed for blood to clot). Symptoms may include severe headache, abdominal pain, nausea, vomiting, and jaundice. HELLP syndrome can lead to serious complications for both the mother and the baby. These complications include liver damage, bleeding disorders, and death. As with preeclampsia, the only treatment for HELLP syndrome is delivery of the baby and the placenta.

Postpartum hemorrhage is bleeding that occurs after childbirth. It is one of the most common obstetric emergencies and can be caused by uterine atony (failure of the uterus to contract after delivery), lacerations or tears in the genital tract, or retained placental fragments. Risk factors for postpartum hemorrhage include prolonged labor, instrumental delivery, uterine dysfunction, and previous postpartum hemorrhage. Symptoms of postpartum hemorrhage may include heavy bleeding, abdominal pain, and abnormal uterine contractions. Treatment may include medications to stimulate uterine contractions, manual removal of placental fragments, and surgery in severe cases. It is important for doctors to diagnose and treat postpartum hemorrhage quickly, to prevent complications such as anemia, shock, and death.

To sum up today’s discussion, preeclampsia and eclampsia, HELLP syndrome, and postpartum hemorrhage are three common obstetric emergencies that require immediate medical attention. Preeclampsia is a condition characterized by high blood pressure and protein in the urine or other organ dysfunction. If not treated, preeclampsia can lead to seizures (eclampsia). HELLP syndrome is a rare but serious complication of preeclampsia that affects the liver, platelets, and red blood cells. Postpartum hemorrhage is heavy bleeding after childbirth and can be caused by uterine atony, lacerations or tears in the genital tract, or retained placental fragments. It is important to recognize the symptoms of these obstetric emergencies and seek prompt medical treatment to prevent serious complications.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

Leave a Reply