1. This document provides notes on obstetric emergencies like antepartum hemorrhage, prolapse of the umbilical cord, shoulder dystocia, and postpartum hemorrhage. 2. It describes the causes and management of these conditions, including the different types of placenta previa and abruption, risk factors for cord prolapse, and techniques for relieving shoulder dystocia. 3. Management strategies are outlined for each emergency, such as immediate delivery for cord prolapse, uterine massage and medications to control postpartum hemorrhage, and surgical options if bleeding remains uncontrolled.

1. NOTE/Disclaimer: These are notes I made for myself during my second year. I cannot
guarantee that there aren’t mistakes. I do know that studying them were great help to me. I
used notes and powerpoints given to my class by lecturers (University of Stellenbosch,
Tygerberg Campus, South Africa) as well as the following textbooks:
Clinical Gynaecology : TF Kruger, MH Botha
Ostetrics in South Africa: Cronje
Obstetric Emergencies
Antepartum Haemorrhage
External bleeding from the genital tract of a pregnant woman from 28 weeks
Aetiology of APH
1. Abruption placentae
2. Placenta Praevia
3. Local lesions
4. Antepartum haemorrhage of unknown origin
Placenta Praevia implantation of placenta in lower segment of uterus, in front of
presenting part of foetus
I Low/local
II Marginal
III Partial
IV Complete
Placenta Abruptio separation of normally situated placenta from uterine wall
Aetiology of PA
a. Trauma/coitus
b. Vaginal exam
c. Effacement
Prolapse of Umbilical Cord
Presentation cord in front of presenting part, membranes intact
Prolapse cord in front of presenting part, membranes ruptured
Management of cord presentation
Caesarean section if foetus alive and viable and mother in labour.
Prolapse risk factors
• Abnormal lie
• ROM without engagement
• Polyhydramnios
• Preterm labour
• Multiple pregnancy
Management of cord prolapse
A. Full dilation and descent, patient bears down and infant delivered ASAP.

2. B. Replace cord in vagina.
Cover cord with warm wet towel.
Keep presenting part from pressing on cord
Fill bladder with Foley’s catheter
Give oxygen
If foetus is viable and cord is pulsating, deliver by Caesarean.
Shoulder Dystochia
Risk factors
• Suspected large infant >4kg
• Patient has DM
• Patient has BMI >45
• Normal progression in active first stage, but slower progression from 7cm
• Poor progress in first stage despite full dilatation
MacRobert’s Method
1. Hold infant’s head between both hands.
2. Firmly pull head down posteriorly.
3. Assistant presses firmly above symphesis pubis.
4. Patient bears down as strongly as possible.
♫ If MacRobert’s does not work, deliver posterior shoulder in the sacral cavity.
Postpartum Haemorrhage
Excessive bleeding after delivery – more than 500mℓ in the first 24 hours
Management
1. Massage fundus of uterus
2. Infuse oxytocin and massage fundus
3. Empty bladder
4. Diagnose cause
Causes of PPH
a. Atonic uterus
b. Trauma – lacerations
c. Clotting defect
d. Inverted uterus
e. Intravenous access
Atonic uterus Trauma
Uterus feels soft and spongy Uterus is well-contracted
Intermittent dark red clots Continuous bright red blood
Surgical indications
1. Uncontrolled haemorrhage
2. Severe clotting defect
3. Organ failure
Surgical options

3. o Local suturing of lacerations
o Uterine packing with swabs
o Subtotal abdominal hysterectomy
o Total abdominal hysterectomy
o Ligation of internal iliac arteries
o β-lynch suture
o Uterine artery embolisation