This document summarizes several obstetrical emergencies including pre-eclampsia and eclampsia, HELLP syndrome, post-partum haemorrhage, and amniotic fluid embolus. For pre-eclampsia and eclampsia, the key signs are hypertension and proteinuria, with eclampsia involving seizures as well. Treatment involves blood pressure control using fluid management and antihypertensives like labetalol, nifedipine or hydralazine. Magnesium sulphate is used to prevent and treat seizures. HELLP syndrome is associated with haemolysis, elevated liver enzymes and low platelets. Management focuses on resuscitation, excluding liver damage,

1. OBSTETRICAL EMERGENCIES

2. OBSTETRICAL EMERGENCIES
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Pre-eclampsia and eclampsia
HELLP syndrome
Post-partum haemorrhage
Amniotic fluid embolus

3. Pre-eclampsia and eclampsia
• The hallmark of pre-eclampsia is hypertension
with proteinuria. It is considered mild if
proteinuria is 0.25–2g/l and severe if >2g/l.
• Eclampsia is the same condition associated
with seizures.

4. Management
Circulatorymanagement
• To Treat High BP use controlled plasma
volume expansion as the first line treatment.
• Fluid management.
• Anti-hypertensives such as labetalol,
nifedipine or hydralazine.

5. Convulsions
• Convulsions are best avoided by good blood
pressure control.
• Benzodiazepines to control seizure
• Magnesium sulphate is the treatment of choice
for eclamptic convulsions. Magnesium levels
should be monitored and kept between 2.53.75mmol/l. Above 3.75mmol/l toxicity with
possible cardiorespiratory arrest may be seen.
• Prophylactic anticonvulsant therapy with
magnesium for pre-eclampsia.
• Elective intubation, mechanical hyperventilation
and further anticonvulsant therapy.

6. Early fetaldelivery
• If fetal maturity has been reached immediate
delivery after control of seizures and hypertension is necessary.

7. Drug dosages
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Labetolol
Nifedipine
Hydralazine
Magnesium

8. HELLP syndrome
• HELLP syndrome is a pregnancy related
disorder associated with haemolysis, elevated
liver function tests and low platelets.

9. Clinical features
• Epigastric or right upper quadrant pain with
malaise.
• Nausea and vomiting.
• Generalised oedema is usual but hypertension
is less common. Presentation may occur postpartum.

10. Criteria for diagnosis of HELLP
syndrome
• Haemolysis
– Abnormal blood film
– Hyperbilirubinaemia
– LDH >600U/l
• Elevated liver enzymes
– AST >70U/l
• Thrombocytopenia
– Platelets <100×109/l

11. Management
• Resuscitation and exclusion of hepatic
haemorrhage or ruptured liver.
• In case of ruptured liver an early Caesarean
section and definitive surgical repair are
urgent.
• Treat Microangiopathic haemolysis and
thrombocytopenia using plasma exchange and
fresh frozen plasma infusion.
• Platelet transfusions only in case of an active
bleeding.

12. Post-partum haemorrhage
• Resuscitation
• Aortic compression using the pressure
between the fist and vertebral column
• Stimulated uterine contraction-Prostaglandin
F2α injected locally in to the uterus or IM
• Arterialocclusion-Angiographic embolisation
or internal iliac artery ligation

13. Amniotic fluid embolus
• The initial response of the pulmonary vasculature
to the presence of amniotic fluid is intense
vasospasm resulting in severe pulmonary
hypertension and hypoxaemia.
• Amniotic fluid contains lipid-rich particulate
material which stimulates a systemic inflammatory
reaction. Hence it leads to capillary leak and
disseminated intravascular coagulation.

14. Management
• Respiratory support – Oxygen (FiO2 0.6–1.0).
• CPAP or mechanical ventilation.
• Cardiovascular support-controlled fluid
loading and inotropic support.
• Haematological management-blood product
therapy.
• Treatment with cryoprecipitate.

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