Midwifery Emergencies and Obstetric Resuscitation
Core concepts
Emergencies to master: postpartum hemorrhage, shoulder dystocia, cord prolapse, eclampsia, amniotic fluid embolism, uterine rupture, fetal distress, and maternal and neonatal resuscitation.
Postpartum hemorrhage
Most common cause is uterine atony. Follow a structured sequence: call for help, assess and massage the uterus, empty the bladder, give uterotonics (oxytocin, then ergometrine or misoprostol per protocol), establish IV access, give fluids, and refer. Remember the causes: tone, trauma, tissue, thrombin.
Shoulder dystocia and cord prolapse
Shoulder dystocia: call for help, use McRoberts maneuver and suprapubic pressure, consider internal maneuvers, never apply fundal pressure. Cord prolapse: call for help, relieve pressure (knee-chest or Trendelenburg), elevate the presenting part, and prepare for immediate delivery.
Eclampsia
Protect the airway, position laterally, give magnesium sulfate, control blood pressure, and deliver after stabilization.
Newborn resuscitation
Dry, warm, stimulate, position, and assess breathing. If not breathing, begin positive pressure ventilation; chest compressions if heart rate remains low after effective ventilation. Use a 3:1 compression-to-ventilation ratio in newborns.
Traps
Do not give fundal pressure in shoulder dystocia. Do not delay uterotonics in hemorrhage. Do not start compressions before effective ventilation in a newborn.
Rule of thumb
In any obstetric emergency: call for help first, then follow ABC, then treat the cause.