Critical Care, Emergency Obstetrics, and Anesthesia
Maternal collapse follows an ABCDE approach with left lateral tilt, and in cardiac arrest the uterus is displaced and perimortem caesarean delivery is performed within 4 minutes to improve maternal resuscitation. Massive obstetric haemorrhage requires a coordinated protocol: uterotonics, tranexamic acid, blood products in balanced ratios, correction of hypothermia, acidosis and calcium, and early escalation to balloon tamponade, uterine artery embolisation or hysterectomy.
Sepsis in pregnancy presents atypically; use obstetric early warning scores and start broad-spectrum antibiotics within an hour. Amniotic fluid embolism is a clinical diagnosis of exclusion characterised by sudden hypoxia, hypotension and coagulopathy. Eclampsia is treated with magnesium sulphate, with calcium gluconate as the antidote, alongside blood pressure control.
Anaesthetic considerations include the increased risk of difficult intubation, aspiration and aortocaval compression; regional anaesthesia is generally preferred, but is avoided in coagulopathy, severe thrombocytopenia or local infection. Local anaesthetic systemic toxicity is treated with intravenous lipid emulsion.
Traps: delaying perimortem caesarean; forgetting that magnesium toxicity can mimic eclampsia; and assuming a normal blood pressure excludes sepsis or haemorrhage.
Rule of thumb: in pregnancy the airway is difficult and the stomach is full - plan for rapid sequence induction with a smaller tube.