What are the critical OBGYN (Obstetrics and Gynecology) emergencies that should be discussed in a comprehensive presentation?

OBGYN Emergencies for PowerPoint Presentation

Life-Threatening Hemorrhagic Emergencies

Postpartum Hemorrhage

• Postpartum hemorrhage is the leading preventable cause of maternal mortality worldwide and requires immediate recognition and treatment 1
• Administer oxytocin 5-10 IU via slow IV or IM injection immediately at shoulder release or postpartum as first-line prophylaxis in every delivery 1, 2, 3
• If bleeding occurs despite oxytocin, give tranexamic acid 1 gram IV within 1-3 hours of bleeding onset (NNT: 276 to prevent one maternal death) 1, 2, 3
• Delaying tranexamic acid beyond 3 hours significantly reduces effectiveness 2, 3
• Essential resources must be immediately available: large-bore IV catheters (18-gauge or larger), fluid warmers, forced-air body warmers, and rapid infusion devices 1, 2, 3
• Transfuse packed red blood cells, fresh frozen plasma, and platelets in fixed 1:1:1 ratio for acute hemorrhage 2
• Maintain maternal temperature >36°C using forced-air warmers, as clotting factors function poorly at lower temperatures 2

Antepartum Hemorrhage

• Placenta accreta spectrum requires planned delivery at 34 0/7-35 6/7 weeks gestation at a center experienced with this condition 4
• Leave placenta in situ if abnormal attachment is evident during cesarean delivery 2
• Avoid forced placental removal with suspected accreta 2
• Consider ureteric stent placement and urologic surgeon involvement if bladder invasion suspected 2

Hypertensive Emergencies

Severe Preeclampsia and Eclampsia

• Severe preeclampsia and eclampsia represent acute neurological and cardiovascular emergencies requiring immediate blood pressure control and seizure prophylaxis 1
• Administer magnesium sulfate as first-line therapy for eclamptic seizures 1, 2, 3
• Initiate antihypertensive treatment immediately to prevent intracranial hemorrhage 2, 3
• Coordinate immediately with emergency services for rapid response 1, 2
• Maintain strict fluid balance and clear documentation 3

Cardiopulmonary Emergencies

Maternal Cardiac Arrest

• Failure to recognize the 4-minute window for perimortem cesarean delivery during maternal cardiac arrest leads to poor maternal and fetal outcomes 1
• Initiate standard ACLS protocols immediately with continuous left uterine displacement by two-handed traction 3
• Prepare for emergency cesarean delivery at 4 minutes if circulation is not restored, regardless of gestational age 3
• Avoid the left lateral position as it reduces cardiac massage efficacy; maintain supine position with manual leftward uterine displacement 3
• Designate a timekeeper to call out times at 1-minute intervals 2

Amniotic Fluid Embolism

• Use cognitive aid checklists focusing on ABC principle: Airway, Breathing, Circulation 1, 2
• Secure airway immediately if respiratory distress and seizure activity occur to prevent aspiration 1, 2
• Transfer to ICU immediately given multi-system involvement with respiratory failure, neurological compromise, and coagulopathy 1
• Avoid prostaglandin F2α and ergometrine in patients with respiratory distress or cardiovascular disease 1, 2

Delivery-Related Emergencies

Imminent Delivery

• Systematically assess for multiparity, history of previous rapid or non-hospital delivery, regular painful uterine contractions, and urge to push 1, 3
• Perform cervical examination before contacting the receiving obstetric team to optimize triage 1, 3

Shoulder Dystocia

• Position patient for McRoberts maneuver if shoulder dystocia is anticipated 1

Labor Dystocia

• Assess for cephalopelvic disproportion before proceeding with augmentation, which occurs in 25-30% of active phase arrest cases 1
• Oxytocin augmentation is first-line treatment with 92% success rate for vaginal delivery when cephalopelvic disproportion is absent 1

Impacted Fetal Head at Cesarean

• Use manual vaginal disimpaction and fetal pillow as prevention techniques 2
• Management techniques include assistant pushing head up from vagina, reverse breech extraction, and tocolysis 2

Gynecologic Emergencies

Ectopic Pregnancy

• Ruptured ectopic pregnancy accounts for approximately 61% of females presenting as acute surgical abdomen 5
• Obtain quantitative β-hCG and transvaginal ultrasound for diagnosis 2
• Consider medical management (methotrexate) versus surgical management based on β-hCG level, mass size, presence of fetal cardiac activity, and patient reliability for follow-up 2
• Hemodynamically unstable patients require immediate surgical intervention (diagnostic laparoscopy or laparotomy) 2
• Almost half (47.8%) of ectopic pregnancy cases undergo salpingectomy 5

Adnexal Torsion

• Twisted ovarian cyst accounts for 7.64% of acute surgical abdomen presentations 5
• Requires prompt surgical intervention to preserve ovarian function 6

Tubo-Ovarian Abscess

• Represents a gynecologic emergency requiring urgent evaluation and treatment 6
• May require surgical drainage in addition to antibiotic therapy 6

Hemorrhagic Ovarian Cysts

• Can present as acute abdomen requiring emergency evaluation 6

Gynecologic Hemorrhage

• Abnormal uterine bleeding may require critical care admission in severe cases 7

Vulvovaginal Trauma

• Requires immediate evaluation and surgical repair when indicated 6

First Trimester Emergencies

Early Pregnancy Loss

• Concerning for early pregnancy loss criteria on transvaginal ultrasound: embryonic crown-rump length <7 mm with no cardiac activity, mean sac diameter 16-24 mm with no embryo, or absence of embryo with cardiac activity 7-13 days following visualized gestational sac with no yolk sac 4
• Diagnostic of early pregnancy loss criteria: crown-rump length ≥7 mm with no cardiac activity, mean sac diameter ≥25 mm with no embryo, or absence of embryo with cardiac activity ≥14 days after visualization of gestational sac with no yolk sac 4

Critical Pitfalls to Avoid

• Not having hemorrhage management resources immediately available (large-bore IVs, rapid infusion devices, blood products) delays critical interventions 1, 3
• Underestimating physiological changes of pregnancy complicates airway management during emergency cesarean delivery 1
• Failing to maintain left uterine displacement during resuscitation perpetuates aortocaval compression 1
• Re-dose prophylactic antibiotics if blood loss ≥1,500 mL 2

System-Level Preparedness Requirements

• Establish direct contact protocols between on-call obstetrician and emergency medical services for all potential obstetric emergencies 1, 3
• Ensure immediate availability of basic and advanced life-support equipment in labor and delivery units 1, 3
• Establish massive transfusion protocol with 1:1:1 ratio of PRBC:FFP:platelets 2, 3
• Conduct emergency drills and debrief staff after actual events to identify strengths and opportunities for improvement 8, 9
• Educate all staff about pregnancy-specific resuscitation modifications 2
• Ensure availability of equipment for cesarean delivery and neonatal resuscitation 2
• Have rigid laryngoscope blades, videolaryngoscopic devices, and endotracheal tubes of assorted sizes immediately available for obstetric airway management 2