Obstetric Emergencies, Childbirth and Neonatal Resuscitation

Antepartum Complications and Trauma in Pregnancy

Caring for a pregnant patient requires understanding how pregnancy alters normal physiology and creates unique medical emergencies. One common issue is supine hypotensive syndrome. This occurs when the gravid uterus compresses the inferior vena cava while the patient is lying flat on her back. When this large vein is compressed, blood return to the heart decreases, causing blood pressure to drop. To treat supine hypotensive syndrome, the EMT should position the pregnant patient on her left side or manually displace the uterus to the left.

Hypertensive disorders also present serious risks during pregnancy. Preeclampsia is new-onset hypertension after 20 weeks of pregnancy, often accompanied by proteinuria or signs of organ dysfunction. Severe headache and visual changes are significant warning signs of this condition, whereas edema is nonspecific. When a patient with preeclampsia develops seizures that are not explained by another cause, the condition is classified as eclampsia. During an eclamptic seizure, the EMT should protect the patient from injury, maintain the airway, provide oxygen or ventilation as indicated, and transport promptly while minimizing stimulation.

Early pregnancy complications include ectopic pregnancy and spontaneous abortion. An ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, most commonly in the fallopian tube. A ruptured ectopic pregnancy is a life-threatening crisis that may cause sudden, severe abdominal or pelvic pain, vaginal bleeding, and signs of hemorrhagic shock; the patient may also report a missed period. In contrast, a spontaneous abortion, commonly called a miscarriage, is the loss of a pregnancy before 20 weeks of gestation. When caring for a patient experiencing a spontaneous abortion, the EMT should treat for shock, collect any expelled tissue, and bring it to the hospital.

Trauma during pregnancy requires specialized awareness of maternal circulatory changes. A pregnant trauma patient's blood volume increases by up to 50 percent, allowing significant blood loss before maternal vital signs indicate shock. Because maternal vitals may remain stable while the fetus is compromised, trauma must be managed with a high index of suspicion. If a patient at or beyond 20 weeks of pregnancy needs spinal motion restriction, the EMT must maintain spinal alignment while relieving pressure from the uterus by tilting the patient to the left or manually displacing the uterus to the left, according to local protocol.