6.3. EMERGENCIES IN OBSTETRICS AND GYNECOLOGY

Related titles

Absent.

Purpose of assistance

1. Recognition of serious conditions associated with bleeding during pregnancy, even if bleeding or pregnancy is not obvious (ectopic pregnancy, placental abruption, placenta previa).
2. Conducting adequate resuscitation measures in case of hypovolemia.

Description of the patient

Inclusion criteria

1. A woman with vaginal bleeding in any trimester of pregnancy.
2. A woman with pelvic pain or a possible ectopic pregnancy.
3. Age of the mother can vary from 12 to 60 years.

Exclusion criteria

1. Active childbirth and childbirth (see the instruction “Childbirth”).
2. Postpartum bleeding (see the instruction “Childbirth”).

Differential diagnosis

1. Premature detachment of the placenta: occurs in the third trimester of pregnancy; the placenta prematurely separates from the uterus and causes intrauterine bleeding:

a) lower abdominal pain and uterine tension;
b) shock, absent or minimal vaginal bleeding.

2. Placenta previa: the placenta partially or completely covers the opening of the cervix:

a) usually occurs in the second or third trimester;
b) painless vaginal bleeding (only not during active labor);
c) to provide assistance with active childbirth, see instruction “Childbirth”).

3. Ectopic pregnancy (broken):

a) occurs in the first trimester;
b) abdominal/pelvic pain with or without minimal bleeding.

4. Spontaneous termination (miscarriage):

a) usually occurs in the first-second trimester;
b) periodic pain in the pelvis (contraction of the uterus) with vaginal bleeding.

Management of the patient

Status assessment

1. Collect history:

a) obstetric anamnesis (see the instruction “Childbirth”);
b) abdominal pain – onset, duration, nature, radiation of pain, factors alleviating or aggravating pain ;
c) vaginal bleeding – onset, duration, volume (number of soaked pads);
d) syncope/dizziness;
e) nausea/vomiting;
e) fever ;

2. Monitoring:

a) monitor ECG indicators for episodes of loss of consciousness or dizziness;
b) monitor pulse oximetry for signs of hypotension or worsening breathing.

3. Secondary examination (focus on obstetric problems):

a) general: vital signs, orthostatic vital signs, skin color;
b) abdomen: distension, tenderness, peritoneal signs;
c) urogenital system: visible bleeding;
d) neurology: mental state.

Treatment and intervention

1. With signs of shock or orthostatic hypotension:

a) place the patient in a supine position and keep him warm;
b) resuscitation with solutions – crystalloid 1-2 l IV;
c) re-evaluation of vital signs after resuscitation.

2. Hospitalization – transport to the nearest reception department.

Patient safety

1. All patients in the third trimester of pregnancy should be transported on the left side or with the uterus manually shifted to the left.
2. Do not insert hands/fingers into the vagina during bleeding, except in situations of cord prolapse or non-progressing breech presentation.

Useful information for training

Key points

Loss of consciousness can be a symptom of bleeding due to an ectopic pregnancy or vaginal bleeding.

Corresponding evaluation results

1. Evaluation of vital signs for signs of shock (for example, tachycardia, hypotension).
2. Abdominal examination (bloating, tension, protective reaction).
3. During pregnancy, estimate the height of the uterine fundus.

Key elements of documentation

Document all vital signs and physical examination results.

Criteria for the effectiveness of aid provision

1. Patients with signs of hypoperfusion or shock should not go to the stretcher independently.
2. If possible, infusion therapy should be initiated in patients with signs of shock or hypoperfusion.
3. Recognition and proper treatment of shock.