Obstetric Emergencies Administrative Guideline

Question 1

History

Answer 1

• Past medical history
• History of hypertension
• Prenatal care
• Prior pregnancies/complications

Question 2

Signs and symptoms

Answer 2

• Vaginal bleeding
• Abdominal pain
• Seizures
• Hypertension
• Severe headache
• Visual changes
• Edema of hands and face

Question 3

Differential

Answer 3

• Preeclampsia/eclampsia
• Placenta previa
• Placental abruption
• Spontaneous abortion
• Ectopic pregnancy

Question 4

How do you know they have an OBGYN event?

Answer 4

Known/suspected pregnancy 
(any trimester)
Missed period
Vaginal bleeding
Abdominal pain 
Contractions/signs of labor

Question 5

Pregnant and having seizures?

Answer 5

Administer magnesium sulfate 5 g in 100 mL NS IVPB
over 15 minutes
Transport to most appropriate receiving center per SAEMS High Risk OBGYN Triage Protocol
Monitor and reassess
For seizure lasting > 5 minutes follow Seizure AG

Question 6

Pregnant and not having seizures?

Answer 6

FSBG
O 2 /pulse oximetry
If shock or signs of orthostasis, place in left lateral decubitus.
Consider IV/IO, cardiac monitor
Administer 20 mL/kg NS/LR fluid bolus as needed

Question 7

What else should you consider?

Answer 7

Consider if indicated:
GI/Nausea AG
Hypoglycemia/Hyperglycemia AG
Shock AG

Monitor and reassess
Transport to most appropriate receiving center per SAEMS
High Risk OBGYN Triage Protocol
Let them know you are coming or contact medical control

Question 8

Ectopic pregnacy

Answer 8

It may mimic other abdominal pathology, like appendicitis.

• Patients may or may not be aware they are pregnant (usually occurs within 5-10 weeks of
  implantation) .
• Maintain a high suspicion in women of childbearing age with severe abdominal pain, syncope, or
  shock.
• May or may not present with vaginal bleeding.

Question 9

Pre-eclapmsia

Answer 9

Occurs in approximately 6% of pregnancies, up to 6 weeks postpartum
- Some symptoms include: headache, RUQ pain, visual disturbances, leg/arm swelling, frothy urine
- Management of hypertension associated with preeclampsia is typically not performed in the
prehospital environment.

Question 10

Eclampsia

Answer 10

seizures or altered LOC in the context of pre-eclampsia.
- Can occur up to 6 weeks post-partum
- Treatment consists of magnesium sulfate administration and delivery of the fetus.
- Priority is administration of magnesium IV. Due to the serious consequences of seizures in the
eclamptic patient, if magnesium sulfate is not effective in stopping seizure activity, administer your
traditional benzodiazepine for seizure control

Question 11

Placental Abruption

Answer 11

a pathological detachment of the placenta, abruption presents as vaginal bleeding
with or without abdominal pain.
- Can occur after abdominal trauma
- Treatment consists of delivery of the fetus.
- May present with shock due to rapid internal blood loss.

Question 12

Where do you take pregnant people?

Answer 12

• > 20 weeks and <28 weeks - BUMC-T or TMC (NICU capable)

- >28 weeks - BUMC-T, TMC, SJH or NMC