Obstetric Emergency Triage

Left-lateral tilt, MgSO4, CTG

Red flags
  • Massive obstetric haemorrhage
  • Eclampsia seizure
  • Cord prolapse
  • Sepsis in pregnancy
  • Ruptured ectopic

First steps

  • ABCDE + left-lateral tilt (>20/40)
  • Continuous CTG >24/40
  • Obstetric team activation

Key investigations

  • FBC, group & save, coag, urate, LFT, U&E
  • CTG, obstetric USS
  • Blood cultures if febrile

Differentials

  • Pre-eclampsia, HELLP
  • PPH (4 Ts: tone, trauma, tissue, thrombin)
  • Sepsis
  • PE (leading cause maternal death)

Initial management

  • MgSO4 4 g load, 1 g/h for pre-eclampsia/eclampsia
  • Uterotonics (oxytocin, ergometrine, carboprost, misoprostol) for PPH
  • Antibiotics for sepsis (co-amoxiclav + gentamicin + metronidazole)
  • Massive transfusion protocol

Referral

  • Obstetric team + anaesthesia + neonatal
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