Summary

  • An obstetric emergency may arise when a woman is pregnant, or during her delivery.
  • In this case, extra care is needed. A woman may need a lot of tests and treatments, and extended hospital stays. She may also face a premature birth or the loss of her baby.
  • If you think you or your unborn baby are at risk, call your doctor or call 000 for an ambulance.

Pregnancy can sometimes present life-threatening health problems for a mother and her baby. These problems are called obstetric emergencies.

In these cases, extra care is needed. A woman may need a lot of tests and treatments, and extended hospital stays. She may also face a premature birth or the loss of her baby. 

Whatever the reason for serious complications during pregnancy, they can cause frustration, distress and sometimes grief.

This article explains some common obstetric emergencies – signs and symptoms, and treatments – and advises what to do in an emergency. 

Pregnancy complications that can be an emergency

An obstetric emergency may arise when a woman is pregnant or during her delivery.

Emergencies during pregnancy

  • Miscarriage ‒ the loss of a baby before 20 weeks gestation. A miscarriage cannot be stopped once it has started. The mother may need treatment for infection, or to remove remaining tissue.
  • Ectopic pregnancy  – where the fertilised egg implants in the fallopian tube rather than the uterine wall. The pregnancy has to be terminated, or the fallopian tube will split and bleed, and lead to permanent infertility.
  • Placental abruption – where the placenta separates from the uterus before birth, causing bleeding and contractions. 
  • Placenta previa – where the placenta attaches to the mouth of the uterus and partly or completely blocks the cervix. As a result, the mother may suffer bleeding and postpartum hemorrhage.
  • Pre-eclampsia and eclampsia (pdf). Pre-eclampsia (toxemia) – or pregnancy-induced high blood pressure – causes severe swelling from water retention. It can lead to kidney and liver failure. If it progresses to eclampsia (convulsions), it can be fatal for the mother and her baby.
  • Premature rupture of membranes (PROM) – where the bag of amniotic fluid breaks before contractions or labour begin. This is an emergency if the waters break before 37 weeks of pregnancy and lead to a major leak of amniotic fluid or infection of the amniotic sac.

 

Emergencies during labour

  • Amniotic fluid embolism – where amniotic fluid moves from the amniotic sac and ends up in the mother’s circulatory system. The fetal cells in the fluid block the pulmonary artery, causing a heart attack. This complication can happen during pregnancy, but usually occurs during strong contractions in labour.
  • Rupture of the uterus – where a weak spot in the uterus tears.
  • Inversion of the uterus – where a portion of the placenta remains attached to the uterine wall, and pulls the uterus out with it during delivery. 
  • Placenta accreta – where the placenta is implanted too deeply in the uterine wall and will not break away during delivery. This results in bleeding.
  • Prolapsed umbilical cord – where the umbilical cord is pushed down into the cervix or vagina. If the cord becomes compressed, the fetus does not receive enough oxygen. The result may be brain damage or even death.
  • Shoulder dystocia – where the baby's shoulders wedge in the birth canal. Depending on its position, the baby may start to lose oxygen.

Why things may go wrong during pregnancy

An early pregnancy complication usually occurs because the fetus has not properly attached or formed. This means the baby will not grow and develop, and a miscarriage occurs. 

In many miscarriages, the mother doesn’t even know she is pregnant. But sometimes, often for unknown reasons, a miscarriage may occur many weeks into a seemingly healthy pregnancy.

Other obstetric emergencies can be caused by a number of factors, including stress, trauma and genetics. Sometimes a woman’s experience in earlier pregnancies can help her doctor identify possible complications and prepare for them.

What to look for – signs of an obstetric emergency

Pregnancy has many possible symptoms that are nothing to worry about. But some symptoms need immediate medical attention. 

If you experience any of the following symptoms, call your doctor immediately. Don’t wait until your next prenatal visit.

  • Less movement by the baby. In the late third trimester, a baby may be distressed if it moves fewer than 10 times in two hours.
  • Abnormal bleeding. Brown, white or pink vaginal discharge is normal during pregnancy. But bright red blood or large blood clots are not normal. 
  • In the first trimester, heavy bleeding with severe stomach pain, stomach cramps or dizziness could be a sign of an ectopic pregnancy (when the egg implants somewhere other than the uterus).
  • In the first or early second trimester, heavy bleeding with cramping could be a sign of miscarriage. 
  • In the third trimester, bleeding with abdominal pain could indicate a placental abruption (when the placenta separates from the uterus).
  • Leaking amniotic fluid. When waters break, they may gush or trickle. You can tell amniotic fluid (which looks a lot like urine) by its slightly sweet smell.
  • Severe stomach pain. Stomach or lower back pain can be signs of pre-eclampsia or an undiagnosed ectopic pregnancy. 
  • Regular, increasingly intense contractions before 37 weeks of pregnancy. Obstetric complications may be causing premature labour.
  • Rapid increase in blood pressure (possibly signalled by nose bleeds, headache or dizziness), which may indicate pre-eclampsia.
  • Sudden and significant swelling of hands and feet, which may indicate pre-eclampsia.
  • Fever, which may indicate an infection.
  • Blurry vision and headaches, which may indicate pre-eclampsia.
  • Severe vomiting, which may lead the mother to need rehydration.

Loss of consciousness during pregnancy can indicate blood loss or amniotic embolism. An ambulance should be called (000) for anyone who loses consciousness and has not regained consciousness within a few seconds, or recovered in a few minutes.

What to do in an obstetric emergency

If you are having an obstetric emergency, call triple zero (000) immediately.

If you are unsure whether your situation is an emergency, you can call your doctor and explain what is happening. Or just call 000.

When to call an ambulance during a home birth

You may have arranged a home birth, but then change your mind. It is absolutely fine to decide to go to hospital. And you can make that decision at any point, right up to the actual birth.

Your midwife may recommend you transfer to a hospital if your home birth is not going to plan or because your labour is not progressing. The midwife might call an ambulance or agree that you can travel to hospital in a car (not driving yourself).

At hospital, your midwife will stay with you as much as possible, but the hospital midwives and doctors will take over your care. 

A hospital birth may be necessary if you need:

  • epidural pain relief (which must be administered by an anaesthetist)
  • control of any bleeding that the midwife cannot stop
  • an assisted delivery (forceps or ventouse), which involves increased risks to the baby (injuries such as head trauma, or complications such as shoulder dystocia) and the mother (severe tearing or bleeding, or both)
  • a caesarean
  • care for your baby because the umbilical cord is around the baby’s neck
  • an emergency caesarean because the umbilical cord is protruding into the vagina
  • help to deliver your baby if the baby’s shoulders are stuck (shoulder dystocia)
  • resuscitation for your baby because the baby has respiratory distress.

Obstetric emergencies – what happens at hospital

If you are sent to hospital with pregnancy complications, a specialist will take your medical history and perform a pelvic and general physical examination. 

You may have blood and urine tests (to look for infection). And you will have your blood pressure monitored (if pre-eclampsia is suspected), and your heart rate. Your baby’s heartbeat will also be monitored.

An abdominal ultrasound may help identify whether the placenta is out of position (placenta previa or placental abruption). It can also provide information on your baby’s size, movement and heart rate, and the amniotic fluid.

A hospital is the safest place for dealing with an obstetric emergency.

Treatment of emergencies during pregnancy

  • Miscarriage. There is no treatment, other than ensuring the mother is not at risk of excessive bleeding or infection. But a procedure may be necessary to treat infection or remove pregnancy tissue.
  • Ectopic pregnancy. The fertilised ovum is removed by laparoscopy (keyhole surgery). If the fallopian tube has burst or been damaged, further surgery is needed.
  • Placental abruption. Bed rest may prevent further separation of the placenta and stop the bleeding. But, for a significant abruption, the baby may need to be delivered immediately and given a blood transfusion.
  • Placenta previa. If more than 20 weeks pregnant, the mother is usually hospitalised or instructed to rest in bed at home. If at 36 weeks gestation or more, and with mature lungs, the baby is delivered by caesarean.
  • Pre-eclampsia and eclampsia. First, blood pressure medication may be used to control blood pressure and prevent convulsions. But sometimes the blood pressure stays high. A woman near full term who has only mild pre-eclampsia may be induced to deliver the baby. Delivery is the only known cure for the condition. But, if the fetus is under 28 weeks, the mother may be hospitalised and given steroids to build the lungs of the fetus. If the life of the mother or baby is at risk, the baby is delivered immediately, usually by cesarean.
  • Premature rupture of membranes (PROM). If PROM occurs before 37 weeks or if amniotic fluid is leaking a lot, the mother is given intravenous antibiotics. If the fetus is close to full term, the mother is usually induced to deliver the baby. Induction is not needed if contractions start within 24 hours of rupture.

Treatment of emergencies during labour

  • Amniotic fluid embolism. The mother is given steroids, and the baby is delivered as soon as possible.
  • Inversion of the uterus. An inverted uterus is moved back (either by hand or surgically) to the proper position.
  • Rupture of the uterus. A ruptured uterus is repaired if possible, although a hysterectomy (removal of the uterus) may be performed if the damage cannot be fixed. The mother may need a blood transfusion.
  • Placenta accreta. Usually, the mother has her placenta surgically removed after delivery. A hysterectomy may be needed.
  • Prolapsed umbilical cord. Saline is infused into the vagina to relieve the compression. If the cord has come out the vaginal opening, it may be able to be put back in place. But an immediate delivery by cesarean section is usually needed.
  • Shoulder dystocia. The mother sits or lies with her knees to her chest, to free the child's shoulder. An episiotomy is also performed to widen the vaginal opening. Different manoeuvres (external and internal) can be tried to free the baby.

 

Remember…

  • An obstetric emergency may arise when a woman is pregnant, or during her delivery.
  • In this case, extra care is needed. A woman may need a lot of tests and treatments, and extended hospital stays. She may also face a premature birth or the loss of her baby. 
  • If you think you or your unborn baby are at risk, call your doctor or call 000 for an ambulance.

 

Where to get help

  • In an emergency, call 000 for an ambulance 
  • Your midwife or obstetrician
  • Your hospital’s Emergency Unit or Maternity Unit
  • The Royal Women’s Hospital Tel. (03) 8345 2000
  • Better Health Channel – explanation of pregnancy terms




References

More information

Healthy pregnancy

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Keeping healthy during pregnancy

Health concerns during pregnancy

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This page has been produced in consultation with and approved by: Royal Women's Hospital

Last updated: November 2016

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