Obstetric Emergencies

from http://www.tenwekhospital.org

There has been global concerns about responses to obstetric emergencies!   This last 24 hours has been a short course in what obstetric emergencies look like “on the ground”!  The direct providers of care were an intern, an anesthetist and an obstetrical attending.  

The first case was a patient with placenta previa at 39 weeks, bleeding with a recent fetal demise.   The second case was a patient with obstructed labor at term for at least 8 hours also with a fetal demise.  Both of these cases had preventable fetal deaths and both were potential maternal deaths.   The good news is that both mothers survived!

The primary reason for maternal survival was the availability of operative facilities with staff, anesthesia and blood.   The primary prevention and missing response was having trained nurses and personnel to detect the pre-emergent presentations of these common complications of pregnancy.   In the developed world, team management is the issue.   In the developing world, the issue is having the basics!   Places like Tenwek are providing responses to obstetric emergencies that are both preventive and emergent. 


Marvin

References:

Paxton A.  Bailey P.  Lobis S.  Fry D.  Global patterns in availability of emergency obstetric care.  International Journal of Gynaecology & Obstetrics.  93(3):300-7, 2006 Jun.

Merien AE.  van de Ven J.  Mol BW.  Houterman S.  Oei SG.  Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. [Review]  Obstetrics & Gynecology.  115(5):1021-31, 2010 May.