OB emergencies

Check the post "Loss" for amniotic fluid embolus.

Other emergencies we've had include: shoulder dystocias, 26 week footling breech that delivered in triage, pt with hourglass membranes, pt arriving complete with a transverse lie, severe eclampsia and/or HELLP resulting in emergency csections, no prenatal care with unexpected twins, placental abruptions, PP hemorrhage, uterine anomalies, cord prolapse..........

Shoulder dystocias I've witnessed have all (luckily) resolved with McRoberts and/or corkscrews. The most impressive intervention has been getting the mum to get on her hands and knees and then pushing/pulling the baby out. That one has never failed the doc that does it.

We had a hemorrhaging abrupted placenta once, coming inby ambulance, and called the doc, the sup, and the lab before she got there. Basically ran it like a code with a recorder and gave uncrossmatched blood while waiting for the OR to set up. The key to being ready for problems in my opinion is to make sure you are stocked for a crisis for EVERY birth, and to run through various emergencies in your mind. What could you do/have beforehand that would save time in a crisis. How would you get the staff you need, and where would you find phone numbers and extra supplies.

Thinking ahead is a good education because you KNOW what you are doing when it actually happens, and you get to ask questions and look up protocols beforehand. I hated being on orientation and seeing the nurse have to leave the room for something that should have been there, or pulling out the instruction book on a piece of equipment when the patient was in dire straits.