OBG505 — Obstetric and Gynaecological Emergencies: Lecture Note

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This is the complete lecture note for OBG505 Obstetric and Gynaecological Emergencies. You can read it online below, open it in the full viewer, or download the PDF for offline study. It pairs with the course's video lectures, so you can read and watch together.

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la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: OBG 505 Course title: Obstetric and Gynaecological Emergencies Course credit load: 2 Units Series 1: Foundations of Emergency Resuscitation • Part 1.1: Recognising the Critically Ill Obstetric and Gynaecological Patient o Sub Part 1.1.1: Physiological changes affecting recognition of critical illness in pregnancy o Sub Part 1.1.2: Early warning scores in obstetrics o Sub Part 1.1.3: Triage and initial assessment in emergencies • Part 1.2: The ABCDE Approach to Resuscitation o Sub Part 1.2.1: Airway and breathing assessment and management o Sub Part 1.2.2: Circulation assessment and management o Sub Part 1.2.3: Disability and exposure assessment • Part 1.3: Shock and Fluid Resuscitation o Sub Part 1.3.1: Classification and recognition of shock o Sub Part 1.3.2: Principles of fluid resuscitation o Sub Part 1.3.3: Blood and blood product transfusion • Part 1.4: Team Working and Systems for Emergency Care o Sub Part 1.4.1: Effective communication and escalation in emergencies o Sub Part 1.4.2: Simulation and drills in obstetric emergency preparedness o Sub Part 1.4.3: Documentation and debriefing after an emergency Introduction

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Picture a labour ward at two in the morning, when a woman who was stable minutes ago suddenly collapses. In that moment, what matters most is not the specific diagnosis, but whether the team in the room knows exactly what to do, in what order, and how to work together under pressure. This Series lays that essential foundation for the whole of this course: the general principles of recognising, resuscitating, and managing the critically unwell obstetric or gynaecological patient, skills that apply whatever the underlying emergency turns out to be, and that we will build on in every Series that follows. The aim of this Series is to equip you with the knowledge and skills to recognise the critically ill obstetric or gynaecological patient and to lead or contribute effectively to her initial resuscitation and team-based emergency care. We shall commence this Series by examining how to recognise the critically ill obstetric and gynaecological patient, including the use of early warning scores and effective triage. Next, we will consider the ABCDE approach to resuscitation in detail. Following that, our attention turns to shock and fluid resuscitation, including the principles of blood and blood product transfusion. Finally, we will conclude by examining team working, communication, and the systems that support safe, effective emergency care. Series Learning Outcomes Upon completing this Series, you should be able to: • SLO 1.1: describe the physiological changes of pregnancy that affect recognition of critical illness, and the use of early warning scores, • SLO 1.2: describe the principles of triage and initial assessment of an obstetric or gynaecological emergency, • SLO 1.3: demonstrate the ABCDE approach to resuscitation, • SLO 1.4: classify shock and describe the principles of fluid resuscitation, • SLO 1.5: describe the principles of blood and blood product transfusion in emergencies, and • SLO 1.6: describe the role of effective teamwork, communication, and systems in emergency care. 1.1 Recognising the Critically Ill Obstetric and Gynaecological Patient 1.1.1 Physiological changes affecting recognition of critical illness in pregnancy

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS The physiological adaptations of pregnancy can substantially mask the early clinical signs of critical illness, as the normal pregnancy-related increase in heart rate and cardiac output, and the physiological fall in blood pressure, mean that a pregnant woman can lose a considerable volume of blood, sometimes well over a litre, before conventional vital sign parameters cross into a range that would normally trigger clinical alarm in a non-pregnant patient, a phenomenon that has repeatedly contributed to delayed recognition of serious obstetric compromise. This physiological reserve means that when a pregnant woman does eventually display overt signs of haemodynamic instability, she may already have lost a dangerously large volume of blood or be significantly more unwell than the vital signs alone initially suggest, making a low threshold for concern and escalation, rather than reassurance from apparently near-normal observations, an essential principle underpinning safe recognition of the critically unwell obstetric patient. Fill in the blank: A pregnant woman can lose a considerable volume of blood before conventional ________ signs cross into an abnormal range. Because of this physiological reserve, a low threshold for concern and ________ is essential in obstetric emergencies. 1.1.2 Early warning scores in obstetrics Modified early obstetric warning scores (MEOWS) are structured tools adapted specifically from general early warning scoring systems to account for the altered normal physiological ranges of pregnancy, tracking parameters including heart rate, blood pressure, respiratory rate, oxygen saturation, temperature, and level of consciousness, generating a composite score or trigger that prompts a defined, standardised escalation response when abnormal parameters are identified. The genuine value of these scoring systems lies not merely in the numerical score itself, but in the standardised, structured escalation pathway they trigger, ensuring that any member of the care team who identifies concerning observations has a clear, unambiguous mechanism to escalate that concern promptly to senior clinical staff, removing reliance on individual clinical judgement or confidence alone to recognise and act upon early warning signs of deterioration. Fill in the blank: Modified early obstetric warning scores are adapted from general early warning systems to account for the altered normal ________ ranges of pregnancy. The genuine value of these scoring systems lies in the standardised ________ pathway they trigger. 1.1.3 Triage and initial assessment in emergencies Effective triage of a woman presenting with a potential obstetric or gynaecological emergency requires rapid, structured initial assessment, typically completed within minutes of arrival, prioritising the identification of immediately life-threatening features (such as heavy vaginal bleeding, severe abdominal pain, reduced consciousness, or signs of shock) over a comprehensive, detailed history, which can and should follow once the immediate priority of stabilisation has begun.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS A structured approach to initial assessment (commonly following the same ABCDE framework used in general emergency medicine) ensures that no immediately life-threatening problem is missed while a more detailed, sequential history and examination are obtained, and that appropriate senior staff and resources are mobilised early, in parallel with the initial assessment itself, rather than only once a full clinical picture has first been fully established. Fill in the blank: Effective triage prioritises identification of immediately life-threatening features over a comprehensive, detailed ________. Senior staff and resources should be mobilised ________ with the initial assessment, not only afterwards. Parameter Example Trigger Thresholds Heart Rate <50 bpm or >120 bpm Blood Pressure Systolic <90 mmHg or >160 mmHg; Diastolic >100 mmHg Respiratory Rate <10 breaths/min or >30 breaths/min Oxygen Saturation <95% Temperature <35°C or >38°C Level of Consciousness New confusion, drowsiness, or unresponsiveness Box 1.1: Parameters and example trigger thresholds of a modified early obstetric warning score. Pilot questions 1.1 1. Explain why the physiological changes of pregnancy can mask the early signs of critical illness. (Linked to SLO 1.1) 2. Explain the concept of physiological reserve in pregnancy and its clinical significance. (Linked to SLO 1.1) 3. Describe the purpose and parameters of a modified early obstetric warning score. (Linked to SLO 1.1) 4. Explain the genuine value of early warning scoring systems in obstetric emergencies. (Linked to SLO 1.1) 5. Describe the principles of effective triage and initial assessment in an obstetric emergency. (Linked to SLO 1.2) 1.2 The ABCDE Approach to Resuscitation 1.2.1 Airway and breathing assessment and management

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Airway assessment is always the first priority in any resuscitation, checking for patency and any obstruction, with simple manoeuvres such as head tilt and chin lift or jaw thrust used to open the airway where needed, before assessment of breathing, which includes respiratory rate, oxygen saturation, chest movement, and auscultation, with supplemental oxygen given to any acutely unwell woman regardless of the specific underlying cause, pending further assessment and definitive treatment. In pregnancy specifically airway management can be more challenging because of physiological changes including increased mucosal vascularity and oedema, particularly in pre-eclampsia, and reduced functional residual capacity from the elevated diaphragm, meaning that a pregnant woman desaturates more rapidly during any period of inadequate oxygenation, an important practical consideration when managing airway and breathing problems in the acutely unwell pregnant patient. Fill in the blank: Airway assessment is always the ________ priority in any resuscitation. A pregnant woman desaturates more rapidly during inadequate oxygenation because of reduced functional residual ________. 1.2.2 Circulation assessment and management Circulation assessment includes pulse rate and character, blood pressure, capillary refill time, skin colour and temperature, and, where relevant, visible or estimated blood loss, with intravenous access (ideally two large-bore cannulae) established promptly in any woman with suspected haemorrhage or significant haemodynamic compromise, alongside sending blood for full blood count, coagulation studies, and cross-matching as clinically indicated. Aortocaval compression

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