Pregnancy and birth - related emergencies

About pregnancy and birth related emergencies

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

Obstetric emergencies during pregnancy

Serious problems that can happen during pregnancy include:

• Miscarriage – the loss of a baby before 20 weeks gestation. A miscarriage cannot be stopped once it has started. Treatment may be needed for infection, or to remove remaining tissue.
• Ectopic pregnancy – where the fertilised egg implants in one of the fallopian tubes (between the ovary, where the eggs are stored and the womb) rather than in the uterus (womb). The pregnancy cannot continue and treatment usually means the loss of the tube. If the pregnancy causes a split in the tube, this can result in pain and serious bleeding. Loss of, or damage to, the tube may affect the ability to become pregnant in the future.
• Placental abruption – where the placenta (afterbirth) breaks away from the uterus before birth, causing bleeding, pain and contractions.
• Placenta praevia – where the placenta attaches to the lower part of the uterus and partly or completely blocks the neck of the womb. Bleeding can occur at any time during the pregnancy.
• Preeclampsia and eclampsia – preeclampsia causes high blood pressure, often with severe swelling caused by water retention. It can lead to kidney and liver failure. If it progresses to eclampsia (convulsions or fitting), as it can lead to serious health complications, including death, for the mother, the baby, or both.
• Premature rupture of membranes (PROM) – where the bag of water (amniotic fluid) breaks before labour begins. This is more serious if the waters break before 37 weeks, known as Preterm pre-labour rupture of membranes (PPROM). This increases the risk of premature birth and infection.
• Placenta accreta – where the placenta is implanted too deeply in the uterine wall and cannot come out after the baby is born. This is usually discovered by a scan before labour. Birth is usually by caesarean and a plan made to make sure the mother is safe. Depending on how deeply embedded the placenta, the womb may need removed to save the mother (hysterectomy).

Obstetric emergencies during labour

Serious problems that can happen during labour include:

• Shoulder dystocia – where the baby's shoulders wedge in the pelvis after the baby’s head is born. If this happens, your carers must act quickly to release the baby’s shoulder and allow it to be born.
• Prolapsed umbilical cord – where the umbilical cord falls down into the vagina before the baby is born. This can happen before or during labour when the bag of water breaks and the baby is not deep enough in the pelvis. When this happens, the cord gets squeezed between the baby’s head and the bones in the pelvis and stops oxygen going to the baby. To survive, the baby must be born quickly, usually by caesarean.
• Rupture of the uterus – where a weak spot in the uterus tears. This is more common in those who have had an operation on their womb before the pregnancy (such as a previous caesarean or surgery for fibroids).
• Inversion of the uterus – where the uterus is partly or fully turned inside-out and may be seen in the vagina. This can happen during the removal of the afterbirth if it has not come away from the wall of the womb properly. Very rarely, it can happen by itself after the baby is born.
• Amniotic fluid embolism – where fluid moves from the amniotic sac (bag of waters) through blood vessels in the womb and ends up in the mother’s blood. This creates a severe allergic reaction affecting all systems in the body. Although this is very rare, it causes serious complications including death.

Why things may go wrong during pregnancy

Miscarriages that happen in early pregnancy may happen because the afterbirth has not formed properly. Often the reason for the miscarriage is unknown. A miscarriage may occur many weeks into a seemingly healthy pregnancy.

Other serious problems can be caused by several reasons, such as trauma or for genetic reasons. Sometimes a woman’s experience in earlier pregnancies can help the doctor identify possible complications and prepare for them.

What to look for – signs of an emergency during pregnancy

Most symptoms of pregnancy are nothing to worry about but there are some symptoms that need immediate medical attention. If you experience any of the following symptoms, call your doctor, midwife or hospital immediately. Don’t wait until your next prenatal visit.

• Any bleeding during pregnancy is not normal – be sure to call your doctor or midwife
  • Heavy bleeding with severe stomach pain in the first 3 months of pregnancy – could be a sign of ectopic pregnancy
  • Heavy bleeding with cramping in the first 3 to 4 months of pregnancy – could be a sign of miscarriage
  • Bleeding with abdominal pain in the last 3 months of pregnancy – could be a sign of placental abruption.
• Stomach cramps in early pregnancy – could be a sign of ectopic pregnancy.
• Dizziness – could be a sign of ectopic pregnancy or preeclampsia.
• Severe vomiting or sickness – could be a severe symptom of pregnancy, or could be due to an infection.
• Severe stomach pain – could be a sign of preeclampsia.
• Lower back pain – could be a sign of preeclampsia.
• Rapid increase in blood pressure, possibly signalled by nose bleeds, headache or dizziness – could be a sign of preeclampsia.
• Blurry vision and headaches – could be a sign of preeclampsia.
• Sudden and significant swelling of hands, face and feet – could be a sign of preeclampsia.
• Fever – could be a sign of an infection.
• A decrease in your baby’s normal daily movements, or if you are worried about how frequently your baby moves.
• Regular, increasingly intense contractions before 37 weeks of pregnancy – might be a sign of premature labour.
• If your waters break before labour begins – you may feel a gush or continual trickle of fluid that has a slightly sweet smell.
• Blackouts (loss of consciousness) or fits (convulsions) – must be taken seriously. Call an ambulance (000) for anyone who fits and for anyone who faints or blacks out and has not recovered in a few minutes.

Treatment of emergencies during pregnancy

Obstetric emergencies during pregnancy are treated as follows:

• Miscarriage – there is no treatment, other than ensuring the mother is not at risk of excessive bleeding or infection. Sometimes a procedure may be necessary to treat infection or remove pregnancy tissue.
• Ectopic pregnancy – the fertilised egg is removed by keyhole surgery (laparoscopy). 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. If the bleeding is very heavy or cannot be stopped, the baby may need to be born immediately. Some women and babies may need a blood transfusion.
• Placenta praevia – most babies will be born by caesarean section before their due date, however this will depend on how low the placenta is.
• Preeclampsia and eclampsia – birth of the baby and delivery of the placenta is the only known cure for the condition. Medication may be used to control blood pressure and prevent convulsions. A woman near full term who has been diagnosed with mild preeclampsia may be advised to have her labour induced. If the baby is under 28 weeks, the mother may be admitted to hospital and given steroids to build the lungs of the baby, in case it needs to be born early. If the life of the mother or baby is at risk, the baby is delivered immediately, usually by caesarean.
• Premature rupture of membranes (PROM) – treatment depends on the number of weeks of pregnancy at which this happens. If PROM occurs before 37 weeks, intravenous antibiotics are recommended. If the baby is close to term, induction of labour is recommended. Induction of labour is not always needed if contractions start within 24 hours of rupture (unless the mother has had a test during the pregnancy that is positive for a bug called GBS that can make babies very unwell).

Treatment of emergencies during labour

Obstetric emergencies during labour are treated as follows:

• 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.
• Prolapsed umbilical cord – if the cord has come out the vaginal opening an immediate delivery by caesarean section is usually needed.
• Placenta accreta – the placenta is usually surgically removed after the baby is born. Other treatments and medications may be used to try to save the uterus but most commonly, a hysterectomy is needed.
• 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.
• Inversion of the uterus – an inverted uterus is moved back (either by hand or surgically) to the proper position.
• Amniotic fluid embolism – the mother is given emergency care and the baby is born as soon as possible.

What to do in an 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, midwife or hospital 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 changed your mind. You always have the right to be admitted to a public hospital for care. You can make the decision to go to the nearest maternity hospital at any point during your pregnancy or labour, right up to the actual birth.

Your midwife may recommend you transfer to a hospital if things are not going as expected or you need more expert care. 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.

In addition to the obstetric emergencies mentioned above, 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
• assistance with the birth of your baby because you cannot push your baby out yourself
• help with the labour because it is too slow, or because of concerns about your baby’s heartbeat or the colour of the amniotic fluid (if it contains meconium, which is baby’s first poo)
• assistance because the placenta is stuck (retained placenta)
• repair of a serious tear
• special care for your baby, often because the baby has breathing problems.

Obstetric emergencies – what happens at hospital

If you are admitted to hospital with serious pregnancy or labour problems, 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 heart rate and blood pressure monitored (if preeclampsia is suspected). Your baby’s heartbeat will also be monitored.

A scan (abdominal ultrasound) may help identify whether the placenta is out of position (placenta praevia or placental abruption). It can also provide information on your baby’s size, movements and heart rate, and the amount of fluid around your baby.

A hospital is the safest place for dealing with any emergency.

Where to get help

• In an emergency, call Triple Zero (000) for an ambulance
• Your midwife or obstetrician
• Your GP (doctor)
• Your hospital’s Emergency unit or maternity unit