COMMON PERIPARTUM EMERGENCIES

Peripartum emergencies occur in patients with no known risk factors. W hen the well-being of the fetus is in question, the fetal heart rate p attern may offer etiologic clues. Repetitive late decelerations may si gnify uteroplacental insufficiency and a sinusoidal pattern may indica te severe fetal distress. Repetitive variable decelerations suggesting umbilical cord compression may be relieved by amnioinfusion. Regardle ss of the etiology of the nonreassuring fetal heart pattern, measures to improve fetal oxygenation should be attempted while options for del ivery are considered. Massive obstetric hemorrhage requires prompt act ion. Clinical signs such as painless bleeding uterine tenderness and n onreassuring fetal heart patterns, may help to differentiate causes of vaginal bleeding that may or may not require emergency cesarean deliv ery. The causes of postpartum hemorrhage include uterine atony, vagina l or cervical laceration, and retained placenta. The challenge of mana ging shoulder dystocia is to effect a rapid delivery while avoiding ne onatal and maternal morbidity. The McRoberts maneuver has been shown t o be the safest and most successful technique for relieving shoulder d ystocia. Eclampsia responds best to magnesium sulfate, supportive care and supplemental hydralazine or labetalol as needed for severe hypert ension.