An urgent call to the labour ward

Abstract

Obstetric anaesthetists’ primary role in the maternity unit is the provision of anaesthesia and analgesia to women in labour and who require Caesarean delivery. In addition, they are essential members of the multidisciplinary team who will assist with the management of the various types of emergency that can arise in the maternity unit. Emergencies in the maternity unit may arise as a result of obstetric, anaesthetic, or general medical problems and there is no widely recognized classification or definition for these situations. Emergency problems in obstetric patients pose a unique set of challenges: these situations are generally rare, so even experienced clinicians may only have limited experience; obstetric units are frequently geographically remote, so clinicians may be working in unfamiliar surroundings and lastly obstetric patients are generally fit and healthy, so, faced with a physiological insult, will initially compensate, before deteriorating precipitously, prompting an urgent call for help. The emergencies that may lead to an urgent call to labour ward are summarized in Figure 1. Maternal collapse is the generic term that may be used to describe the endpoint of a variety of clinical problems. It is defined as ‘an acute event involving the cardiorespiratory systems and/or brain resulting in a reduced or absent conscious level (and potentially death), at any stage in pregnancy and up to 6 weeks postdelivery’. Maternal collapse may arise as a result of pregnancy-related conditions, pre-existing disease, or co-incidentally during pregnancy. As with all patients, the aide memoire four Hs and four Ts (Hypoxia, Hypovolaemia, Hypothermia, Hypoor hyper-kalaemia/-magnesaemia/-calcaemia, Thromboembolism, Toxins, Tamponade, Tensionpneumothorax) can be used to classify common causes of collapse in pregnancy, with the addition of eclampsia and intracranial haemorrhage (Fig. 2).