Do you know the knowledge about early identification of obstetric critical illness?

With the continuous advancement of medical technology, the level of modern obstetric medical care has been significantly improved, and most pregnancies are relatively smooth. However, obstetric emergencies still threaten the health of mothers and babies, and are an issue that cannot be ignored in clinical practice. Early identification and timely treatment of critical obstetric emergencies are very important for the life safety of mothers and babies. Here we share with you the relevant knowledge of early identification of obstetric emergencies (as shown in Figure 1).

Figure 1 (Picture from the Internet)

1. What is an obstetric emergency?

Obstetric emergencies refer to acute diseases that occur suddenly in obstetrics and pose a serious threat to the life safety of mothers and infants. Clinically, there are more than ten types of obstetric emergencies. The more common obstetric emergencies include amniotic fluid embolism, pregnancy complicated by pulmonary embolism, postpartum hemorrhage, obstetric sepsis, preeclampsia, acute fatty liver of pregnancy, placental abruption, obstetric DIC, acute heart failure, etc. These diseases have a high incidence in pregnant women and once they occur, they may pose a serious threat to the health of mothers and infants.

2. Detailed introduction to obstetric critical illness

2.1 Amniotic fluid embolism

Amniotic fluid embolism refers to an allergic reaction caused by amniotic fluid or other heat-absorbing substances entering the maternal blood circulation during delivery. It is an extremely serious complication during delivery that may cause serious consequences such as respiratory failure, shock, and sudden death.

2.2 Pregnancy complicated by pulmonary embolism

It refers to the embolus (substances that block blood vessels, such as blood clots, etc.) in the veins or heart of pregnant women that break off, drift with the blood, enter the pulmonary artery, block the blood circulation in the lungs, and cause pulmonary blood circulation disorders, which in turn cause a clinical syndrome with dyspnea, chest pain, cough, hemoptysis, etc. as the main manifestations, which can cause respiratory failure or even death.

2.3 Postpartum hemorrhage

Postpartum hemorrhage is mainly caused by excessive expansion of the uterus, which makes it difficult to close after delivery, or due to excessive and frequent births, which causes degeneration of uterine muscle fibers, reduced muscle fibers and weak contraction. Postpartum hemorrhage is one of the important causes of maternal death. Even if the mother is rescued, she may still suffer from sequelae such as hypopituitarism.

2.4 Obstetric sepsis

Puerperal infection refers to the invasion of pathogens into the reproductive system during delivery or the postpartum period, when bacteria or toxins enter the circulation, causing the mother to experience persistent high fever, chills, etc. In severe cases, it can cause multiple organ damage, shock, and even death.

2.5 Preeclampsia

Preeclampsia, also known as pregnancy-induced hypertension syndrome, is a pregnancy-specific disease. It may be related to factors such as abnormal immune system of pregnant women. Preeclampsia seriously endangers the health of pregnant women and fetuses. If not treated in time, it may lead to serious complications such as premature birth and fetal death.

2.6 Acute fatty liver of pregnancy

Acute fatty liver of pregnancy is a disease in late pregnancy (usually after 30 weeks of pregnancy) caused by various factors that leads to acute fatty degeneration of liver cells. It is relatively rare but can be fatal. It has the characteristics of rapid onset, severe condition, rapid development and high mortality rate.

2.7 Placental abruption

Placental abruption refers to the separation of a normally located placenta from the uterine wall before delivery, which may cause a variety of complications such as acute renal failure, hemorrhagic shock, and intrauterine fetal death.

2.8 Obstetric DIC

Disseminated intravascular coagulation (DIC) is a pathological change characterized by activation of the systemic coagulation system, disorder of the fibrinolytic system, fibrin deposition, microthrombosis in multiple organs, and secondary hyperfibrinolysis. It is an intermediate link in many diseases with a high mortality rate and poor prognosis.

3. How to identify obstetric emergencies early?

Early identification of obstetric emergencies is very important. Critical and severe illnesses may occur before, during, and after childbirth, so medical staff need to have the ability to identify them early.

3.1 Prenatal identification

Before delivery, medical staff can conduct a preliminary risk assessment based on the medical history and family history of pregnant women. Understand whether pregnant women have chronic diseases such as hypertension, diabetes, heart disease, and whether there is a family history of premature birth, fetal maldevelopment, etc., so as to determine whether the mother is at risk of obstetric emergency and severe illness. The physical signs and symptoms of the mother are also the main basis for early identification of obstetric emergency and severe illness. The doctor will check the blood pressure, weight, urine and other indicators of the pregnant woman to observe whether there are abnormal conditions such as edema and proteinuria. The doctor will also pay attention to whether the pregnant woman has discomfort symptoms such as headache, blurred vision, abdominal pain, etc., which may be early signs of obstetric emergency and severe illness. Blood tests for pregnant women are also very important. Doctors will check the hemoglobin level, platelet count, liver function and other indicators of pregnant women to assess whether the pregnant woman has anemia, abnormal coagulation function, abnormal liver function, etc. These abnormal indicators may be signs of obstetric emergency and severe illness. Ultrasound examinations of pregnant women can also help doctors identify early critical and severe conditions. Ultrasound examinations can evaluate fetal development, placental position, amniotic fluid volume and other indicators, helping doctors determine whether there are problems such as fetal maldevelopment and placental dysfunction (as shown in Figure 2).

Figure 2 (Picture from the Internet)

3.2 Identification during production

During childbirth, medical staff need to monitor changes in maternal signs, including blood pressure, heart rate, respiration, etc., so as to detect abnormalities in time. Especially for blood pressure detection, hypertension is a common indicator of obstetric emergency and severe disease. Early detection and taking corresponding measures can effectively reduce the incidence of complications. During the delivery process, fetal monitoring is also required. Through technical means such as fetal heart monitoring and uterine contraction monitoring, the fetal condition can be understood in real time. Once the fetal psychological abnormalities or excessive uterine contractions are found, medical staff can take emergency measures to avoid fetal distress. In addition, labor assessment of pregnant women can also identify obstetric emergencies and severe diseases early. By observing the progress of labor of the parturient, such as cervical dilation, water breaking time and uterine contraction, it can be judged whether there is abnormal labor. Once an abnormality is found, medical staff can take corresponding treatment measures according to the specific situation to avoid dangerous situations caused by too fast or too slow progress of labor (as shown in Figure 3).

Figure 3 (Picture from the Internet)

3.3 Postpartum Identification

After delivery, medical staff should pay close attention to the mother's vital signs, such as respiratory rate, blood pressure, heart rate, and maternal symptoms, such as fever, pain, bleeding, etc. They should also pay close attention to some changes in the mother's senses and behaviors, such as consciousness, anxiety or irritability. Sudden changes in these conditions may be early signs of obstetric emergencies. In addition to observation and evaluation, postpartum identification also includes some specific examinations and laboratory tests. Common examinations include gynecological examinations, pelvic ultrasound examinations and on-site examinations. These examinations can help medical staff detect potential problems, such as uterine bleeding, uterine infection, thrombosis, etc. Therefore, regular maternal reexaminations should be conducted to promptly detect and deal with potential critical and severe illnesses.

3.4 Requirements for medical staff

Early identification of obstetric critical and severe illnesses requires medical staff to have professional knowledge and rich experience. Medical staff should have the ability to clinically diagnose and treat critical and severe illnesses, be able to accurately judge the severity of the illness, and take corresponding rescue measures. At the same time, medical staff should also work closely with other departments, conduct multidisciplinary collaboration, and provide comprehensive medical services (as shown in Figure 4).

Figure 4 (Picture from the Internet)

3.5 Ordinary people’s demands

As ordinary people, we should also understand some basic knowledge about obstetric emergencies and seek help in time when necessary. We should understand the common symptoms of obstetric emergencies, such as bleeding, abdominal pain, high blood pressure, etc., and know how to contact medical institutions in an emergency (as shown in Figure 5).

Figure 5 (Picture from the Internet)

Conclusion: In short, early identification of obstetric critical illness is very important for the life safety of mothers and babies. Medical staff need to have professional knowledge and service experience, and we should also understand some basic knowledge so that we can seek help in time when necessary. Only through the joint efforts of doctors and individuals can the health and safety of mothers and babies be guaranteed.