Obstetric & Gynecologic Emergencies

Resuscitation Quick Ribbon (First 2 Minutes)

Magnesium Sulfate (Eclampsia):4–6g IV loading dose over 20 min, followed by 1–2g/h continuous maintenance infusion

Severe Hypertension in Pregnancy:Labetalol 20 mg IV push (repeat 40–80 mg q10m) OR Hydralazine 5–10 mg IV (target SBP 140–150)

Oxytocin (Postpartum Bleed):10–40 units in 1000 mL crystalloid infusion at 250–500 mL/h; never push undiluted IV bolus

TXA (Obstetric Hemorrhage):1g IV over 10 min within 3 hours of delivery (WOMAN trial protocol)

Resuscitative Hysterotomy:Gravid uterus at or above umbilicus (>= 20 wks); perform at 4 min of arrest; deliver by 5 min

Bottom-Line Clinical Pearl

Any female of reproductive age presenting with abdominal pain, syncope, or vaginal bleeding has an ectopic pregnancy until proven otherwise with a quantitative serum beta-hCG and pelvic ultrasound. In preeclampsia with severe features (BP >= 160/110 with end-organ dysfunction), immediately administer Magnesium Sulfate (4–6g IV loading over 20m, then 1–2g/h) to prevent seizures and lower blood pressure with IV Labetalol or Hydralazine. In maternal cardiac arrest >= 20 weeks gestation, perform a Perimortem Cesarean Delivery (resuscitative hysterotomy) within 4 minutes if no ROSC.

1. Ruptured Ectopic Pregnancy Diagnostic Algorithm

Ruptured ectopic pregnancy is the leading cause of first-trimester maternal mortality. The discriminatory zone for transvaginal ultrasound (TVUS) is a beta-hCG of 1,500–2,000 mIU/mL; an intrauterine gestational sac MUST be visible at or above this level. If the beta-hCG is above discriminatory zone and no IUP is visualized, ectopic pregnancy is presumed.

Free Fluid on FAST Exam in Pregnancy: A positive FAST (free fluid in Morison's pouch or pelvis) in a hemodynamically unstable woman with a positive pregnancy test is an operative emergency. Skip formal ultrasound and transport immediately to the operating room for exploratory laparoscopy/laparotomy.

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