New-onset tonic-clonic seizure in a patient with pre-eclampsia, not attributable to another cause. Can occur antepartum, intrapartum, or postpartum (up to 6 weeks).
Clinical Features
•Tonic-clonic seizure in pregnancy ≥ 20 weeks or within 6 weeks postpartum
•Often preceded by: severe headache, visual disturbance, epigastric pain, hyperreflexia
•BP ≥ 140/90 mmHg with or without proteinuria
•Postpartum eclampsia can occur without prior antenatal hypertension
Immediate Actions
1
Left lateral position — prevent aortocaval compression + aspiration
Premature separation of the normally implanted placenta before delivery of the fetus. Bleeding may be revealed (vaginal), concealed (retroplacental), or mixed. Severity ranges from minor to catastrophic.
Clinical Features
•Painful dark red vaginal bleeding (60–80%) — absent in concealed abruption
•Sudden onset severe abdominal pain, often constant (tetanic uterus)
•"Woody hard" uterus on palpation — board-like rigidity
•Fetal heart rate abnormalities: bradycardia, late decelerations, loss of variability
•Maternal shock disproportionate to visible blood loss (concealed haemorrhage)
•DIC in severe abruption — check fibrinogen urgently
Entry of amniotic fluid or fetal cells into maternal circulation triggering an anaphylactoid cascade causing cardiovascular collapse, hypoxia, and DIC. Incidence: 1.9–6.1 per 100,000 deliveries. Mortality 20–60%.
Clinical Features
•Sudden cardiovascular collapse during labour, delivery, or within 30 min postpartum
•Classic triad: hypoxia + hypotension + DIC — rarely all three present simultaneously
•Acute dyspnoea → respiratory arrest
•Arrhythmia, tachycardia → cardiac arrest
•DIC: massive haemorrhage with clinical coagulopathy
•Seizure or loss of consciousness
•Diagnosis of exclusion — no confirmatory test in acute setting
Immediate Actions
1
CALL CODE — cardiac arrest team + senior obstetric + anaesthetic cover now
2
Perimortem caesarean section if arrested with viable fetus ≥ 20 weeks — within 5 min to optimise CPR
3
Left lateral tilt 15–30° during CPR if uterus not yet empty
4
Secure airway early — intubate before further deterioration
5
Aggressive DIC management: 1:1:1 ratio FFP:pRBC:platelets
6
Adrenaline per ALS if cardiac arrest
7
Consider ECMO if available and other measures failing
8
Hydrocortisone 500 mg IV (anaphylactoid component)
Pre-eclampsia with any severe feature: BP ≥ 160/110 mmHg on two readings ≥ 4 h apart, platelet count < 100 × 10⁹/L, creatinine > 97 µmol/L, transaminases > 2× ULN, pulmonary oedema, or new-onset headache/visual disturbance unresponsive to analgesia. Affects 2–8% of pregnancies globally.
Clinical Features
•BP ≥ 160/110 mmHg — confirmed on two readings ≥ 4 h apart (or ≥ 15 min if treatment urgently needed)
•Platelet count < 100 × 10⁹/L
•Creatinine > 97 µmol/L (1.1 mg/dL) or doubling from baseline
Collection of blood in the vulvovaginal or paravaginal spaces, most commonly following vaginal delivery, episiotomy, or perineal trauma. Can be occult and rapidly expanding.
Clinical Features
•Severe perineal/pelvic pain disproportionate to visible wound size post-delivery
•Visible purple/blue discolouration and swelling of the vulva or perineum
•Feeling of rectal pressure or urinary retention
•Haematoma may extend into broad ligament (retroperitoneal) — less visible, more dangerous
•Maternal tachycardia and falling BP if haematoma is large or expanding
Clinical Reference Only. These protocols summarise current evidence-based guidelines for educational and reference purposes. They do not replace clinical judgement, local hospital protocols, or senior clinical review. Always refer to primary guidelines and involve senior staff in emergency management.
