Obstetrical Emergencies – How we can help each other

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When you hear about emergency situations, generally people imagine Emergency Rooms, Ambulances or Intensive Care Units.  For most people a birth center is never synonymous with emergency healthcare.  The reality is obstetrical emergencies need close attention to detail because in most cases you have to act immediately to save the lives of the mother and the baby.  The stakes are high, and good communication amongst healthcare personnel is key in generating optimum outcomes for each mother baby couplet.  The CDC reports sadly, about 650 women die each year in the United States as a result of pregnancy or delivery complications.  The death of a woman during pregnancy, at delivery, or soon after delivery is a tragedy for her family and for society as a whole.

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During pregnancy, a woman’s body goes through many changes.  I’ve outlined specific pregnancy changes you can learn more about here… The purpose of prenatal care is to identify existing risk factors and any deviations from normal so that pregnancy outcomes can be enhanced,  Traditional prenatal care usually occurs in the first trimester with monthly vistas through the week 28.  Then visits occur every 2 weeks until week 36 and then every week until birth.  Some practices have fewer visits with women who are at lower risk for complications.  Prenatal care is so unbelievably important for all pregnant women and is key to preventing pregnancy related complications and death.

Statistics provided by the CDC indicate that obstetrical deaths are on the rise in the United States.  In 1987 – 7.2 deaths per 100,000 live births were reported as compared to 17.8 deaths per 100,000 live births in 2011.

The graph below shows percentages of pregnancy-related deaths in the United States in 2011 caused by

causes-pregnancy-related-death-2010_600pxCardiovascular diseases, 15.1%.
Non-cardiovascular diseases, 14.1%.
Infection or sepsis, 14.0%.
Hemorrhage, 11.3%.
Cardiomyopathy, 10.1%.
Thrombotic pulmonary embolism, 9.8%.
Hypertensive disorders of pregnancy, 8.4%.
Amniotic fluid embolism, 5.6%.
Cerebrovascular accidents, 5.4%.
Anesthesia complications, 0.3%.
The cause of death is unknown for 5.9% of all 2011 pregnancy-related deaths.

Considerable racial disparities in pregnancy-related mortality exist. In 2011, the pregnancy-related mortality ratios were

12.5 deaths per 100,000 live births for white women.
42.8 deaths per 100,000 live births for black women.
17.3 deaths per 100,000 live births for women of other races.

Interestingly, Cheryl K. Roth, PhD, nurse practitioner in obstetrics at Scottsdale Healthcare in Arizona, and colleagues conducted an extensive literature search and concluded that some deaths may have resulted from the assumption that all steps will be taken as long as enough people (“all hands on deck”) are present at an emergency.  “When confronted with unexpected or unusual events, like uterine rupture, people have to act immediately [to save] the lives of [the] mother and child and also need specific roles so people don’t miss obvious things. Adrenaline kicks in, and even though cognitively everyone knows how to deal with postpartum hemorrhage, when it’s severe, very often people will miss a crucial element, such as whether the [intravenous drip] is flowing well or if extra tubes of blood have been transferred to the lab,” said James Byrne, MD, chair, Department of Obstetrics and Gynecology at Santa Clara Valley Medical Center, San Jose, and affiliated clinical professor, Stanford University School of Medicine, California. Dr Byrne compares the chaos at an obstetric emergency with other complex situations: commercial aviation, the scene of an automobile accident, and military maneuvers. Individuals have specific roles, but the team must function together so well that no detail is missed.

So how can we help each other, as nurses and healthcare providers, to ensure we are aware, prepared and well trained for all obstetrical emergencies.  A group of healthcare professionals and researchers have developed protocols and guidelines for establishing obstetric emergency response teams to handle several common (postpartum hemorrhage, shoulder dystocia, & emergency cesarean delivery) as well as uncommon emergencies (eclamptic seizure & maternal code).  You can access the full research article here.  Developing Protocols for Obstetric Emergencies .  The goal is to educate and rehearse so that when an emergency happens, people are trained and aware and nothing is overlooked that could potentially make the difference in outcomes of mother or babies.

My hospital is soon to implement TeamSTEPPS. tslogo TeamSTEPPS is a teamwork system designed for health care professionals that is:  An evidence-based teamwork system to improve communication and teamwork skills among health care professionals.  TeamSTEPPS provides higher quality, safer patient care by:  Producing highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients.  It will be our units responsibility to work with our clinical educators and leadership team to develop a plan for our obstetrical patients using the TeamSTEPPS model.  We are a very fortunate hospital that has a simulation mom that has allowed us to practice obstetrical emergencies hands on. Our “Sim Mom” helps manage normal deliveries as well as childbirth complications and obstetrical emergencies. The birthing simulator offers reliable, realistic training for childbirth maneuvers and emergency response when time is short and teamwork is essential.

The key to all emergencies, no matter the location, is #1 communication, #2 education, #3 preparedness & #4 collaboration.  In obstetrics we are caretakers for not only our patient but the entire family unit.  Our commitment to our specialty field comes with the responsibility to support each other in this amazing professional journey.

During the month of August I will be detailing 1 obstetrical emergency a week.  Check back and quiz yourself!

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at http://scrub-ed.com/. If you are interested in participating find out more details and sign up.

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Comments

    • 2

      Nurse Kelly says

      Donna
      I’m looking forward to Team Stepps ~ our educator has been to training and really thinks it will be a huge success – I’ll let you know!

  1. 3

    says

    Wow, what a great article. I have never worked OB myself so this was great information to learn. And, I think that providing an environment of safe and clear communication is a great program idea. As Donna said above, keep us posted on how it goes. I also really enjoyed how you will be covering an OB emergency each week on the blog- great idea! Nice work and thanks for sharing.

  2. 5

    says

    Great post! OB emergencies can be terrifying. Nobody bleeds like a postpartum mother. My vote for week 4 is cord prolapse. This can happen at home and most mothers do not know what to do.

    Thanks,

    Carrie Sue

    • 6

      Nurse Kelly says

      Thanks Carrie Sue! I love your idea about cord prolapse it is scary enough when it happens IN the hospital, so if it was to happen at home I cannot even imagine!

  3. 7

    says

    Kelly, wonderful post! I really admire you and other healthcare professionals that work with OB patients. Yes, indeed the stakes are so very high. Thank god for the OB team professionals that have the dedication to help bring new life safely into this world. Thanks so much for the information!

  4. 9

    says

    Thank you Kelly for the amazing article. I will definitely be sharing it with friends. “The key to all emergencies, no matter the location, is #1 communication, #2 education, #3 preparedness & #4 collaboration.” I couldn’t agree with you more. Already looking forward to your next article, take care.

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