Obstetric Emergencies in the Field
OB calls are low-frequency, high-acuity, and heavily tested. Every OB scenario reduces to a handful of patterns — recognize them fast and remember: you're treating two patients.
EMT · AEMT · Paramedic
Third-trimester bleeding
Painless bright-red bleeding = placenta previa. Painful dark bleeding with rigid uterus = abruption. Both get left-lateral positioning, high-flow O₂, IV access, and rapid transport. Never perform a vaginal exam.
Preeclampsia and eclampsia
BP ≥ 140/90 after 20 weeks + headache, vision changes, edema, or RUQ pain = preeclampsia. Seizure = eclampsia. Calm dark environment, left-lateral tilt, magnesium sulfate (paramedic) or benzos, prep for delivery.
Cord prolapse
True emergency — the cord is compressed against the presenting part. Put mom in knee-chest or Trendelenburg, insert a gloved hand to lift the presenting part off the cord, keep the cord moist, and transport code 3. Do not attempt to reduce the cord.
Shoulder dystocia
Anterior shoulder impacted behind the pubic symphysis after the head delivers ('turtle sign'). McRoberts maneuver (hyperflex thighs to abdomen) + suprapubic pressure. Do NOT apply fundal pressure — it worsens impaction.
Postpartum hemorrhage
> 500 mL after vaginal delivery. Fundal massage first — a boggy uterus is atony. Encourage breastfeeding to release oxytocin. IV fluids, transport, and consider TXA per protocol.
Frequently asked
- Why left-lateral positioning for pregnant patients?
- After 20 weeks, the gravid uterus compresses the inferior vena cava when supine, reducing preload. Left-lateral tilt restores venous return.
- What's the first step for postpartum hemorrhage?
- Vigorous fundal massage. Most postpartum hemorrhage is uterine atony and responds to massage plus breastfeeding-induced oxytocin release.
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