🚨 Obstetric Emergencies
Shoulder dystocia, uterine rupture, inversion and amniotic fluid embolism — the four that turn a normal birth into a crisis in seconds.
🚨 Shoulder dystocia
The head delivers, then retracts back against the perineum — the turtle sign. The anterior shoulder is stuck behind the pubic bone.
The clock starts immediately. Cord compression means the baby is not being oxygenated.
Never apply FUNDAL pressure. It drives the shoulder harder into the pubic bone and can rupture the uterus. Suprapubic only.
McRoberts works by rotating the pelvis, flattening the sacral promontory and freeing the shoulder. It is simple, non-invasive and resolves most cases.
Risk factors: macrosomia, maternal diabetes, previous dystocia, post-dates, obesity.
Complications: brachial plexus injury (Erb’s palsy), fractured clavicle, and for the mother, hemorrhage and lacerations. Examine the newborn’s arm movement and clavicle after.
🚨 Uterine rupture and inversion
Uterine rupture — the paradox
The classic sign is that the pain suddenly STOPS, along with loss of contractions.
- Sudden sharp abdominal pain then cessation of contractions
- Fetal bradycardia or loss of the heart rate
- Loss of station — the presenting part rises
- Signs of shock; abdomen may change shape
Pain that suddenly stops during strong labor is not relief. It is rupture until proven otherwise.
Highest risk: previous classical cesarean scar, oxytocin overstimulation, grand multiparity, trauma.
Uterine inversion
The uterus turns inside out, usually from traction on the cord or pressure on a non-contracted fundus.
- Sudden massive hemorrhage and profound shock, often out of proportion
- The fundus is not palpable abdominally
Never pull on the umbilical cord to deliver the placenta, and never push on a soft fundus. Those are the two causes.
🚨 Amniotic fluid embolism
Amniotic fluid and fetal cells enter the maternal circulation and trigger a catastrophic reaction.
Rare, unpredictable, and one of the leading causes of maternal death.
Care is entirely supportive and immediate: oxygen, intubation, CPR if needed, massive transfusion, blood products for DIC, and emergency delivery.
There is no way to prevent or predict this one. Recognition and speed are everything.
🎯 NCLEX traps
- Turtle sign → McRoberts + suprapubic. Never fundal pressure
- Pain stops = uterine rupture
- Never pull the cord — inversion
- Sudden dyspnea + collapse + DIC = amniotic fluid embolism
- Maternal diabetes is the classic dystocia risk factor