Triage Quick Reference Guide


Page last updated: 21 January 2013

The ABCs of obstetrics

The following table provides the urgency indicators for obstetrics.

Urgency Urgency Indicator Reason for Caution
  • Any potential compromise
  • Increased nasal congestion
  • Often difficult intubations due to:
    - increased patient size
    - difficulty with patient positioning
    - different induction agents required
  • Increased vascularity of nose and airways causes difficulty in breathing
  • Asthma
  • Progesterone may be responsible for increased drive to breathe
  • One third of pregnant asthmatic women experience a deterioration in their condition
  • Palpitations
  • Headache
  • Sudden drop in BP
  • Symptoms of pulmonary embolus
  • Progesterone causes widespread vasodilatation
  • Oestrogen may contibute to increases in blood volume
  • Diastolic BP - 6-17mmHg
  • BP lowest during second trimester
  • Cardiac output (CO) - by 30-50%
  • Haemodynamic flow
  • High volume and dynamic flow may cause cerebral haemorrhage, especially subarachnoid haemorrhage (SAH) during pregnancy
  • Sudden and serious deterioration of their condition
  • Changes in coagulation system associated with pregnancy

Points to remember

  • Hyperdynamic physiological changes occur as early as 6-8 weeks gestation.
  • An assessment of urgency must be made on the basis of both the woman and the foetus.
  • An elevated BP is an ominous sign: the higher the BP the more urgent the review.
  • At 20 weeks the weight of the uterus compresses the inferior vena cava if the woman is lying on her back - a compromise to foetal wellbeing.
  • The risk of many conditions is higher in pregnant women than non-pregnant women of child bearing age. These conditions include:
    - cerebral haemorrhage or cerebral thrombosis
    - severe pneumonia
    - atrial arrythmias
    - venous thrombosis
    - cholelithiasis
    - pyelonephritis
    - spontaneous arterial dissections, e.g. splenic and subclavian dissections, with no previous medical history.
  • Domestic violence is more prevalent during pregnancy. This can mean increased complications for mother and adverse neonatal outcomes.
  • In the setting of trauma, maternal signs may remain stable even when the loss of one-third of blood volume may have occured.
  • The best initial treatment for the foetus is the optimum resuscitation of the mother.
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