GuidelinesOther guideline
The Unconscious Obstetric Patient
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
Management of the unconscious obstetric patient
CAUSES
- Eclampsia
- Cerebrovascular accident
- Subarachnoid haemorrhage, including from a ruptured berry aneurysm
- Status epilepticus
- Amniotic fluid embolism
- Metabolic problems, e.g. hyper/hypoglycaemia, electrolyte abnormalities
- Infections – meningitis, malaria, or severe sepsis
- Hypoxia resulting from cardiorespiratory problems
- Head injury
- Drugs & poisons
Management of the unconscious obstetric patient
- Hello Mrs Tilt
- Call for help
- Evaluate using the principles of CAB (circulation, airway, breathing) & correct these, by CPR if necessary. Consider intubation
- Assess Glasgow Coma Scale (GCS) or AVPU (alert, voice, pain, unre-sponsive), consider intubation if coma scale ≤8 or responsive only to pain
- Turn the woman on her left side
- Measure BP, heart rate, respiratory rate & temperature
- Attach a pulse oximeter
- Take history from persons accompanying the patient & find the antenatal record & notes of previous hospital admissions if possible
- Do a complete physical examination, including neurological assessment & vaginal examination
- Evaluate systems:
- Big 5: Cerebral, Cardiac, Respiratory, Renal, Liver/gastrointestinal
- Forgotten 4: Haematological, Immune, Endocrine, Musculoskeletal
- Core 1: Genital system
- Insert an intravenous line with Ringer-Lactate
- Insert a urinary catheter
- Do fingerprick blood glucose, U&E, FBC & ABG, and other tests if needed, e.g. malaria smear, malaria antigen, toxicology screen, depending on possible cause
- Evaluate fetal condition with ultrasound and/or NST
- Transfer to a high care area
- Investigate & treat according to the differential diagnosis
- Consult with appropriate colleagues, e.g. neurology, internal medicine
- Decide on further obstetric management