Chapter 18: Emergency medicine

Specific recommendations for the management of pregnant women attending Emergency Departments (ED)

All ED clinicians must, at the start of their post and at regular intervals thereafter, have regular training in the identification and management of:

Pregnant women with the following, otherwise unexplained, signs must be reviewed by an experienced doctor from the obstetric gynaecology team. If not available on site then arrangements should be made with the local maternity unit to discuss cases of:

Pregnancy testing should be routine for all women of child-bearing age with a potentially pregnancy-related condition.

The woman’s GP and midwife or obstetrician must be informed of the reasons for, and outcome of, every pregnant woman’s visit to an ED.

The care of pregnant women with medical conditions requiring treatment, and particularly hospital admission, should be discussed and planned in conjunction with the local obstetric team.

Perimortem caesarean section should only be carried out when a maternal cardiac arrest has been witnessed within the previous five minutes; the outcomes of any other circumstances are universally poor. In addition the baby must be delivered within five minutes of the procedure being started to facilitate resuscitation.

Individual obstetric units should develop protocols for the management of pregnant women who are acutely ill / collapsed for non-obstetric reasons. This must involve liaison with emergency services and EDs regarding the most appropriate site (ED, local labour suite or another hospital) to ensure women receive speedy resuscitation.