Page 75 - 2026 SMOG

OBSTETRIC EMERGENCIES
Signs and Symptoms Differential Diagnosis
• Gravidity/Parity • Pre-eclampsia/eclampsia
• Any pregnancy complications? • Placenta previa
(i.e., preeclampsia, gestational diabetes, etc.) • Abruptio placentae
• Any abnormal bleeding? • Spontaneous abortion
• Painful uterine contractions/back pain/ • Uterine rupture
stomach pain? • Ectopic pregnancy
• Blurry vision/dizziness?
• Changes in fetal movement?
Treatment
• O if hypoxemic, IV/IO, cardiac monitor, blood glucose check, and place in left lateral
2
decubitus or pad under right hip
• Is the patient seizing?
˚ Magnesium Sulfate 4–6g IV over 15–30min or 5mg IM each buttock
˚ If blood glucose is within normal limits and the patient is in Status Epilepticus, move to
SEIZURE PROTOCOL.
■ Midazolam 5mg IV/IO or 10mg IM
OR
Lorazepam 24mg IV/IM
■ Wait 5min and if not resolved, give an additional dose
˚ If blood glucose is <70 or >250, move to HYPER/HYPOGLYCEMIA PROTOCOL.
• Do they have severe hypertension? (≥160/110): serial vitals q5min for 15min
˚ Hypertensive emergency? (Persistent BP ≥160/110 for 15+min)
Labetalol 20mg IV
■
OR
Nifedipine 10mg PO/IR
■ Magnesium Sulfate 4–6g IV over 15–30min
• If the patient is experiencing abdominal pain alone, refer to the ABDOMINAL INJURY
PROTOCOL.
• Is there vaginal bleeding present? If tachycardic/orthostatic, administer blood if available,
1g TXA IV/IO over 10–20min. If bleeding continues >30min, may repeat TXA dose.
˚ If vitals are within normal limits, are there S/S of labor? Refer to CHILDBIRTH
PROTOCOL
• Continue to monitor, reassess, and address changes in BP, seizures, glucose, vision changes,
and headaches.
Notes, Cautions, Warnings
• Use caution when using Magnesium—it can lead to cardiorespiratory collapse with
hypotension and decreased respiratory drive.
• Treat all hypertensive patients as if they are pre-eclamptic despite any prior history of
hypertension.
• The leading cause of postpartum hemorrhage is uterine atony (lack of contraction), which can
be treated with uterine massage.
• Seizure: can give Midazolam 0.1mg/kg IV every 15–30min or 1mg IV every 2–3min up to 5mg
while waiting for magnesium to take effect
• Seizure activity in an OB patient signifies eclampsia
• The best life support for the fetus is to resuscitate the mother

2026 Standard Medical Operating Guidelines (SMOG) • 67