Introduction

Obstetric emergencies can be unpredictable and sudden, and may result in significant morbidity and mortality. Successful manage­ment requires a rapid coordinated response from multiprofessional maternity teams.

In the recent Confidential Enquiry into Maternal Deaths in the United Kingdom, substandard care was identified in over 50% of cases and one-third of these could have been prevented with better care (1). Recurring problems were identified, including a lack of multiprofessional team working, poor communication, and late rec­ognition of the severely unwell woman.

Multiprofessional training for obstetric emergencies has been demonstrated to reduce intrapartum harm and improve maternal and neonatal outcomes (2, 3). Official organizations have recom­mended multiprofessional training for many years. Most recently, Better Births (4), by the National Maternity Review, recommends multiprofessional training as a standard part of continued profes­sional development: ‘Those who work together should train to­gether... Maternity services are multi-professional; teams should learn and train together, breaking down barriers between midwives, obstetricians and other professionals to deliver safe and personal­ized care for women and their babies.’

This chapter focuses on the immediate management of obstetric emergencies and is largely derived from the authors’ work with the PROMPT Maternity Foundation (5) and the contents of the PROMPT (PRactical Obstetric Multi-Professional Training) course manual that is published by Cambridge University Press (6) (https:// www.youtube.com/channel/UCh8PZGugxqDKBUcpTrulAfw).

There are a number of key components for the effective manage­ment of all emergencies:

• Early recognition of an obstetric emergency or an unwell woman.

• Call for help.

• State the problem clearly.

• Multiprofessional team working.

• Early senior involvement.

• Closed-loop communication: clear, addressed to specific individ­uals, delivered calmly, acted upon and acknowledged (7).

• A structured approach to managing emergencies, using simple tools that make it easy for teams to provide the correct care.

Additionally, simple tools can help facilitate best practice (3):

• Modified Obstetric Early Warning Score (MOEWS) charts aid identification of the unwell woman. Trends in observations are clear to see and abnormal observations are highlighted in amber or red, necessitating prompt referral.

• Treatment algorithms containing the key investigations and man­agement of emergencies using a structured, step-by- step approach.

• Many maternity units have emergency boxes containing algo­rithms, medications, and equipment for the immediate manage­ment of emergencies such as pre-eclampsia and haemorrhage to enable prompt, effective management. All maternity staff need to be aware of the location of their emergency boxes, so that one of the team members can collect it promptly.

• Clear documentation of timings, actions, and outcomes is es­sential. The use of a standardized pro forma may improve documentation.

• SBAR (Situation, Background, Assessment, and Recommendation) sheets can be used at handover, to aid the transfer of information.

Obstetric emergencies can be very traumatic for women and their families. During the emergency, it is important to communicate with them and explain what is happening. Interestingly, women want al­most the same information as staff, namely the problem, reassurance about their baby and themselves, followed by an explanation of the management required. Furthermore, there are some data suggesting that providing information (careful commentary) during traumatic situations may reduce post-traumatic stress (8).

After the event, full debriefing and support should be offered. Staff members can also be emotionally affected and a formal debrief ses­sion may be helpful.