Safe motherhood is one of the most cherished dreams of every woman and making this dream come true is the prime duty of all obstetric care providers[1-2]. Although the majority of childbirth-related difficulties can be effectively managed with time, there are a few that require immediate intervention and systematic quick therapy in order to have a successful outcome. These complications are considered obstetric emergencies[3]. These emergencies are encountered not only in perinatal period but also in early pregnancy, being equally fatal. Obstetrical emergencies are life threatening medical conditions that occur in pregnancy or during or after labour. Obstetrics emergencies occur suddenly & unexpectedly[4]. Although the majority of childbirth-related difficulties can be effectively managed with time, there are a few that require immediate intervention and systematic quick therapy in order to have a successful outcome. These complications are considered obstetric emergencies[5-6]. In the latter half of pregnancy, there can be haemorrhage due to placenta previa or accidental haemorrhage. During labour, women may present with severe anemia and may develop third stage haemorrhage & post-partum haemorrhage or other complications resulting in severe blood loss and sudden deterioration in general condition can occur[7].

The best treatment option is often determined by the mother's clinical status at the time of presentation. In Early pregnancy, if patients have signs and symptoms of tubal rupture, surgery must be performed immediately[6]. In case of inevitable, incomplete, septic abortion evacuating any retained products of conception, either with expectant (conservative) management or pharmacologic or surgical intervention[8]. In late pregnancy, in cases of abruptio placentae & placenta previa emergency cesarean section may become necessary at any time because further placental separation massive blood loss respectively, may cause fetal death hemodynamically unstable mother. In cases of placenta accreta spectrum, unfortunately most cases require a hysterectomy.

All cases admitted at Department of Obstetrics & Gynaecology Gandhi Medical College, Bhopal during study period after satisfying inclusion & exclusion criteria were included in the study. A cross-sectional study was conducted in patients with obstetrics emergencies. All women admitted to the obstetrics department irrespective of the nature or type of emergency. The participants for the present study were recruited from this pool of patients according to inclusion criteria described below.

Inclusion criteria:

All obstetric emergencies are admitted to the Department of Obstetrics & Gynaecology, Gandhi Medical College, Bhopal. Obstetric emergencies like:

1. a) Antepartum haemorrhage: Placenta previa with shock

Morbidly adherent placenta, Placenta accreta Placental abruption Ruptured ectopic pregnancy

1. b) Postpartum haemorrhage: Atonic PPH Traumatic PPH
2. c) DIC
3. d) HELLP
4. e) Invasive or vesicular mole with shock
5. f) Acute inversion of uterus

• Exclusion Criteria:

1. All obstetric non-emergency cases
2. Those who are not willing to give written informed consent

Table 1: Distribution of patients according to age group

The age distribution of the participants revealed that the majority were within the age group of 26-30 years, comprising 195 (44%) of the patients followed by aged 21-25 years, accounting for 135 (31%) followed by aged 31-35 years represented 66 (15%) followed by age range of 18-20 years constituted 24 (5.5%) followed by patients older than 35 years made up 20 (4.5%) of the cohort. This age distribution indicates a predominant antenatal care among younger women in their reproductive age.

Table 2: Distribution according to Booking Status

The booked status of the 440 obstetric patients indicated that the majority, 273 (62.04%), were unbooked patients, having received little to no antenatal care prior to their emergency. Conversely, 167 (37.9%) were booked patients, meaning they had received regular antenatal care. This data underscores the importance of regular antenatal care in managing and potentially mitigating obstetric emergencies.

Table 3: Distribution according to socioeconomic status (according to kuppuswamy scale)

This distribution indicates that most of the patients, 224(50.91%), belonged to the lower middle socioeconomic class, followed by 110(25%) in the lower class. A smaller percentage of patients were from the middle and upper middle socioeconomic classes. This data shows the of lack of knowledge, education & antenatal care in lower & lower middle class increasing obstetric emergencies burden.

Table 4: Distribution according to Management in 1^st trimester

In the first trimester, among the 63 cases, the majority of patients 42(66.66%) underwent laparotomy. Manual vacuum aspiration (MVA) was performed in 18(28.57%) of the cases, while conservative management was employed in 03 ( 0.047%) of the cases. Blood transfusion were done with surgical & conservative management.

Table 5: Distribution according to Management in 2^nd trimester

In the second trimester, among the 24 cases, 08 (33.33%) of patients underwent a hysterotomy. Spontaneous and induced expulsion, as well as suction and evacuation, were each performed in 06(25%) of the cases. Manual vacuum aspiration (MVA) was used in 02 (8.33%) of the cases, and laparotomy followed by resection of a ruptured rudimentary horn was also performed in 02(8.33%) of the cases.

Table 6: Distribution according to Management in 3^rd trimester

In the third trimester, among the 227 cases, 85(37.44%) of patients underwent a C-section followed by balloon tamponading. C-section alone was performed in 61(26.87%) of the cases. Both obstetric hysterectomy and vaginal delivery were performed in 22(9.69%) of cases each. Vaginal delivery followed by balloon tamponading was carried out in 20(8.81%) of the cases. Laparotomy followed by scar rupture repair and laparotomy followed by uterine repair were performed in 08(3.5%) and 06(2.64%) of cases, respectively. Uterine inversion repositioning was necessary in 03 (1.32%) of the cases.

Table 7: Distribution according to Management in postpartum period

In the postpartum period, among the 126 cases, most common management done was conservative management 50(39.68%) patients , these patients were of hypertensive disorder of pregnancy , severe anaemia with shock , HELLP , DIC, hepatic encephalopathy. Cervicovaginal Exploration f/b repair 38(30.15%) followed by Cervicovaginal exploration f/b repair f/b balloon tamponading 29(23.01%) were in patients of atonic & traumatic PPH followed by Manual removal of placenta were done in 08(6.34%) patients followed by laparotomy for rectus sheath hematoma was done in 01 (0.79%) patient.

Table 8: Maternal Outcome

The maternal outcomes for the 440 obstetric emergency patients that 322 (73.18%) of the patients survived , whereas 88(20%) patients had various morbidity, while 30 (6.8%) resulted in mortality. This outcome indicates that mortality rates can be reduced by timely intervention.

Table 9: Foetal Outcome

This data highlights the significant impact of obstetric emergencies on foetal outcomes, with a high rate of adverse outcomes such as IUFD 93(40.9%) and NICU admissions 77(33.9%).

In present study age of study participants ranged from 18 to >35 years. Majority of patients 195 (44%) with obstetric emergencies were in age group of 26-30 years followed by aged 21-25 years, accounting for 135 (31%) followed by aged 31-35 years represented 66 (15%) followed by age range of 18-20 years constituted 24 (5.5%) followed by patients older than 35 years made up 20 (4.5%) of the cohort , which was comparable to the results found in a study by Chawla S et al (2018), in India where majority of patients were in the age group of 21-30 years[9]. In present study , in obstetric emergencies most common obstetric intervention done in 1^st trimester were laparotomy 42(66.66%) in ectopic pregnancy followed by MVA 18 (28.57%) in incomplete & septic abortion with shock, followed by conservative management 03(0.047%) in patients of severe anemia with CCF whereas, in 2^nd trimester hysterotomy 08(33.33%) was the most commonly done in patients of abruptio placentae & placenta previa followed by spontaneous & induced expulsion as well as suction & evacuation were each performed in 06(25%) of the cases. Manual vacuum aspiration (MVA) was used in 02 (8.33%) of the cases, and laparotomy followed by resection of a ruptured rudimentary horn was also performed in 02(8.33%) of the cases[10-11].

In the third trimester, among the 227 cases, 85(37.44%) of patients underwent a C-section followed by balloon tamponading in cases of abruption, placenta previa, placenta accreta. C-section alone was performed in 61(26.87%) of the cases. Both obstetric hysterectomy and vaginal delivery were performed in 22(9.69%) of cases each. Vaginal delivery followed by balloon tamponading was carried out in 20(8.81%) of the cases. Laparotomy followed by scar rupture repair and laparotomy followed by uterine repair were performed in 08(3.5%) and 06(2.64%) of cases, respectively[12-13]. Uterine inversion repositioning was necessary in 03 (1.32%) of the cases.

In the postpartum period, among the 126 cases, most common management done was conservative management 50(39.68%) patients, these patients were of hypertensive disorder of pregnancy, severe anaemia with shock, HELLP, DIC, hepatic encephalopathy.  Cervicovaginal Exploration f/b repair 38(30.15%) followed by Cervicovaginal exploration f/b repair f/b balloon tamponading 29(23.01%) were in patients of atonic & traumatic PPH followed by Manual removal of placenta were done in 08(6.34%) patients followed by laparotomy for rectus sheath hematoma was done in 01 (0.79%) patient[14].

These obstetric emergencies were responsible for 30(6.8%) maternal death & 93(40.9%) perinatal death. In a study done by L M Adelaja et al.(2011) authors noted unbooked patients formed the bulk of the cases (60.3%). The most common emergencies were prolonged/obstructed labour, postpartum haemorrhage, fetal distress, severe pregnancy-induced hypertension/eclampsia, and antepartum haemorrhage[15]. Obstetric emergencies were responsible for 70.6% of the maternal mortality and 86% of the perinatal mortality within the period. Obstetric emergencies have a profound effect on mother and fetus resulting in high maternal/perinatal morbidity and mortality[16]. The management of one affects the management of the other. Peripartum haemorrhage and hypertensive emergencies are two of the leading causes of maternal mortality worldwide. Prevention/effective management of obstetric emergencies will help to reduce maternal and perinatal mortality in our environment.

Pregnancy although a physiological state, can turn pathological, suddenly and unexpectedly, if not cared for. Aggressive obstetric emergency management is the key to success. Most common obstetric intervention done in 1^st trimester were laparotomy (66.66%) in ectopic pregnancy.In 2^nd trimester hysterotomy (33.33%) was the most commonly done in patients of abruptio placentae & placenta previa.

Caesarean sections f/b balloon tamponading (19.77%) is the most common management procedure done in 3^rd trimester in patients abruptio placentae & placenta previa & placenta accreta spectrum. In postpartum period, most of the patients were managed conservatively (39.68%). Maternal survival rates are high, but foetal outcomes are concerning, with a significant number of IUFD’s (40.9%) and NICU admissions (33.9%). The third trimester is the most critical period for blood transfusions, with 33-36 weeks (51.54%) being the peak. Obstetric emergencies often necessitate rapid and efficient medical interventions, with blood transfusion being a critical component of such interventions. Despite advances in medical care, maternal mortality and morbidity due to hemorrhage and other complications remain significant challenges in obstetrics. Government should establish more blood banks and strengthen transport facilities to higher center or improving their effectiveness as availability of transfusion facility and blood products in obstetric care setting in peripheral health centers can reduce need for referral of patients and indirectly reduce the maternal morbidity and mortality.

1. Stallworthy J. Blood Transfusion in Obstetrics. Br Med J [Internet]. 1939 Jan 28 [cited 2024 Jul 6];1(4073):153–5. Available from: https://www.bmj.com/content/1/4073/153
2. Leo Zimmerman BM, Howell KM. Annals of Medical History: History of Blood Transfusion. 1932;(1673).
3. Gopalani S, Benedetti TJ. Chapter 15 - Complicated Deliveries: Overview. In: Taeusch HW, Ballard RA, Gleason CABTAD of the N (Eighth E, editors. Philadelphia: W.B. Saunders; 2005. p. 146–58. Available from: https://www.sciencedirect.com/science/article/pii/ B9780721693477500172
4. Prior CH, Burlinson CEG, Chau A. Emergencies in obstetric anaesthesia: a narrative review. Anaesthesia [Internet]. 2022 Dec 1;77(12):1416–29. Available from: https://doi.org/10.1111/anae.15839
5. Hepner D, Kodali BS, Segal S. CHAPTER 19 - Pregnancy and Complications of Pregnancy. In: Fleisher LABTA and UD (Fifth E, editor. Philadelphia: W.B. Saunders; 2006. p. 547–81. Available from: https://www.sciencedirect.com/science/article/pii/B978141602212150022 6
6. Wang PH, Chao HT, Tseng JY, Yang TS, Chang SP, Yuan CC, et al. Laparoscopic surgery for heterotopic pregnancies: a case report and a brief review. Eur J Obstet Gynecol Reprod Biol. 1998 Oct 1;80(2):267–71.
7. Hepner D, Kodali BS, Segal S. Pregnancy and Complications of Pregnancy. Anesth Uncommon Dis. 2006 Jan 1;547–81.
8. Pedigo R. First trimester pregnancy emergencies: recognition and management. Emerg Med Pract. 2019 Jan;21(1):1–20.
9. Vasava DC, Thaker V, A T. Analysis of transfusion of blood and blood products and their utilization pattern at department of obstetrics of tertiary care hospital. 2019;9(1):261–5.
10. Waters JH, Bonnet MP. When and how should I transfuse during obstetric hemorrhage? Int J Obstet Anesth [Internet]. 2021;46:102973. Available from: https://www.sciencedirect.com/science/article/pii/S0959289X21000315
11. Pavord S, Daru J, Prasannan N, Robinson S, Stanworth S, Girling J. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2020 Mar 1;188(6):819–30.
12. Patterson JA, Roberts CL, Bowen JR, Irving DO, Isbister JP, Morris JM, et al. Blood Transfusion During Pregnancy, Birth, and the Postnatal Period. Obstet Gynecol [Internet]. 2014;123(1). Available from: https://journals.lww.com/greenjournal/fulltext/2014/01000/blood_transfus ion_during_pregnancy,_birth,_and_the.18.aspx
13. Ekeroma AJ, Ansari A, Stirrat GM. Blood transfusion in obstetrics and gynaecology. BJOG An Int J Obstet Gynaecol [Internet]. 1997 Mar 1;104(3):278–84. Available from: https://doi.org/10.1111/j.1471-0528.1997.tb11454.x
14. Gulucu S, Uzun KE. Evaluation of blood transfusion rate in obstetric patients. Ginekol Pol. 2022;93(8):637–42.
15. Mustafa Adelaja L, Olufemi Taiwo O. Maternal and fetal outcome of obstetric emergencies in a tertiary health institution in South-Western Nigeria. ISRN Obstet Gynecol. 2011;2011:160932.
16. Gupta VK, Kaur P, Singh G, Bansal P, Sidhu BS. Comprehensive evaluation of Drug De-Addiction Centres (DDCs) in Punjab (Northern India). J Clin Diagnostic Res. 2014;8(3):52–5.