[Emergencies in obstetrics]

The survey on emergencies in Obstetrics is addressed here to practitioners and advanced medical students. The specialized gynecologist will, however, find some case reports interspersed illustrating what he/she has already experienced sometimes. The paper should be a refreshment for them. Acute abdominal pain in pregnancy challenges the diagnostic skills of the physician first contacted. Is it, what causes the pain, appendicitis as is frequently in nonpregnant young women, or gall-bladder disease as in the elderly obese, or even dangerous intestinal obstruction, or is the pain deriving from a twisted pedicle of an occult ovarian cyst or is it simple gastrointestinal discomfort? Putting into account the differing frequency of incidences of disease does not always help. Emergency may arise from the rarest event. With increasing traffic on our streets blunt trauma occurs and it might hurt pregnant women as well as their fetus. Even seat-belts can cause damages, if pelvic belts are used instead of shoulder belts. Traumata from accidents are often associated to immediate shock. Shock in pregnancy poses different questions according to the physiology of the progressing pregnancy. There is a variety of shock etiologies. Bleeding from the vagina is the most common complaint. Those can be harmless or they can be the first and leading sign of imminent danger to the fetus and the mother. Diagnosis does not allow any delay. One of the most striking complications in late pregnancy is described by the acronym "HELLP"-syndrome [hemolysis, elevated liver enzymes, low platelets]. This syndrome is a critical complication of preeclampsia. One third of the cases occur after delivery. It has not yet been clearly decided whether active management including immediate delivery by cesarean section in disregard of the maturity of the child, or the conservative approach with intensive care, drastic antihypertensive medication and additional serial plasmapheresis might prove to be more efficient in terms of live-saving for mother and child. The mortality of mothers suffering from HELLP remains to be high, the perinatal mortality is even higher. Post partum hemorrhage is due to the lack of contractibility of the uterus after overdistension, protracted labour, malpositions, mere inertia etc., from lacerations, or from placental retention. It is always an emergency with hemorrhagic shock impending. The risk situation around even normal birth is well known. Emergencies will appear every time unannounced. There are post partum risks as well; they should not be underestimated when home-delivery is desired.