Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Emergencies in pregnancy. As pregnancy completely changes the
physiology of a woman's body (as we discussed in the first
article in this series), one of the changes that can happen
is the processing of sugars. Hormones from the placenta can
induce a diabetes during pregnancy. This condition is
routinely monitored by the obstetrician and is treated like
regular diabetes except for two important differences. The
first is that the feared complication of diabetic acidosis is
rare in pregnancy. Also the condition completely disappears
after birth. The dangers are macrosomia, a very large baby,
which can lead to complications in birth.
Another routine screen in pregnancy is for strep, a common
microorganism that can play havoc with a newborn who has an
immature immune system, A simple culture can prevent tragedy.
This, again, is another reason why prenatal care is so
important. Herpes is a virus that also can be acquired from
the mother during birth that can cause death and disability
to a newborn. Rashes and bumps on a newborn must be watched
carefully, as this virus can cause damage rapidly.
The birth process is complicated and many things can go
wrong. Arrest of labor is usually managed by medications to
continue the process, but if the baby's heartbeat shows that
it is affected by the birth process, an emergency C-section
may need to be done. This is why late stages of pregnancy
involve monitoring of both heartbeats -- that contraption
they tie around you that looks like a big seatbelt. Births
that require forceps and vacuum deliveries are wrought with
trouble. If there is no choice, OK -- but check beforehand
how often they do these when you choose a hospital.
Breech births in these days of ultrasound should never be a
surprise, and this is a complicated delivery. Most of these
either are rotated many days before birth or go to C-section.
Shoulder dystocia, where the shoulder gets stuck, involves
techniques that rotate the baby. But one must act fast. A
stuck baby is a setup for disaster. A cord that presents
first is also an emergency, but cords that wrap around the
baby's neck are less of a problem if they are loose. We
simply remove them. What should be clear is that you want an
experienced person delivering your baby. Furthermore,
prenatal care is essential.
Last: emergency births are terrible. Do not take chances on
giving birth in a taxi. Better to be sent home because it is
too early than to get there too late. While labor generally
gets shorter in mothers with more children, you never know.
Write me in care of the Yated.
A message from Glaxo, sponsor of this column. Imitrex,
the oldest antimigraine drug, has now accumulated enough
evidence that it may be safe to take in pregnancy. The
decision still must be made by the FDA, but the evidence is
in. If you have no heart disease then Imitrex is the drug for
your migraines. Available now in quick-acting nasal spray as
well.
