Chart — Maternal-Newborn
Obstetric Emergency Recognition
Four labor emergencies, each with a hallmark cue and a first action. The discriminator that saves seconds: match the cue to the one action that buys time.
Educational use only. Obstetric emergencies are provider-directed and time-critical. This chart is an educational quick-reference for recognition, not a delivery protocol. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Recognition & First Action
| Emergency | Hallmark cue | First nursing action | Key risk |
|---|---|---|---|
| Umbilical cord prolapse | Sudden fetal bradycardia / severe variable decels right after ROM; cord visible or palpable | Gloved hand lifts presenting part off the cord; knee-chest or Trendelenburg; O₂; call for emergent cesarean | Fetal hypoxia from cord compression |
| Shoulder dystocia | Head delivers then retracts ("turtle sign"); anterior shoulder stuck | McRoberts maneuver + SUPRAPUBIC pressure (never fundal) | Brachial plexus injury, clavicle fracture, hypoxia |
| Uterine rupture | Sudden severe "tearing" abdominal pain, loss of fetal station, contractions stop, FHR drops | Stop oxytocin; emergent cesarean; treat hemorrhage/shock | Maternal hemorrhage + fetal demise (prior cesarean scar) |
| Amniotic fluid embolism | Abrupt collapse — dyspnea, hypoxia, hypotension — then DIC/bleeding | Call a code: O₂/intubation, CPR, circulatory support, blood products for DIC | Cardiorespiratory collapse; high mortality |
Exam Traps
- ✦Cord prolapse first action = RELIEVE cord pressure (lift the presenting part + knee-chest/Trendelenburg) — never push the cord back in.
- ✦Shoulder dystocia = SUPRAPUBIC pressure, never fundal (fundal pressure worsens the impaction).
- ✦Uterine rupture red flags: 'tearing' pain, loss of fetal station, contractions stop — highest risk with a prior cesarean scar; stop the oxytocin.
- ✦Amniotic fluid embolism = sudden collapse then DIC; it's a maternal resuscitation, not a delivery-position problem.
- ✦New severe variable decels or bradycardia right after the membranes rupture → do a vaginal exam to rule out cord prolapse.
Related Resources
Standards & sources
This page is written to align with American College of Obstetricians and Gynecologists (ACOG) · AWHONN · American Academy of Pediatrics (AAP) — newborn. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →