This chapter describes the types, key implications and management strategies of massive obstetric haemorrhage. Antepartum haemorrhage due to placental abruption and intrapartum haemorrhage due to uterine rupture are associated with increased perinatal mortality. Visible blood loss greater than 2 litres, ongoing bleeding are some key pointers of massive obstetric haemorrhage. Immediate management involves active resuscitation to ensure a patient airway, breathing and maintaining circulation with intravenous fluids, blood and blood products as well as correction of coagulopathy. In women who are not acutely compromised or bleeding severely, interventional radiology can be considered. If the bleeding is predominantly from the lower segment, a total abdominal hysterectomy is warranted. Women with massive obstetric haemorrhage often need multi-organ support. Hence, transfer to an intensive care unit or high dependency unit should be considered for monitoring. Thromboprophylaxis should be considered once the coagulation parameters return to normal.

This chapter discusses the pathophysiology, key implications, diagnostic signs and management of severe preeclampsia and eclampsia in an obstetric setting. Preeclampsia may affect multiple organ systems. Blood pressure greater than or equal to160/110 mmHg, severe headache with visual disturbance, epigastric pain, clonus and papilloedema are some of the diagnostic signs of severe preeclampsia. Patients should be managed in a high-dependency obstetric care setting with one-to-one experienced midwifery care. Hourly measurement and documentation of maternal observations like (blood pressure, pulse, respiratory rate, oxygen saturation, temperature, urine output, and neurological status) should be done. Magnesium sulphate should be commenced at diagnosis of severe preeclampsia/eclampsia; continuing until 24 hours following delivery/last seizure/commencement of magnesium sulphate therapy, whichever is the later. Antihypersensitives should be administered, and fluid management should be considered. Postpartum haemorrhage should be anticipated and managed efficiently. Regular 'skills drills' should be conducted on management of severe preeclampsia/eclampsia.