Ọbara Ọbara nke atọ nke atọ, Mwepụ Plasenta, na Mwepụta Umbilical Cord¶

Ọbara ikpu, mgbu afọ na mberede na-aga n'ihu na mberede, ọsọ nke mmiri ọmụmụ na-esochi eriri eriri afọ, ma ọ bụ isi ọwụwa na-egbuke egbuke mgbe izu iri abụọ nke ime ime (na n'ime ọnwa atọ nke atọ, site na izu 28 ruo n'afọ) bụ oge mberede mberede obstetric nke na-eyi ndụ ma nne na nwa ebu n'afọ egwu n'ime nkeji. N'adịghị ka mgbakasị afọ ime n'oge ma ọ bụ mgbatị ọrụ nke ọkwa mbụ nke na-abịa ma na-aga na oge ezumike na-enweghị mgbu, ọgba aghara nke atọ nke atọ dịka ** placental abruption **, ** placenta previa **, ** vasa previa ***, ** mgbawa uterine *, ** umbilical cord prolapse, na *eclampsia nwere ike ime ka agụụ na-agwụ ngwa ngwa tupu nwa ebu n'afọ. akara apụta na-ele anya siri ike.

Ọrụ gị ozugbo n'oge ihe mberede ime ime ọ bụla bụ ịkpọ ụgbọ njem ahụike obstetric dị elu, ** emela nyocha ọ bụla ma ọ bụ tinye mkpịsị aka ma ọ bụ tampons n'ime ikpu**, dobe nne n'akụkụ ya ** akụkụ aka ekpe** (iji bulie akpanwa dị ime dị arọ pụọ n'ọbara nkwụghachi azụ nke afọ ya) ma ọ bụ n'ime ** ikpere-obi n'obi akwadoro (ọ bụrụ na ọ naghị adị ọkụ n'ọnụ ya) , ọ bụrụ na ọ na-ekpo ọkụ n'ọnụ ya). maka nnyefe cesarean mberede, ma soro mfu ọbara na oke iku ume nke nne na iku ume ruo mgbe ndị ọrụ ahụike weghaara.

Mee nke a ugbu a¶

1. Kpọọ ndị ọrụ ahụike mberede ozugbo: Kpọọ nọmba mberede mpaghara gị (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, 000 na Australia) ma ọ bụ lelee akwụkwọ ndekọ aha anyị. nọmba mberede. Kwuo kpọmkwem izu nne nke afọ ime wee kwuo ma enwere ọbara ọgbụgba nke ikpu, mgbu afọ mgbe niile, eriri eriri ahụ a na-ahụ anya, ma ọ bụ njide.
2. Ọ bụrụ na ị na-ahụ ma ọ bụ na-ahụ eriri afọ n'oghere ikpu, were ọnọdụ ikpere ikpere ozugbo: Ọ bụrụ na mmiri ahụ agbajie na ụdọ dị ka eriri afọ a na-ahụ anya n'èzí vulva ma ọ bụ nwee mmetụta na-akụ na oghere, mee ka nne ya gbuo ikpere n'ala n'aka na ikpere ya madobe obi ya na ihu ya gbadaa n'ala ma ọ bụ ihe ndina na-eji úkwù na ikuku elu ya elu.** Ike ndọda na-adọpụ isi nwa ahụ azụ azụ site na pelvis ka ọ kwụsị ịzọpịa eriri ikuku oxygen nke nwa ahụ n'onwe ya.
3. ** Maka ọbara ọgbụgba ma ọ bụ ihe mgbu ọ bụla ọzọ nke ọnwa atọ, tụgharịa nne n'akụkụ aka ekpe ya:** Mee ka nne dina ala n'akụkụ aka ekpe ya ** (ma ọ bụ kwado ohiri isi siri ike ma ọ bụ akwa akwa akwa 15 ruo 30 n'okpuru úkwù aka nri ya ma ọ bụrụ na ọ ga-edina n'azụ ya). Ekwela ka nwanyị nọ n'ọgwụgwụ ọnwa nke abụọ ma ọ bụ nke atọ dina ala n'azụ ya, n'ihi na ịdị arọ nke afọ dị ime na-etipịa vena cava nke dị ala ma na-ebelata ọbara eruba na placenta na obi nne site na pasent 30.
4. Agbanyela mkpịsị aka, tampons, ma ọ bụ akwa n'ime ikpu: Ọ bụrụ na ọbara ọgbụgba na-adị, tinye akwa nhicha dị ọcha ma ọ bụ akwa akwa akwa akwa nke ọma n'akụkụ ** n'èzí* nke vulva ma chekwaa paịlị ma ọ bụ akwa nhicha ọbara niile n'ime akpa rọba ka ndị ọrụ ụlọ ọgwụ nwee ike tụọ ha iji tụọ ọbara ọbara. Otu mkpịsị aka etinyere n'ime ikpu nwanyị nwere placenta previa nwere ike igbapu placenta wee kpalite ọbara ọgbụgba n'ime sekọnd.
5. ** Tinye iwu NPO siri ike (ọ dịghị ihe n'ọnụ):** enyela nne ya mmiri, ihe ọṅụṅụ, nri, ma ọ bụ ọgwụ ọnụ. Ọtụtụ ihe mberede hemorrhagic nke ọnwa atọ nke atọ chọrọ ngalaba cesarean mberede ngwa ngwa n'okpuru nkụnwụ izugbe mgbe ha rutere n'ụlọ ọgwụ.
6. ** Chebe nne n'oge ọdịdọ eclampsia ma lelee anya maka ịma jijiji:** Ọ bụrụ na nne na-enwe njide n'ozuzu ya (eclampsia), kwụchie isi ya, tụgharịa ya n'akụkụ aka ekpe ya, wepụkwa arịa ụlọ. Debe ya ọkụ na akọrọ blanketị ma jikere ịrụ CPR nne gbadara aka ekpe ọ bụrụ na ọ naghị anabata ya ma kwụsị iku ume.

flowchart TD
    Start["Mberede ime ime n'ikpeazụ (karịa izu ime ime afọ 20): Ọbara, oke mgbu, nrịanrịa nke mmiri mmiri, ma ọ bụ ọdịdọ."] --> Call["1. Kpọọ Ọrụ Mberede (911 / 112 / 999) na steeti ahụ kpọmkwem izu ime ime"]
    Call --> CheckCord{"2. Mmiri ọ na-agbaji eriri eriri afọ ka a na-ahụ anya ma ọ bụ nwee mmetụta na mmeghe nke ikpu?"}
    CheckCord -->|Yes: Umbilical Cord Prolapse| KneeChest["Debe nne n'ọnọdụ ikpere ikpere (Ihu/Chest Down, Buttocks High in Air), Jiri akwa mmiri na-ekpo ọkụ kpuchie eriri, anaghị agbanye eriri azụ azụ."]
    CheckCord -->|No Cord Visible| CheckSeizure{"3. Nne na-enwe ihe ọdịdọ ma ọ bụ nnukwu isi ọwụwa / ọhụhụ (Eclampsia)?"}
    CheckSeizure -->|Yes: Eclampsia| LeftSideSeizure["Nyefee n'akụkụ aka ekpe, isi nkuku, ụlọ dị ọcha, etinyela ihe ọ bụla n'ọnụ, debe NPO"]
    CheckSeizure -->|No Seizure: Bleeding or Severe Belly Pain| LeftTilt["Nyefee Nne N'akụkụ akaekpe (Tilt n'akụkụ akaekpe) iji weghachi mkpakọ Vena Cava"]
    LeftTilt --> BleedRule["4. Emela ule ikpu ma ọ bụ tinye tampons; Debe mpe mpe akwa dị ọcha na mpụga naanị wee chekwaa paịlị etinyere"]
    KneeChest --> NPO["5. Debe Nne na-ekpo ọkụ na akwa akwa na NPO siri ike (Ọ dịghị Mmiri ma ọ bụ nri) maka Ngalaba C- Mberede"]
    LeftSideSeizure --> NPO
    BleedRule --> NPO

Ịmata ọdịiche dị n'ihe anọ na-akpata ọbara ọgbụgba n'ime ọnwa atọ (Antepartum hemorrhage)¶

Ndị ọkachamara n'ihe gbasara obstetric na-akọwa hemorrhage antepartum (APH) dị ka ọbara ọgbụgba ọ bụla sitere na tract genital mgbe izu iri abụọ nke ime ime (ma ọ bụ izu 24 na United Kingdom) na tupu a mụọ nwa. Ọ bụ ezie na obere eriri nke pink ma ọ bụ agba aja aja ("ihe ngosi ọbara") ka cervix na-adị nro n'oge adịghị njọ, ọbara ọgbụgba ọ bụla dị ka oge ịhụ nsọ, nwere mkpụkọ, ma ọ bụ ihe mgbu na-esonyere ya chọrọ ọdịiche ozugbo n'etiti ọnọdụ anọ na-eyi ndụ egwu.

Concealed placental abruption and trauma in pregnancy (Car crashes and falls)¶

One of the most dangerous traps in obstetric first aid is concealed placental abruption, which accounts for 20 percent of all abruptions. When the center of the placenta tears away from the uterine wall while the outer edges of the placenta remain glued down, 1.5 to 2.5 liters (3 to 5 pints) of maternal blood can pour into the space behind the placenta (retroplacental hematoma) without a single drop of blood escaping through the cervix.

Why every minor fall or car crash in pregnancy requires immediate hospital monitoring¶

During the third trimester, the muscular uterus is elastic and stretches when jolted, whereas the placenta is spongy and inelastic. When a pregnant woman is involved in even a low-speed motor vehicle collision (where the lap belt or steering wheel compresses her belly), slips on stairs and lands on her buttocks or side, or suffers a blow to the abdomen, the shear force between the elastic uterine wall and the inelastic placenta can peel the placenta loose.

• Delayed abruption after trauma: Placental abruption after a car crash or fall can occur immediately or evolve over 4 to 24 hours after the impact.
• Seatbelt positioning rule: Pregnant women should always wear a three-point seatbelt, with the lap belt positioned low and flat across the hip bones and pelvic brim completely underneath the curve of the pregnant belly (never across the dome of the belly) and the shoulder strap routed snugly between the breasts and to the side of the belly.
• Mandatory fetal monitoring: The American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) mandate that every pregnant woman beyond 20 weeks who experiences any abdominal trauma, car crash, or fall must undergo at least 4 to 24 hours of continuous electronic fetal heart rate and uterine contraction monitoring in a hospital, even if she feels fine and has zero vaginal bleeding.
• Rh-negative blood type sensitization ( Fetomaternal hemorrhage): If the mother has an Rh-negative blood type (A-negative, B-negative, AB-negative, or O-negative), even a tiny microscopic bleed between the placenta and uterus during trauma or abruption mixes fetal Rh-positive blood into her circulation, requiring an injection of anti-D immunoglobulin (RhoGAM) within 72 hours at the hospital to protect the fetus and future pregnancies.

Maternal physiological camouflage: why pregnant women look stable until they crash¶

During pregnancy, a woman's total blood volume expands by 40 to 50 percent (adding 1.5 to 2.0 liters of extra blood), and her resting heart rate increases by 10 to 15 beats per minute. Because of this massive physiological reserve, when a pregnant woman bleeds internally or externally from placental abruption or uterine rupture, her body automatically shunts blood away from the pregnant uterus and placenta to keep her own brain and heart perfused.

As a result, the baby goes into severe, life-threatening distress long before the mother's blood pressure drops. A pregnant woman can lose 30 to 35 percent of her total blood volume (1,500 to 2,000 milliliters) while her blood pressure still looks normal; once her blood pressure finally drops and she becomes cold, clammy, and confused, she is already in decompensated Class III or IV hemorrhagic shock and at extreme risk of disseminated intravascular coagulation (DIC) (where tissue thromboplastin released from the torn placenta consumes all her clotting factors, causing uncontrollable bleeding from every surface).

Umbilical cord prolapse: immediate gravity decompression maneuvers¶

Umbilical cord prolapse occurs in roughly 1 in 300 to 500 births when the amniotic sac ruptures (water breaks) and a loop of the umbilical cord washes out through the cervix ahead of or alongside the baby's presenting part (head, shoulders, or breech). It is most common when the baby has not yet dropped deeply into the pelvis at the moment the water breaks, such as in breech presentations, transverse (sideways) lies, premature births, twins, or polyhydramnios (excess amniotic fluid that gushes out forcefully like a firehose).

Why cord prolapse kills the baby within 5 to 10 minutes unless you act¶

Once the amniotic fluid drains out, gravity and uterine contractions drive the baby's hard skull or buttocks downward directly against the bones of the mother's pelvis, crushing the soft umbilical cord like stepping on a garden hose. In addition, when the wet umbilical cord emerges out of the warm 37.5-degree-Celsius (99.5-degree-Fahrenheit) vagina into cool 20-degree-Celsius (68-degree-Fahrenheit) room air, or if someone handles and squeezes the cord, the muscular walls of the two umbilical arteries and single umbilical vein go into violent vasospasm, clamping shut completely.

Step-by-step first aid for umbilical cord prolapse¶

1. Call 911 / 112 / 999 on speakerphone immediately and announce: "Obstetric emergency: umbilical cord prolapse." Paramedics will notify the receiving hospital to hold an operating room open for a "crash" cesarean section.
2. Immediately put the mother into the Knee-Chest Position (First choice at home):
3. Have the mother kneel on a bed or padded floor on her hands and knees.
4. Have her lower her head, shoulders, and upper chest flat down onto the mattress or floor while keeping her knees tucked under her hips so her buttocks point as high into the air as possible.
5. Why it works: Tilting the mother's torso steeply downward uses gravity to slide the baby's body and head out of the pelvic bowl toward her diaphragm, immediately taking the crushing weight off the umbilical cord.
6. Alternative Exaggerated Sims / Trendelenburg Position (If the mother is exhausted or inside an ambulance):
7. If the mother cannot hold the knee-chest posture for 15 to 20 minutes, roll her onto her left side with her upper (right) knee drawn up toward her chest, and wedge three or four thick firm pillows or folded blankets underneath her hips and buttocks to elevate her pelvis 30 to 45 centimeters (12 to 18 inches) higher than her shoulders and head.
8. Protect an externally exposed cord without squeezing it:
9. Never try to push or stuff the prolapsed umbilical cord back inside the vagina. Pushing on the cord kinks the vessels and triggers severe vasospasm, ruining the baby's remaining blood flow.
10. If a loop of the cord is hanging outside the vulva, soak a clean, soft cotton washcloth or sterile gauze pad in warm clean tap water or sterile saline (body temperature, never hot and never cold) and drape it loosely over the exposed cord to keep it warm and moist while preventing room air from chilling the vessels.
11. Trained responder internal elevation (Only if instructed by emergency medical dispatch): If the baby's head is still pressing hard on the cord despite the knee-chest position and a trained clinician, midwife, or paramedic is present (or emergency medical control explicitly instructs a caregiver during a prolonged rural transport), the responder puts on sterile gloves, inserts two fingers into the vagina against the hard bony skull of the baby (carefully avoiding touching or squeezing the cord itself), and pushes the baby's head steadily upward away from the cord, holding that gentle upward pressure continuously all the way into the operating room until the surgeon lifts the baby out via C-section.

Supine hypotensive syndrome (Aortocaval compression) and the left lateral tilt¶

Throughout the late second and third trimesters (from 20 weeks onward), the combined weight of the fetus, placenta, amniotic fluid, and enlarged uterus reaches 6 to 10 kilograms (13 to 22 pounds).

When a woman in late pregnancy lies flat on her back (supine) on a bed, floor, or ambulance stretcher, the heavy uterus sinks straight backward onto her spine and crushes two major blood vessels running along the right side of the lumbar vertebrae:

1. The Inferior Vena Cava: The large, thin-walled vein returning all deoxygenated blood from the legs and pelvis back to the right side of the mother's heart.
2. The Abdominal Aorta: The main artery carrying oxygenated blood down to the uterine arteries and placenta.

Within 2 to 5 minutes of lying flat on her back, venous return to the mother's heart drops by 25 to 30 percent. The mother suddenly feels nauseated, sweaty, dizzy, short of breath, and pale, her blood pressure plummets, and blood flow to the baby's placenta drops precipitously (supine hypotensive syndrome).

Otu esi edobe onye ọrịa ọ bụla dị ime gafere izu iri abụọ¶

• Onye ọrịa nwere uche (ọnọdụ mgbake / aka ekpe): Nyefee nne n'ụzọ zuru oke na ya ** akụkụ aka ekpe** (n'ihi na vena cava dị ala na-agba ọsọ n'akụkụ aka nri ** nke spain, na-atụgharị n'akụkụ aka ekpe na-atụgharị afọ dị arọ kpamkpam na vein). Tinye ohiri isi n'etiti ikpere ya gbadara agbagọ na nke ọzọ n'okpuru afọ ya maka nkasi obi.
• ** mmerụ ahụ azụ ma ọ bụ enweghị ike imegharị ya:** Ọ bụrụ na nne ya daa n'elu ma ọ bụ nọrọ n'ihe mberede ụgbọ ala ebe a mmerụ ahụ azụ a na-enyo enyo na a ga-edobe ya larịị n'ahịrị, akwa akwa akwa akwa, blanketị, ma ọ bụ ohiri isi n'okpuru ** akụkụ aka nri nke pelvis ya na azụ azụ ** (ma ọ bụ tigharịa bọọdụ spinal dum) na akụkụ nke ** 15 ruo 30 degrees n'aka ekpe **.
• ** Ejideghi obi / obi amaghi ama n'ime ime (ntughari uterine nke aka ekpe):** Ọ bụrụ na nwanyị dị ime pụtara ìhè daa n'ime njide obi wee chọọ ya. CPR, ịtọgbọ ya gbadaa n'elu ohiri isi na-eme ka mgbaka obi ghara ịdị ike ma ghara ịdị irè. Kama, debe ya ** azụ agbada n'ala siri ike *** maka mkpakọ obi siri ike (etiti ọkpụkpụ ara, 100 ruo 120 kwa nkeji, 5 ruo 6 cm / 2 na 2.4 sentimita miri emi), ebe ** onye nnapụta nke abụọ na-egbu ikpere n'akụkụ ya, na-etinye aka abụọ n'akụkụ aka nri nke afọ ime ya, na-adọta (ma ọ bụ na-esi n'akụkụ aka nri 4.5 . sentimita asatọ) n'akụkụ akụkụ aka ekpe ya na-aga n'ihu** n'oge ntughari (** ntughari uterine aka ekpe nke aka ekpe**).

Preeclampsia siri ike, ọrịa HELLP, na ọdịdọ eclampsia¶

Ọ bụghị ihe mberede niile nke ọnwa atọ na-agụnye ọbara ọgbụgba nke ikpu. Preeclampsia bụ nsogbu ime ime ọtụtụ sistemu nke eji amata mbelata nke arịa ọbara nke nne na ọbara mgbali elu (140/90 mmHg ma ọ bụ karịa, ma ọ bụ 160/110 mmHg ma ọ bụ karịa na preeclampsia siri ike) nke na-eme mgbe izu iri abụọ gachara afọ ime, yana ruo izu isii mgbe amuchara nwa.

Mgbe preeclampsia a na-agwọghị ya na-aga n'ihu na HELLP syndrome (H emolysis nke mkpụrụ ndụ ọbara uhie, E levated Liver enzymes, na Low Platelets) ma ọ bụ *eclampsia (nnukwu ihe ọdịdọ tonic-clonic zuru oke n'ime nwanyị dị ime ma ọ bụ nwanyị ime nwa na nso nso a), imeju hemorrupl mgbapu, na ọnwụ nwa ebu n'afọ nwere ike ime ngwa ngwa.

Ọkọlọtọ uhie nke preeclampsia siri ike na eclampsia na-abịa (Kpọọ 911/112/999 ozugbo)¶

Never dismiss these symptoms in the second half of pregnancy or the first 6 weeks after birth as "normal pregnancy aches" or indigestion:

• 1. Unrelenting, pounding headache: A severe frontal or throbbing headache that does not go away within 30 to 60 minutes of resting in a dark room or taking standard pregnancy-safe acetaminophen.
• 2. Visual disturbances (Brain occipital lobe swelling): Seeing flashing lights (photopsia), sparkling spots (scotomata), wavy lines, blurry vision, double vision, or sudden partial blindness.
• 3. Severe right upper quadrant or epigastric pain ("The HELLP Pain"): Sharp, tight, squeezing, or burning pain directly underneath the breastbone or under the right rib cage (often mistaken for severe heartburn, gallbladder pain, or stomach flu). This pain is caused by the mother's liver swelling and bleeding underneath its tight outer Glisson capsule, a precursor to fatal hepatic rupture. Never massage or press hard on the upper right abdomen of a pregnant woman with this pain.
• 4. Rapid, sudden swelling (Edema) of the face, eyelids, and hands: While mild ankle swelling at the end of the day is common in pregnancy, waking up with eyes swollen nearly shut, a puffy face, or fingers so swollen rings must be cut off signals severe capillary leak.
• 5. Mkpirisi iku ume na izu ike ma ọ bụ ụkwara sputum pink na-asọ oyi: Na-egosi na mmiri na-abanye n'ime akpa ume nne (** pulmonary edema**).
• 6. Hyperreflexia and clonus: Twitching muscles or jumpy ankles just before an eclamptic seizure strikes.

Enyemaka mbụ ozugbo maka ọdịdọ elamptic¶

1. Call emergency services immediately and report "Pregnant woman at [X] weeks having an eclamptic seizure, needs intravenous magnesium sulfate."
2. Prevent falls and roll onto the left side: Ease the mother to the floor, move hard furniture away, place a folded jacket or pillow under her head, and keep her rolled onto her left side so saliva, blood (from a bitten tongue), or vomit drains out of her mouth while keeping the uterus off her vena cava.
3. Never put anything in her mouth and never hold her down: Do not try to force a spoon, wallet, or fingers between her teeth.
4. Stay vigilant after the jerking stops: Most eclamptic seizures last 60 to 90 seconds, followed by deep unconsciousness or confusion (postictal phase) during which the baby's heart rate often drops temporarily due to maternal apnea. Keep her airway open in the left-side recovery position and monitor her breathing continuously until paramedics arrive with intravenous or intramuscular magnesium sulfate (the definitive anticonvulsant for eclampsia) and blood pressure medications.

Reduced fetal movements: when to go straight to maternity triage¶

Malite na 24 ruo izu iri abụọ na asatọ nke ime ime, nwa ebu n'afọ dị mma na-ewepụta usoro ịgba, mpịakọta, swishes na ịmagharị kwa ụbọchị. Ntuziaka mgbochi ọmụmụ nwa mba ụwa sitere na Healthtù Ahụ Ike (wa (WHO), UK National Health Service (NHS * Ịchekwa Ndụ Ụmụaka*), na ACOG na-emesi iwu dị oke mkpa gbasara ** mbelata mmegharị nwa ebu n'afọ (RFM) ***:

• ** Echiche ụgha a ga-atụfu: ** Ụmụaka anaghị eme ** 'Ịdị nwayọọ'' ma ọ bụ mee ka ọ dị ntakịrị na njedebe nke ime ime n'ihi na ọnụ ụlọ na-agwụ. Omume mmegharị ahụ nwere ike isite n'ịkpọ ọkpọ dị nkọ gaa na mpịakọta siri ike ma gbatịa, mana ** ugboro na ike mmegharị kwesịrị ịdị na-agbanwe agbanwe ruo mgbe ọrụ**.
• ** Iwu nke izu 28 ("Gụta na 10"):** N'ime ọnwa atọ nke atọ, ịdina n'akụkụ aka ekpe gị ** n'oge oge nwa ọhụrụ na-arụ ọrụ kwesịrị inye ma ọ dịkarịa ala **10 mmegharị dị iche iche n'ime awa 2 ** (ọtụtụ ụmụaka nwere ahụike na-eme mmegharị 10 n'ime nkeji 15 ruo 45).
• ** Echela ruo echi ma atụkwasịla onye na-azụ ahịa Doppler n'ụlọ obi: *** Ọ bụrụ n'ịhụ mbelata ma ọ bụ enweghị mmegharị nke nwa gị n'ụzọ doro anya, ** adala ụra na-eche ka nwa ahụ na-emegharị n'ụtụtụ **, na ** ejikwala obi obi nwa ebu n'afọ Doppler ma ọ bụ ngwa ama ama iji mesie onwe gị obi ike. Doppler n'ụlọ na-ebulikarị akwara pelvic nne ya n'amaghị ama, ọ bụrụgodị na obi nwa ebu n'afọ ka dị ugbu a, nwatakịrị nọ n'agụụ placental na-adịghị ala ala na-akwụsị ịkwaga iji chekwaa oxygen ** awa tupu nku ume n'ikpeazụ kwụsị **. Gaa ozugbo na ngalaba ịmụ nwa n'ụlọ ọgwụ maka nyocha cardiotocography ọkachamara (CTG / non-stress test).

Ajụjụ a na-ajụkarị¶

enyochara isi mmalite¶

• American College of Obstetricians and Gynecologists (ACOG, United States): Practice Bulletins on Gestational Hypertension and Preeclampsia (No. 222), Obstetric Hemorrhage, and Management of Pregnant Trauma Patients.
• Royal College of Obstetricians and Gynaecologists (RCOG, United Kingdom): Green-top Guidelines on Antepartum Haemorrhage (No. 63), Umbilical Cord Prolapse (No. 50), and Reduced Fetal Movements (No. 57).
• World Health Organization (WHO, International): WHO Recommendations for the Prevention and Treatment of Preeclampsia and Eclampsia and Managing Complications in Pregnancy and Childbirth (MCPC).
• American Heart Association (AHA, United States) and European Resuscitation Council (ERC): Guidelines for Cardiopulmonary Resuscitation and Cardiac Arrest in Pregnancy (Manual Left Uterine Displacement Protocols).
• Society of Obstetricians and Gynaecologists of Canada (SOGC) and Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG): ALARM Course Obstetric Emergency Triage Standards.

Ntuziaka emetụtara¶

• Omumu nwa mberede na ime ngwa ngwa
• Ruptured ectopic pregnancy and first-trimester bleeding
• Seizures and convulsions first aid
• Ujo na ọbara ndakpọ enyemaka mbụ
• Ndị okenye CPR na iku ume nnapụta
• Nọmba mberede site na obodo