Diabetic coma M ost complications of pregnancy allow time for transfer to specialized obstetric units, but a few women present as emergencies where successful outcome depends on prompt recognition of the problem and rapid stabilising management. In the young and healthy, tachecardia and hypotension are very late features of shock and need to be considered extremely seriously. The blood loss may be revealed or concealed, usually both, and is easily underestimated. Pain is intense and constant, and the uterus large and rigid.
Abruption is more common if high parity, poor nutrition, hypertension, or toxaemia.
Large bore IV access, with blood collected for group and crossmatch to be transferred with the patient. Replace estimated losses plus 2 litres IV fluid. Consider catheterisation to monitor output, and because a full bladder can contribute to uterine relaxation and further bleeding. Arrange escorted transfer to obstetric unit for further assessment even if bleeding seems to settle, as the fetus may be compromised. Anti-D may be required.