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Seizure in pregnant woman is an emergency that requires immediate actions that do not require any high-tech facilities or drugs. Generalised epileptic seizures originate within, and rapidly engage, bilaterally distributed networks. During an absence seizure a person becomes unconscious for a short amount of time, usually a few seconds. During the seizure senior staff should be summoned and the patient should not be left on her own. Vital signs including blood pressure, pulse, ECG, respiration rate, temperature, saturated O2 and fetal heart rate should be monitored. For treatment of status epilepticus lorazepam (4mg) should be administered followed by phenytoin infusion (15 mg/kg at a rate of 50 mg/min) or diazepam infusion. In resource poor settings, where most obstetrical care occurs later in pregnancy and home births are the norm, women with epilepsy, especially those with poorly controlled seizures, should be encouraged to deliver at the hospital.
Cord prolapse is an obstetric emergency with a high risk of perinatal mortality. Selective transvaginal scanning in women with high-risk factors such as a transverse lie, malpresentation (e.g. footling or lexed breech) or high presenting part of fetus, may be useful. Amniotomy is contraindicated if the cord is palpable below or by the side of the presenting part during vaginal examination. Women with prelabour (prolonged) rupture of membranes (PROM) should be offered a speculum examination irrespective of the period of gestation. A digital vaginal examination indicates the presence of PROM or preterm PROM (PPROM) with cardiotocograph (CTG) abnormalities such as variable decelerations, prolonged decelerations and bradycardia and a suspicion of cord prolapse. Emergency caesarean section (CS) is frequently needed but assisted or operative vaginal delivery may be possible if the cervix is fully dilated. Post-delivery debriefing and counselling of parents and risk-management discussions are needed.