6 Emergency Scenarios and Care Handoffs

Recognize threats and act early

Childbirth, pregnancy-related, postpartum, and gynecological emergencies can deteriorate quickly. Begin with the patient’s immediate condition rather than waiting for a confirmed diagnosis. Follow local emergency medical services (EMS) protocols and remain within your scope of practice.

Assess responsiveness, airway, breathing, circulation, major bleeding, and mental status. Treat immediate threats first and reassess frequently. Summon help early for instability, severe pain, seizure, heavy bleeding, breathing difficulty, fainting, or birth that appears imminent. In the United States, call 911 for a life-threatening emergency.

Ask whether the patient is pregnant or has been pregnant during the past year, if known, but do not delay urgent care to establish pregnancy status. Serious pregnancy-related warning signs can occur during pregnancy and up to a year after birth.

Choose transport according to urgency and available capability. An unstable patient needs emergency transport and an appropriate receiving facility; do not delay departure for a complete history or nonessential procedures. Contact the receiving team early when feasible, and use local protocols to determine the destination and care en route. Record vital signs, changes, interventions, responses, and times.

Heavy bleeding after birth

Heavy or increasing vaginal bleeding after a recent birth, especially with weakness, dizziness, or altered alertness, may indicate postpartum hemorrhage and shock. Call EMS or activate the facility emergency response. Assess the ABCs and mental status, monitor vital signs, keep the patient warm, arrange urgent transport to a facility able to provide obstetric emergency care, and do not leave the patient alone.

Report the amount and trend of bleeding, time of birth, and any known placenta-related information. Follow local protocols for additional care. Prompt recognition and treatment are important.

Seizure, severe headache, or collapse

A severe persistent headache, visual changes, seizure, breathing difficulty, chest pain, or fainting during pregnancy or after birth requires urgent attention. Treat seizure, breathing, or circulation problems as immediate threats and summon emergency help. Protect a person having a seizure from injury; do not restrain them or put anything in their mouth. After the seizure ends, reassess breathing and responsiveness.

Report the pregnancy or recent birth, symptom onset, seizure duration, vital signs, and recovery. These symptoms include urgent maternal warning signs.

Possible ectopic pregnancy

Pelvic or abdominal pain with vaginal bleeding in a patient of reproductive age may involve an ectopic pregnancy, particularly if the patient becomes weak, dizzy, faints, or reports shoulder pain. Consider the possibility of time-critical internal bleeding. Call EMS for severe pain, collapse, or signs of shock, and arrange urgent emergency-department assessment.

Do not rule out pregnancy because the patient does not expect to be pregnant, uses contraception, or has no known pregnancy. Communicate the pain and bleeding timeline, pregnancy possibility or test result if known, fainting, and vital-sign changes. Sudden severe pain, shoulder pain, weakness, or fainting are especially concerning.

Labor with birth possibly imminent

A strong urge to push or a visible baby can mean birth is imminent. Call EMS, explain that birth may be imminent, and do not leave the patient alone. Follow dispatcher instructions and local training; avoid an unplanned move if birth appears imminent.

While help is on the way, prepare a safe, warm area and gather clean towels or blankets. Tell EMS about contractions, the urge to push, visible presentation, bleeding, and any birth that occurs. Immediately report complications such as heavy bleeding or a baby not breathing normally, and follow emergency instructions. Transport and delivery decisions depend on how imminent birth is and the patient’s condition; follow local protocols.

Severe pelvic pain or bleeding

Sudden severe pelvic pain, persistent vomiting, fever, or heavy vaginal bleeding with dizziness, shortness of breath, or chest pain warrants careful assessment for instability. Arrange urgent emergency assessment for severe or worsening pain, fainting, fever with significant illness, or heavy bleeding accompanied by weakness or other symptoms of blood loss.

Pregnancy may still be possible, so report its status as known or uncertain. Do not delay transport while trying to determine the exact cause. Acute abnormal uterine bleeding can require immediate assessment for blood loss and stabilization, and sudden pelvic pain also warrants urgent evaluation.

Transport and SBAR handoff

When feasible, contact the receiving provider, explain why transfer is needed, and send a written record with the patient. Use SBAR to organize a concise handoff and confirm that key information was understood.

• Situation: Identify yourself and the patient, then state the main problem and urgency.

• Background: Give relevant pregnancy or birth history, symptoms and onset, medical history, medications or allergies if known, and key events.

• Assessment: Report current and previous vital signs, mental status, changes in bleeding or pain, findings, and response to care. State what is suspected and what remains uncertain.

• Recommendation: State the transport destination or support needed, concerns about deterioration, and any immediate requests. Ask the receiver to repeat back critical information or clarify questions.

For example, a handoff might report a recently postpartum patient with rapidly increasing vaginal bleeding who is becoming weak and lightheaded, a falling blood pressure during assessment, emergency transport underway, and concern about postpartum hemorrhage requiring immediate obstetric-capable emergency evaluation.