Obstetric Emergencies

Find answers to the most frequently asked questions about OB emergencies VR Simulation.

Published On: October 22, 2022Categories: Labor & Delivery VR

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Application Overview

This VR simulation allows users to practice their knowledge and situational management skills in 3 different high-risk obstetric emergency scenarios: Maternal Cardiac Arrest (code), Hypertensive Crisis, and Maternal Sepsis.‍

Room 1: Scenario Information – Maternal Code (MC)

MC Patient History 

Mrs. Cisneros is a 38-year-old, G3 P1 at 40 weeks and 2 days gestational age. She is in active labor and is on oxytocin, 10 milliunits/minute. Her height is 165 cm and her weight 88 kg. She has no known allergies and is not on any medications other than prenatal vitamins. Other than a history of mild asthma, she has no significant medical or OB history. Her last vaginal exam was 20 minutes ago. She was 6 cm,100% effaced, -1 station and the doctor ruptured her membranes for a moderate amount of clear fluid. She has 10 milliunits per minute of oxytocin infusing and has been on that dose for the past hour. She just received an epidural bolus top-off dose 10 minutes ago.

Vital signs: BP: 123/80; Pulse: 90; O2 Saturation: 98%.

Fetal Status: Fetal heart rate tracing: baseline 125 beats per minute, moderate variability, no accelerations present, no decelerations. Contractions every 2-3 minutes, lasting 60 seconds, moderate by palpation with soft resting tone.

MC Learning Objectives 

  • Instruct team members on how to perform effective chest compressions during cardiopulmonary resuscitation and recognize when they are not being performed properly per ILCOR and ACOG standards
  • Recognize the need to properly position the patient and bed to perform high-quality CPR
  • Ensure supportive airway management of the patient in cardiac arrest
  • Instruct team members to perform manual left uterine displacement during cardiopulmonary resuscitation and when to perform it
  • Initiate timely perimortem cesarean section within 4 minutes of recognized cardiac arrest and delivery of baby by 5 minutes.
  • Communicate effectively with a multidisciplinary team of anesthesiologists, obstetricians and nurses during patient management

Room 2: Scenario Information – Hypertensive Crisis (HC) 

HC Patient History

Eleanor is a 26 year old G4P2 at 35 weeks gestation who has had a headache and blurry vision for the past day. Patient also reports a small amount of vaginal bleeding. Patient has no other complaints. She’s had scant prenatal care because of childcare obligations but her pregnancy has been uneventful. She has always had normal BPs. Her reported due date is based on an early ultrasound. She reports occasional, mild, contractions and denies leakage of fluid. She reports active fetal movement. Eleanor previously had one preterm NSVD 4 years ago followed by a term c-section two years ago; but she doesn’t remember why the c-section was performed. She also has a history of 1 S.A.B. She had no known allergies and is taking no medications.

Vital Signs: BP: 168/90; Pulse: 80; O2 Saturation: 100%; Respiratory Rate: 15 sinus rhythm.

Baseline Labs: WBC: 8,500; H/H: 13.5/39%; Plt: 250,000; AST: 160; ALT: 100; URIC Acid: 5.5; Urine Protein/Creatinine ratio: 0.9.

Fetal Status: Fetal heart rate tracing: baseline 140 beats per minute, moderate variability, accelerations present, no decelerations. Contractions every 8 minutes, lasting 30 seconds, mild by palpation with soft resting tone.

HC Learning Objectives

  • Identify signs and symptoms of preeclampsia with severe features
  • Manage preeclampsia with severe features appropriately per the ACOG or CMQCC guidelines Appropriately assess maternal vital signs, fetal heart rate and contraction pattern
  • Manage eclampsia correctly
  • Make decision to deliver baby after mother is stabilized
  • Demonstrate teamwork and effective communication

Room 2: Scenario Information – Maternal Sepsis 

MS Patient History 

Suzanne Thompson, is a 26-year-old G1P0.  Suzanne has no significant medical or obstetric history. She has NKDA and is not on any medications other than prenatal vitamins. She was hospitalized 5 days ago for preterm rupture of membranes at 33 weeks and 0 days gestation. She received her 2nd dose of betamethasone for fetal lung maturity three days ago. This morning, on her fifth day of hospitalization, she called out to her nurse and reported “feeling warm” and that it felt like her heart was racing.

Vital Signs: BP: 115/62; Pulse: 130; O2 Saturation: 98% on room air; Respiratory Rate: 22; Temperature: 36.6°C (97. 8°F.

Baseline Labs: WBC collected daily and was 22,000/mm3 this morning.

Fetal Status – The fetal heart rate is 160 with moderate variability, no accelerations and no decelerations. She recently began contracting every 3 minutes, palpating mild with soft uterine resting tone. Her recent cervical exam was 3/80/-1. No colored or foul-smelling drainage is noted.

MS Learning Objectives

  • Recognize the signs and symptoms of a patient at high-risk for sepsis
  • Use of Maternal Early Warning System aka MEWS (types of MEWS screens are the MEWC, MEOWS, MEWT) Initiate proper workup and therapy for sepsis
  • Correctly manage a patient with a positive MEWS score using the ACOG and CMQCC guidelines Notification of provider & prompt bedside evaluation for patient with a positive MEWS score
  • Begin antibiotic therapy within 1 hour of identification of at-risk patient


Maternal Cardiac Arrest: 

1. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000300 (retrieved 2/1/2022)

2. www.costr.ilcor.org (retrieved 2/1/2022)

2. https://www.uptodate.com/contents/sudden-cardiac-arrest-and-death-in-pregnancy (retrieved 2/1/2022)

3. https://cpr.heart.org/-/media/CPR-Files/CPR-GuidelinesFiles/Algorithms/AlgorithmACLS_CA_in_Pregnancy_InHospital_200612.pdf (retrieved 2/1/2022)

Obstetric Emergencies 2 

Hypertensive Crisis: 

1. https://www.cmqcc.org/resources-tool-kits/toolkits/HDP (retrieved 2/10/2022)

2. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/06/gestational-hypertension-and preeclampsia (retrieved 2/10/2022)

3. https://www.aafp.org/afp/2019/1215/p782.html (retrieved 2/10/22)

Maternal Sepsis: 

1. https://journals.lww.com/greenjournal/Abstract/2019/05000/ACOG_Practice_Bulletin_No__211__Critical_Care_in.39.aspx (retrieved 2/25/22)

2. https://www.cmqcc.org/resources-toolkits/toolkits/improving-diagnosis-and-treatment-maternal-sepsis (retrieved 2/25/22)

3. https://pubmed.ncbi.nlm.nih.gov/30684460/ (retrieved 2/25/22)

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