Medical disorders in pregnancy are now the leading cause of maternal death in developed countries; including Malaysia. The 2009-2011 Confidential Enquiries into Maternal Death in Malaysia reported that 31% of maternal deaths in Malaysia had associated medical disorders in pregnancy, with 48% of them having an underlying cardiac cause.

Obstetricians have traditionally been trained and skilled in managing obstetric emergencies such as post partum haemorrhage and eclampsia; but essential medical emergencies in the labour ward may pose significant diagnostic challenges. Hence there is an increasing need for the modern obstetrician to have sufficient knowledge in common and sinister medical emergencies which one may inadvertently manage in the labour ward; as the front liner in such conditions are the Obstetrician rather than the Physicians.

Having a systematic approach for medical emergencies are essential while ensuring sinister causes are ruled out. An approach to common presentations such as shortness of breath, chest pain, palpitations, headache and syncope are discussed in detail including common pitfalls, challenges and management pearls for the busy practicing obstetrician with the aim to provide awareness; apart from a systematic approach to these potential emergencies.

The importance of history taking, having “resuscitative hysterotomy kits” and monitoring respiratory rate and electrocardiography in the labour ward will also be highlighted with the recommendations of optimizing the Early Obstetric Warning Scoring System in all labour wards will be discussed.

In summary; as per the Royal College of Obstetricians & Gynaecologist recommendations; think of Three P’s in a pod which highlights the cardiovascular system, respiratory and venous thromboembolism in pregnancy, the neurological system and mental health in the post partum period and finally the importance of identifying the problem and directly communicating with the relevant professionals for optimal care with regards to medical emergencies in the labour ward.

There is now a dire need to incorporate sufficient training and knowledge in maternal medicine for all obstetricians apart from creating better awareness among all labour ward health professionals; as we endeavor towards reducing maternal mortality globally and within Malaysia.