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Emergency Room Delivery

Emergency Room Delivery. Tintinalli Chapter 107. Emergency Room Delivery. Be Prepared prior to arrival Tables 107.1 & 107.2 review the standard delivery tray and medications used for delivery and post-op Get Medical and Current Pregnancy Hx Evaluation of the patient

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Emergency Room Delivery

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  1. Emergency Room Delivery Tintinalli Chapter 107

  2. Emergency Room Delivery • Be Prepared prior to arrival • Tables 107.1 & 107.2 review the standard delivery tray and medications used for delivery and post-op • Get Medical and Current Pregnancy Hx • Evaluation of the patient • If signs of active labor and stable vitals, first determine the due date or length of the pregnancy • Naegle rule: add 9 months and 7 days to the LMP • Fundal Height: cm from the pubic symphysis to the top of the fundus • Initiate immediate monitoring of the maternal vital signs and fetal heart rate • FHT <120 indicates fetal distress and emergent OB/GYN consult

  3. Emergency Room Delivery • False Labor – uterine contractions that do not lead to cervical changes and are irregular & brief • True Labor – painful, repetitive uterine contractions that increase in intensity and duration and lead to effacement and dilation of the cervix • Three stages of labor: • 1st begins with contractions • Two stages – latent phase has irregular contractions and active phase marked by dilation of the cervix to 3cm • 2nd begins after complete dilation and stops with delivery • 3rd begins after delivery of the infant and ends with delivery of the placenta

  4. Emergency Room Delivery • Normal Physical Examination and then focused • Determine if blood or fluid from the vagina by either patient history or inspection • Ultrasound before sterile speculum or bimanual exam if vaginal bleeding • Avoid digital exam if preterm • If fluid only, determine if SROM: by pooling of aminotic fluid in the vaginal vault, nitrazine test, or ferning • Speculum exam allows examination of the cervix and cultures if never done (Group B Strep, G & C)

  5. Emergency Room Delivery • Cervix Exam • Effacement – thin of the cervix; described in terms of the percentage of the normal cervix • Dilation – diameter of the internal cervical os from a finger tip to 10cm • Station – the level of the fetus in the pelvis in reference to the ischial spines (found at 4 & 8 o’clock); before the spines = negative station; at the spines = 0 station; then 1+....3+ = head at the introitus

  6. Emergency Room Delivery • Premature Rupture of Membranes • Rupture more than 1 hour prior to onset of labor • Preterm Premature Rupture of Membranes – rupture premature and prior to 37 wks • Causes – infection, hx PPROM, trauma, multiple gestations, fetal anomalies, placental abruption, and placenta previa

  7. Emergency Room Delivery • Fetal Distress • Indicators of distress: • Decelerations of fetal heart rate (HR drop that lasts > 30s after a contraction finishes) • Episodic bradycardia > 5 minutes • Interventions: • Repositioning in left lateral, right lateral, then knee-chest • Maternal O2 • Fetal Scalp stimulation

  8. Emergency Room Delivery • Basics of birth • Six cardinal movements of fetal descent: 1) engagement 2) flexion 3) descent 4) internal rotation 5) extension 6) external rotation

  9. Emergency Room Delivery • After delivery of the head, suction the nose and mouth and check a nuchal cord • If present & loose, remove • If present & tight, clamp and cut • Once delivery of the head and anterior should, be ready NOT TO DROP THE BABY • Clamp the cord 3 cm from the Umbilicus

  10. Emergency Room Delivery • After delivery do APGAR @ 1 & 5 min • Sign 0 1 2 • Activity absent arms & legs flexed active movement • Pulse absent below 100 above 100 • Grimace no activity Grimace Sneeze, cough, pulls away • Appearance blue-gray, pale only arms/legs pale entire body normal color • Respiration Absent Slow & Irregular Good & Crying

  11. Emergency Room Delivery • Delivery of the Placenta • Delivers in 15-30 min with gradual tension • After delivery, gentle massage of the uterus • May infuse oxytocin (20 units in 1 liter @ 200ml/hour IV or 10 units IM

  12. Emergency Room Delivery • Cord Prolapse • Examination reveals a palpable pulsating cord • Do not remove your hand and elevate any presenting fetal part • Immediate OB/GYN consult • Shoulder Dystocia • Shoulders impacted at pubic symphysis • Usually with larger infants • Position mother with knees to chest • Empty bladder • Apply steady suprapubic pressure • Woods maneuver – grasp posterior scapula with 2 fingers and rotate the shoulder girdle 180 degrees as the mother pushes

  13. Emergency Room Delivery • Breech Presentation • 4% of deliveries; 4 x morbidity as cephalad • Classification: frank, complete, incomplete, or footling • Main rule is not to touch the fetus until at least the umbilicus is present inorder to allow maximal dilation of the cervix for the head; head entrapement is the main complication • Incomplete and footling presentations are not considered safe by via vaginal delivery (call OB/GYN)

  14. Breech Deliveries

  15. Resources • Tintinalli Chapter 107

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