Obstetrics & Neonatal Resuscitation

Question 1

Primary Survey

Answer 1

• Confirm there are no D-Spine precautions
• Assess lvl of consciousness (AVPU scale)
• Assess and manage ABC’s as required
• Complete RBS
• Apply O2 (Standard face mask or non-rebreather)
• Consider position for comfort

Question 2

Decision Point

Answer 2

Prepare to assist the delivery of the baby at scene if:
- Contractions less than 2 mins, Crowning and/or the urge to push/have a BM
- Presence of true contractions, regularly spaced, increasing in intensity, and less than 2 mins apart
- There is an urge to push

Question 3

Findings in an unstable PT include

Answer 3

• Abnormal presentation
• Signs of shock in birth giver or fetal distress
• MOI to initiate labour caused by traumatic event
• Known complications of childbirth or pregnancy
• Limb, cord, multiple, preterm, or hemorrhage

Question 4

Load and Transport

Answer 4

Transport PT and infant as securely as possible

If history and physical assessment indicate the ability to make it to the closest hospital:
- Position PT left lateral
- Remove any underclothes that may obstruct delivery
- Initiate transport

Question 5

Secondary Survey

Answer 5

• Critical History
• Patient History (SAMPLE & OPQRRRST)
• Vital signs
• Notification (ISBAR)
• Head to Toe/Functional Inquiry

Question 6

Protocol(s)

Answer 6

Pain management protocol (if indicated)

Question 7

Treatment - Normal childbirth in field

Answer 7

• Attempt to attend the emotional needs of the birth giver, stay calm
• Make all attempts to ensure a sterile environment for the delivery
• Inspect for crowning if there’s any signs of true labour
• Consider and anticipate possible complications based on history & presentation

Question 8

Treatment - Breech Presentation

Answer 8

• Position birth giver with buttocks at edge of bed
• Allow baby to deliver spontaneously, do NOT pull on baby
• Support the anatomy that has been provided with your hands & forearms
• If baby’s head has not been delivered & there is fear of suffocation, place gloved hand on vagina, palm towards baby’s face. Using 2 fingers form a “V” on the baby’s face to apply gentle flexi on of the neck

Question 9

Treatment - Other Abnormal Presentation (prolapsed umbilical cord or limb presentation)

Answer 9

• Do NOT attempt to deliver in field
• Support any limb or cord presentation. Apply warm, moist, sterile dressings to the visible cord
• Position PT w/ pelvis elevated, slightly on left side

Question 10

Assessment of the Neonate

Answer 10

• Assess the ABC’s
• Maintain a APGAR score at 1 and 5 mins post birth
• Manually clear neonate’s airway using your finger or gauze
• Vigorously warm & dry the child
• Place the child at level of the vagina
• Clamp & cut the cord. When the cord has finished pulsating clamp at 10 cm from the neonates umbilicus and 5 cm from first clamp
• Once the cord is clamped and cut, encourage skin to skin contact w/ the birth giver to feed
• Initiate an NRTC transport
• The new born baby should be transported on an approved child safety seat for safety purposes
• Keep birth giver and child warm, notify hospital & monitor vitals of both birth giver & child including blood pressures, SpO2 and blood sugars
• Be prepared for delivery of the placenta and place in a bio bag for the OB to inspect upon arrival to the hospital