PEPP 7: Emergency Delivery Flashcards
Pregnancy complication
Preterm labor
Post term pregnancy
Multiple kids
Placenta previa: placenta detaches causing bleeding. Transport immediately
Known breech presentation: transport immediately
Labor triage
Is this your first delivery? If not, how long were previous ones. Gives you a time frame.
Do you feel the urge to push? If yes, take a look. Delivery is 30 min away
Do anatomical conditions allow for delivery? If no, transport.
Breech delivery
See foot or butt
Transport immediately
Urge to push?
Delivery in 1 hr for first pregnancy
30 min for later ones
If delivering on scene
Are you having twins?
When are you due to deliver?
What color was the amniotic fluid?
Twins
Get additional caregiver for the second baby
Consider a second ambulance
Premature baby
Meconium
Greenish fluid
Fecal matter from baby
Suction mouth and orophanx if you can without delaying deliver. Don’t do too much may trigger bradycardia
Position
Supine: raise butt with folded towels
Sims: lying on her side. Infant head is accessible for suctioning if needed before delivering body
Or supine on edge of bed with feet up on chairs
Delivery process
Allow mother to push head out
With one finger, feel neck for umbilical cord: if so gently lift over head
Shoulder may need to be guided out/down. Don’t pull
Don’t raise baby over or below placenta
Tie cord in two places and cut the cord
Dry and warm the baby
If not crying, gentle suction to clear mouth
Placenta delivered 10-15 min later, don’t wait for it
Complications: Umbilical cord prolapse
Cord is visible before baby.
Push baby head down to relieve pressure
Put two fingers on either side of cord to make sure cord is not smashed.
Complications: Nuchal chord
Chord around the neck.
Move if you can, tie and cut if you can’t
Very risky
Complications: Meconium
If baby is ok, just suction
If baby is not vigorous, may need intubation
Complications: Shoulder dystochia
Physical entrapment of shoulder after head comes out. Hyperflex mom’s thighs up to rotate pelvis
Complications: Cephalopelvic disproportion
Head is too big.
Must do C section
Complications: Post partum hemorrhage
Most common death of mom. Loss of 500ml of blood is normal Signs are tachycardia and hypotension. Perform uterine massage 3-5 min till uterus is firm Encourage breast feeding if possible
Immediate care of newborn
Dry, warm, position, suction and stimulate baby Clear the airway Assess breathing Assess heart rate Assess color
Clearing the airway
Nasopharyngeal suction
Clear the mouth, then the nose
If merconium and baby is not vigorous, deep endotracheal suctioning
Assessing breathing
Slightly irregular is normal
Gasping or grunting is not
If apneic and no signs of visible breathing, immediate treatment
Assessing heart rate
Bradycardia is caused by hypoxia
Palpate at base of umbilical cord
If not felt, use stethescope on left side of chest
Assessing color
If cyanotic and apneac, start BVM
If central cyanosis but breathing, apply Pulse ox to verify hypoxia
If hypoxic, blow by O2 at 6 lpm
Peripheral cyanosis is no treatment
Hyperoxia may be harmful
Don’t give O2 to healthy baby
BVM rate
40-60 per minute
Don’t press on mask too much, may trigger something
Say: squeeze, release, release
Ressusitation
Dry, warm suction baby
If still non responsive, assess breathing and HR
If HR
Shock treatment
Usually from hypoxia
Abnormal appearance, color, tachycardia, poor pefusion, weak pulse
O2 saturation of 80-90 is normal
Note
Hypoglycemia
Rare in first 30 min
Check of sudden change in baby
40 is low
