PEPP 7: Emergency Delivery

Question 1

Pregnancy complication

Answer 1

Preterm labor
Post term pregnancy
Multiple kids
Placenta previa: placenta detaches causing bleeding. Transport immediately
Known breech presentation: transport immediately

Question 2

Labor triage

Answer 2

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.

Question 3

Breech delivery

Answer 3

See foot or butt

Transport immediately

Question 4

Urge to push?

Answer 4

Delivery in 1 hr for first pregnancy

30 min for later ones

Question 5

If delivering on scene

Answer 5

Are you having twins?
When are you due to deliver?
What color was the amniotic fluid?

Question 6

Twins

Answer 6

Get additional caregiver for the second baby

Consider a second ambulance

Question 7

Premature baby

Question 8

Meconium

Answer 8

Greenish fluid
Fecal matter from baby
Suction mouth and orophanx if you can without delaying deliver. Don’t do too much may trigger bradycardia

Question 9

Position

Answer 9

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

Question 10

Delivery process

Answer 10

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

Question 11

Complications: Umbilical cord prolapse

Answer 11

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.

Question 12

Complications: Nuchal chord

Answer 12

Chord around the neck.
Move if you can, tie and cut if you can’t
Very risky

Question 13

Complications: Meconium

Answer 13

If baby is ok, just suction

If baby is not vigorous, may need intubation

Question 14

Complications: Shoulder dystochia

Answer 14

Physical entrapment of shoulder after head comes out. Hyperflex mom’s thighs up to rotate pelvis

Question 15

Complications: Cephalopelvic disproportion

Answer 15

Head is too big.

Must do C section

Question 16

Complications: Post partum hemorrhage

Answer 16

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

Question 17

Immediate care of newborn

Answer 17

Dry, warm, position, suction and stimulate baby
Clear the airway
Assess breathing
Assess heart rate
Assess color

Question 18

Clearing the airway

Answer 18

Nasopharyngeal suction
Clear the mouth, then the nose
If merconium and baby is not vigorous, deep endotracheal suctioning

Question 19

Assessing breathing

Answer 19

Slightly irregular is normal
Gasping or grunting is not
If apneic and no signs of visible breathing, immediate treatment

Question 20

Assessing heart rate

Answer 20

Bradycardia is caused by hypoxia
Palpate at base of umbilical cord
If not felt, use stethescope on left side of chest

Question 21

Assessing color

Answer 21

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

Question 22

Hyperoxia may be harmful

Answer 22

Don’t give O2 to healthy baby

Question 23

BVM rate

Answer 23

40-60 per minute
Don’t press on mask too much, may trigger something
Say: squeeze, release, release

Question 24

Ressusitation

Answer 24

Dry, warm suction baby
If still non responsive, assess breathing and HR
If HR

Question 25

Shock treatment

Answer 25

Usually from hypoxia

Abnormal appearance, color, tachycardia, poor pefusion, weak pulse

Question 26

O2 saturation of 80-90 is normal

Answer 26

Note

Question 27

Hypoglycemia

Answer 27

Rare in first 30 min
Check of sudden change in baby
40 is low