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Labor and Delivery | Obstetrical Emergencies

Labor and Delivery

First Stage: Dilation. Beginning of regular contractions to complete dilation of cervix to approx 10 cc. Averages 12.5 hours to 7 hours
Second Stage: Expulsion. 10cc cervix to delivery of newborn. 80 min to 30 min If birth is imminent, do not transport. Place patient in a semi-reclining position on the firm, comfortable surface.

Signs:
Frequent contractions less than 2 min apart
Intense urge to push
Crowning
Remember, gentle back pressure to prevent explosive delivery/tears to perineum
Manually rupture amniotic sac
As head delivers, check for the cord, if wrapped, slip it over head
Suction mouth first and then nose, preferably before the chest is delivered

Position head slightly down to drain fluids
Support head while it rotates and rock shoulders up and down gently
Clamp umbilical cord 4” from baby and 6” from baby, cut between the clamps
Record time of delivery.

Perform an APGAR test at 1 min and 5 min

apgar1

Third stage: delivery of the placenta 5-20 min
Do not pull on it
Do not delay transport
Place in clean plastic bag or other container for inspection in hospital

Postpartum care: breastfeeding helps uterus contract> constricting blood flow, massaging uterus will help stop bleeding. Hemorrhage of more than 500mL immediately after delivery is cause for concern.

Abnormal Presentations:

Multiple Births. Twins are 1 in 90 live births. 40% are premature. There may be a shared placenta or two placentas
Breech: 3-4% of deliveries, preterm 20-30%. If the head does not deliver within 3 minutes of the torso, or tries to breathe, form a V with your fingers to try and make a tunnel of air to the newborn’s face. If the baby’s head does not deliver, transport mom with buttocks elevated or in knees to chest position

Prolapsed Cord: cord presents first and may get compressed between the newborn and the mother’s pelvis, cutting off fetal circulation before delivery. Insert a gloved finger and try to keep the head from mashing the cord. Pulsations in the cord indicate a viable newborn. Transport with mom in Trendelenberg or knee to chest. Cover the cord with warm moist gauze.

Limb Presentation: Transport asap, requires C-section
Cephalopelvic Disproportion: transport asap, requires C-section

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