EMERGENCY DELIVERY-SPONTANEOUS VERTEX

 

  1. Prior
  • Mother in the dorsal lithotomy position
  • Nitrous oxide if available
  • Gather the equipment required for neonatal resuscitation

 

  1. Procedure
  • One hand on the fetal head as it distends to vaginal introitus to control delivery of the head
  • The other hand applies upward pressure through a towel to the perineum just in the front of the coccyx
  • Following delivery of the neck, if loops of umbilical cord encircle the neck, slip them over the infant’s head
  • Grasp the sides of the infant’s head and apply gentle downward traction to deliver the anterior shoulder
  • Gently lift the infant’s head to deliver the posterior shoulder

 

  1. Post
  • Assess the newborn-see Checklist Neonatal Resuscitation
  • If resuscitation is unnecessary, position the child at the level of the vaginal introitus and cut the cord between two clamps 5 cm from the infant 2 min post delivery.
  • Assess the mother, prepare for placental delivery, plan in case of postpartum hemorrhage

 

 

EMERGENCY DELIVERY-SHOULDER DYSTOCIA

 

Steps to Deliver the Shoulders

  • Assistants grasp the maternal legs and flex them against her abdomen (McRobert’s maneuver)
  • Apply gentle downward traction to the infant’s head while an assistant applies downward and lateral suprapubic pressure
  • Rotate the infant 180° by applying pressure with two fingers to the infant’s posterior scapula (Reverse Wood’s screw)
  • Insert a hand to identify the posterior elbow, flex the elbow, grasp the forearm and sweep it in front of the infant’s chest to deliver the posterior shoulder (Barnum maneuver)
  • If the anterior shoulder does not deliver spontaneously, rotate the infant and repeat the Barnum maneuver.

 

 

EMERGENCY DELIVERY-BREECH

 

  1. Prior
  • No delivery measures unless feet, legs and buttocks have advanced through the introitus
  • Terbutalin 0.25 mg SC may inhibit labor and allow for transfer to the delivery suite

 

  1. Procedure
  • Grap the fetal pelvis through a towel
  • Rotation the infant into the transverse position; if the anterior arm does not deliver spontaneously, grasp the feet in one hand and lift the infant to deliver the posterior shoulder
  • If the posterior arm does not deliver spontaneously, follow the posterior humerus to the elbow, flex the elbow, grasp the forearm and deliver the arm.
  • Deliver the anterior arm by lowering the infant and rotate the infant so that its back is facing upwards.
  • Place your index and middle finger of one hand on the infant’s maxilla; hook the 2nd and 4th finger of the other hand over the fetal neck while pressing down on the head with the 3rd finger; these measures flex the infant’s neck
  • Ask an assitant to apply suprapubic downward pressure
  • Apply downward traction until the suboccipital region appears
  • Elevate the body of the fetus to deliver the head

 

  1. Post
  • Assess the newborn-see Checklist Neonatal Resuscitation
  • If resuscitation is unnecessary, position the child at the level of the vaginal introitus and cut the cord between two clamps 5 cm from the infant 2 min post delivery.
  • Assess the mother, prepare for placental delivery, plan in case of postpartum hemorrhage