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EMERGENCY DELIVERY

Clarity in Emergency Medicine

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

 

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