Pediatric emergency medicine trisk 2591 2591

Summon obstetrical and neonatal provider support Familiarize yourself with the location and contents of your department’s standard delivery kit Review the basics of precipitous delivery on a periodic basis Useful videos are available online at www.operationalmedicine.org/ed2/Video/delivery_of_a_baby_video.ht m Always make sure that the mother and baby are not separated until correct identification bands are placed on both patients Goals of Treatment The mother and newborn are both in need of medical attention Summon assistance so both patients receive appropriate medical attention Clinical considerations Assess maternal stage of labor immediately Is the infant crowning? Is the amniotic sac intact? How dilated is the cervix? If fetus is not visible, the mother does not feel the need to bear down, and contractions are 10 or more minutes apart, strongly consider transporting the mother to the nearest labor and delivery unit Presence of a crowning head is a sign of imminent delivery Triage Considerations Obtain the following information from the mother: gravity, parity, presence of multiple gestations, history of previous cesarean delivery, prenatal care, current medications Check for maternal fever, which can suggest chorioamnionitis, and hypertension, which may be a sign of preeclampsia Headache, epigastric pain, and scotoma are additional findings concerning for preeclampsia If not addressed, preeclampsia can progress to eclampsia in the mother with concurrent seizures, pulmonary edema, hepatic rupture, stroke, renal failure, and death Clinical Assessment Assess fetal heart rate with a stethoscope or Doppler US Normal fetal heart rate ranges from 110 to 160 Assess fetal position and note if the fetal head has already descended into the pelvis Management Obtain a standard delivery kit (which should include umbilical cord tape or clamps, vitamin K for intramuscular injection, and erythromycin eye ointment) and ensure you have plenty of warm towels/blankets to receive the