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
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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