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OBSTETRICAL EMERGENCIES: 14.0

All Providers

  • Focused history and physical exam
    • Do not perform pelvic exam
  • Cardiac monitor, pulse oximetry
  • Treatment Plan
    • Imminent Deliveries: normal delivery procedures
      • Attempt to prevent explosive delivery
      • Wipe face to clear secretions
      • Keep infant at level of vagina until cord is cut
      • Double clamp the cord 2-4 inches from baby, then cut
      • Dry and stimulate infant
      • Skin-to-skin on chest if possible, allow to nurse
      • Apgar score at 1 and 5 minutes
    • Special Situations – transport to the closest hospital
      • Excessive hemorrhage
        • fundal massage
      • Nuchal cord
        • attempt to reduce the cord, if too tight then double clamp and cut
      • Prolapsed cord or limb presentation
        • do NOT attempt delivery
        • cover presenting part with sterile towel
        • place mother in Tendelenburg, knee chest if possible
      • Breech presentation
        • support baby’s body as it delivers
        • if head does not deliver a gloved hand can push the vaginal wall from baby’s mouth
      • Shoulder Dystocia
        • flex thighs, firm hand pressure above the pubis symphysis (not fundal)
      • Stillborn/Abortion
        • all products of conception should be carefully collected and transported with mother

ADULT

AEMT
  • IV/IO Access and Fluid Therapy Protocol
Paramedic
  • Seizure Protocol if needed
  • Cytotec 800 mcg PO or PR for hemorrhage not relieved by fundal massage
℗ High risk preterm labor with imminent delivery: - Nebulized albuterol , 2.5 mg Mag Sulfate 1 gm IV

Pediatric

AEMT
  • IV/IO Access and Fluid Therapy Protocol
Paramedic
  • Refer to Newborn Resuscitation Protocol