Emergency Delivery



CUH ED - Who to contact:

Infant delivery

  • Your EM senior
  • Anaesthetic registrar / consultant
  • Neonatal flying squad = midwife, incubator & paediatrician (CUMH)

Paediatric Resuscitation

  • Your EM senior

MUH ED - Who to contact:

Infant delivery

  • Your EM senior
  • Anaesthetic registrar / consultant
  • Neonatal flying squad = midwife, incubator & paediatrician (CUMH)

Paediatric Resuscitation

  • Your EM senior
  • MUH Paediatric Consultant on call (switch)
  • CUH can be contacted on 8831

Clinical

  • If time permits, listen to fetal heart tones (normal, 120 to 160). A heart rate outside the normal range indicates fetal distress.
  • If the fetal heart tones are normal, examine the mother’s abdomen.
  • Palpate and count contractions.
  • Coach the mother to relax between contractions.
  • If delivery is not imminent (no crowning), time will allow for transport to labour and delivery.
  • If crowning is present, prepare for an ED delivery.
  • Sterile delivery kit (MUH Resusc shelves on the right)
  • Gown, cover one hand with a sterile towel, and prepare for delivery.

Preparation

  • When the head is delivered, suction the mouth, then the nose, of the infant.
  • If the cord is around the infant’s neck, loosen it and slip the cord over the head or clamp it in two places and cut between the clamps.
  • Once the head is delivered and rotated, support it gently.
  • Hold the infant downward to assist with delivery of the anterior shoulder and then gently upward to assist with delivery of the posterior shoulder.
  • Keep the infant in a head-dependent position to reduce the risk of aspiration.
  • Suction the mouth and then the nose.
  • Gently rub the back if crying or breathing is not spontaneous.

The infant

Apgar score

>
  0 1 2
Appearance Blue Blue limbs, pink body Pink
Pulse Absent <100/min >100/min
Grimace Limp Some flexion Good flexion
Activity Absent Some motion Good motion
Respiratory Absent Weak cry Strong cry

Determine the Apgar score at delivery and 5 minutes post delivery. A score of 7 to 10 is good; 4 to 6 is depressed; 0 to 3 is severely depressed.

  • Reassess the airway
  • If the airway is not clear, suction the mouth and then the nose, position the newborn, and perform a slight chin lift. Do not hyperextend the neck
  • If breathing is absent or heart rate is <80 beats per minute, begin CPR Please (see neonatal resuscitation)
  • Provide oxygen, establish effective ventilation with a bag-valve mask or endotracheal intubation, and perform chest compressions.
  • Check BM - administer a 10% glucose if necessary.
  • If the baby is well, place on the mother’s abdomen and encourage the mother to breast feed the infant.
  • Prepare for delivery of the placenta, which usually occurs 5 to 10 minutes after the infant is born.
  • A sudden gush of blood occurs when the placenta separates from the uterine wall, the uterus moves upward in the abdomen, and the cord shortens. When this process is complete, apply gentle traction on the cord, pushing downward on the dome of the uterus towards the suprapubis. The placenta will enter the vaginal area, continue gentle traction, and remove.
  • Clamp the umbilical cord at least 15cm from the umbilicus when it has stopped pulsating and cut between the clamps.
  • Dry the infant, cover it and place in a warm environment, and determine the Apgar score.


Content by Dr Íomhar O' Sullivan 18/11/2005. Reviewed Dr Dr ÍOS 20/01/2007. Last review Dr ÍOS 30/08/14