0071643192.pdf

OBSTETRICS AND GYNECOLOGY

596

Normal Vertex Delivery

Emergency delivery often proceeds rapidly and requires minimal help from

the ED provider.

■ Delivery of the fetal head should be controlled by applying moderate up-

ward pressure on the fetal chin through the perineum while holding the

fetal head against the pubic symphysis.

■ Nose and airway suctioning, followed by palpation for a nuchal cord,

should occur immediately after delivery of the fetal head.

■ The anterior shoulder should be delivered first by placing hands on either

side of fetal head and applying gentle downward traction. The posterior

shoulder typically follows spontaneously.

DELIVERY COMPLICATIONS

Nuchal Cord

Occurs in a quarter of all cephalad presenting deliveries; can result in fetal

asphyxia if not identified and treated promptly

TREATMENT

■ Loose nuchal cord: Slip over head of fetus in between contractions

■ Tight nuchal cord: Cut and clamp on perineum; prompt delivery must

follow

Cord Prolapse

Occurs when the umbilical cord presents ahead of the fetal presenting part; most

likely to occur with abnormal fetal presentations and with fetal prematurity

DIAGNOSIS

■ Visualization or palpation of pulsating umbilical cord at or through the

cervical os

TREATMENT

■ Elevate the presenting fetal part to reduce compression of the cord.

■ This is an obstetrical emergency and a C-section is indicated. The examiner’s

hand should stay in the vagina elevating the presenting part until the patient

undergoes surgery.

■ Other adjunctive maneuvers include knee chest position and manually

filling bladder with fluid (via Foley catheter).

TABLE 12.2. Stages of Labor

Stage 1: Cervical stage Onset of regular contractions to complete cervical dilation/

effacement

Stage 2: Expulsion stage Complete dilation/effacement to delivery of fetus

Stage 3: Placental stage Delivery of fetus to delivery of placenta