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Transcript of Precipitous Delivery
V. Barss, MD Precipitous labor is defined as:
Labor which lasts less than 3 hours from first contraction to completion of stage 3. Who is at risk? Multiparous women Women with a large pelvis Women carrying a small baby Young Maternal Age for example:
MVC victims Women at risk for abruption Comorbidities Abruption Meconium Low APGARs Decreased
Fetal Reserves POST PARTUM HEMORRHAGE So...
What do we do now? REALLY, NO, WHAT DO WE DO? First, take a deep breath... Call for HELP! Please do so in a manner
so as not to increase your patient's PANIC! Grab some
gloves Probably not sterile Of course, they won't be your size JUST GET SOME GLOVES ON BECAUSE somebody's got to deliver this baby, and you've just been nominated AS IF! Next, put on some gloves Start asking questions Gravida and Para Gestational
Problems Fetal Problems and anything else that comes to mind as you are putting on your gloves By now, you should have some help on hand to put on EFM And open a delivery kit Encourage panting Especially in your patient, but if it helps you, feel free to join her Place your hand on the fetal head to help keep it flexed Deliver the head Feel for a cord Did you find one? You have three options a) Slip it over the head
b) Clamp it and cut it
c) Slip it over the anterior
shoulder and deliver the
body through the cord Now, guide the head downward Watch for turtling Deliver the anterior shoulder The body should follow easily Keep the baby level with the placenta.
This keeps blood from flowing with gravity
back down the cord and into the placenta
which can cause fetal anemia. Clamp and cut the cord Pass the infant off to a teammate Ask Mom to breathe, and not to push
"Okay mom, just blow for a minute, don't push right now" Take a deep breath
because you're not done That's right...you still have to handle the placenta Keep gentle tension on the cord -
DON'T pull on it Be patient, you have up to 30 minutes Catch it in the bucket Perform fundal massage and watch out for...? "the uterus that contracts with unusual vigor before delivery is likely to be hypotonic after delivery" Williams Obstetrics Results to watch out for Neonatal bruising Decreased neonatal reserves Erb's palsy Hopefully, by now, you have a provider who can order meds Now you get to document! Phwew! That's over! But wait - there's more In a perfect world, you would hand off post-partum care and go somewhere quiet to document what just happened Start with the times you DO know Use all the sources you can Admissions APGAR timer EMS Emergency room Other staff Write out your times, then fill in the blanks Be honest, don't try to fill in what you aren't sure of Make notes before completing your professional note That's right, ONE note. This is an appropriate
time to write one note, with a list of times.
Don't be afraid to clump events together if
they happened at the same time. DEBRIEF Assess your strengths as a team - "what did you do well?" Assess your weaknesses as a team -"what could have gone better?" What opportunities for process improvement can you find? What threats to teamwork and patient safety did you identify? "Oh yeah, the placenta" just be sure to shred them after you have completed your professional note PLEASE PRESS ESC NOW When did your water break?
What did it look like? Cervical and vaginal lacerations