Precipitous Labor and Emergency Department Delivery

Borhart, Joelle; Voss, Kathryn

doi:10.1016/j.emc.2019.01.007

Cited by 5 publications

(6 citation statements)

References 21 publications

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“…Precipitous deliveries are defined as three hours or less from the onset of labor to delivery, however, all ED deliveries should be managed as precipitous deliveries [ 6 ]. All deliveries outside the hospital or in the ED require specialized equipment, training, and protocols [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…All deliveries outside the hospital or in the ED require specialized equipment, training, and protocols [ 7 ]. ED and prehospital deliveries are associated with a high degree of complications for both mother and infant including cervical spine injury and asphyxiation for the baby, large perineal lacerations, retained placenta, and postpartum hemorrhage [ 6 , 8 ]. This is particularly pertinent for EDs without obstetrical facilities available within the same hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Footling breech presentations are higher-risk vaginal deliveries [ 9 ]. If cesarean section is not an option due to staff resources, lack of surgical experience, or necessary facility capabilities, a series of maneuvers are indicated to provide for a successful vaginal delivery [ 1 , 6 ]. Place patient in the McRoberts position if in dorsal lithotomy birthing position which allows for the pelvic tilt facilitating delivery around the symphysis pubis (Figure 1 ) [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…A second method is a Burns-Marshall technique using a more “hands-off” approach in some instances to allow the fetal presenting part to dilate the cervix [ 1 , 6 ]. Aggressive traction increases the risk of cephalic entrapment which increases the risk for asphyxiation [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

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Footling Breech Delivery in an Emergency Department Without Obstetrical Services: A Case Report

Bragg,

Bragg

2024

Cureus

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Hospitals without formal obstetric services place the emergency physician in the position of managing potentially complicated precipitous labor and delivery such as breech presentations. Breech deliveries pose an increased risk of significant morbidity and mortality to both the mother and fetus. Recent emphasis on cesarean section as the optimal delivery method for breech presentation has decreased education and comfort levels with breech vaginal deliveries. This case study highlights a patient who presented to a suburban emergency department (ED) in active labor with a footling breech presentation. No obstetrical services were available. The delivery was successful, and the neonate was resuscitated. Though emergency medicine residents receive training in standard vaginal deliveries, most residents do not receive firsthand experience with difficult deliveries. This case highlights the need for policy and procedure and annual competency training for physicians and allied staff in ED facilities without obstetrical services. Structured protocols and annual simulation training will improve outcomes for imminent deliveries with potential complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Footling Breech Delivery in an Emergency Department Without Obstetrical Services: A Case Report

Bragg,

Bragg

2024

Cureus

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“…There are no formal guidelines for prehospital personnel that would lead them to suggest to the command and control center in the emergency department that placental abruption has occurred. After the initial diagnosis, it is suggested that the timing for delivery of the child is important; however, there is no guideline to suggest whether the delivery should be done in the emergency department or in the operating theatre [11,12]. We present a case of placental abruption that was diagnosed based on the mechanism of injury for a woman, 8 months pregnant, who complained of moderate abdominal pain following a Motor Vehicle Crash (MVC) of only moderate severity.…”

Section: Introductionmentioning

confidence: 99%

Emergency Department Cesarean Section for Placental Abruption; Anticipation from Prehospital History with Preparation for Immediate Delivery

Sundararajan

Speybroeck

Marsee

et al. 2020

COGO

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Emergency department cesarean section for placental abruption is an uncommon surgical procedure that requires anticipation in the prehospital environment as well as preemptive recognition of impending fetal demise by the emergency physician. The presence of an obstetrician ready to perform immediate cesarean section on an unstable patient with placental abruption may be lifesaving for both the mother and the fetus. However, there are no specific guidelines for prehospital recognition of patients with placental abruption that require emergency cesarean section. While the emergency department is not the optimum surgical theatre for an emergency cesarean section, placental abruption often deteriorates so quickly that even a few minutes of delay can have catastrophic consequences for both mother and fetus. We describe a case of placental abruption following moderate motor vehicular trauma in an eight month pregnant woman whose only complaint was moderate abdominal pain. The emergency physician’s suspicion based on the mechanism of injury caused her to mobilize the obstetrician, who was ready to perform an emergency department cesarean section with successful delivery of the fetus. Subsequent managing of the mother’s surgical incision and coagulopathy was performed in the operating room. This case highlights the importance of vigilance that prehospital providers, emergency department physicians, and obstetricians should have for a pregnant patient involved in a motor vehicle crash.

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Obstetric/Gynecologic Emergencies

Wares¹,

Bullard²

2022

Emergency Medicine Simulation Workbook

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Precipitous Labor and Emergency Department Delivery

Cited by 5 publications

References 21 publications

Footling Breech Delivery in an Emergency Department Without Obstetrical Services: A Case Report

Footling Breech Delivery in an Emergency Department Without Obstetrical Services: A Case Report

Emergency Department Cesarean Section for Placental Abruption; Anticipation from Prehospital History with Preparation for Immediate Delivery

Obstetric/Gynecologic Emergencies

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