1. Emergency Delivery 임상전임강사 권 자 영

2. Initial evaluation Parity EDC (estimated date of confinement) Medical and Obstetrical history –(ex. previa, precipitating labor…) US- presentation, active heart beat Palpation (false vs true) Pelvic exam

3. Effacement Dilatation Station Presentation Cord?

4. Vertex Transverse lie Frank breech Complete breechFootling

5. Stages of labor 3-4cm to full Full dilation to fetal expulsion Placental expulsion

6. Cardinal movements

7. Crowning 4cm Spinal needle-1% lidocaine injection along the incision site Median vs. right mediolateral (eg. Preterm)

10. Delivery of the placenta (Stage 3)

14. McRoberts Woods Rubin Delivery of posterior arm SHOULDER DYSTOCIA

15. Cord prolapse Tocolysis with Terbutaline 0.25 mg SC Push cord back into vagina and maintain with gauze pack Hand in vagina elevates presenting part Consider filling bladder with 500-700 cc Saline Minimize handling of the cord Do not attempt to replace cord back into uterus Adjust maternal position to reduce cord pressure Mother in knee-chest position

18. Breech delivery Term vs Preterm Complications –Head entrapment –Cord prolapse –Fetal acidosis and asphyxia –Cervical cord injury –Fracture

19. Cesarean delivery is commonly but not exclusively used in the following circumstances: 1.A large fetus. 2.Any degree of contraction or unfavorable shape of the pelvis. 3.A hyperextended head. 4.When delivery is indicated in the absence of spontaneous labor (some clinicians use oxytocin augmentation). 5.Uterine dysfunction (some use oxytocin augmentation). 6.Incomplete or footling breech presentation. 7.An apparently healthy and viable preterm fetus with the mother in either active labor or in whom delivery is indicated. 8.Severe fetal growth restriction. 9.Previous perinatal death or children suffering from birth trauma. 10.A request for sterilization. 11.Lack of an experienced operator.

20. ‘Spontaneous delivery up to umbilicus level’