2. Delivery in the ER
Preparedness for Antepartum, Intrapartum, and Postpartum Complications
Joel Henry, M.D. Associate Professor, Ob/Gyn

3. I have no financial disclosures

4. Antepartum Complications
Direct Pregnancy Related
Other Systemic Complaints related to pregnancy

5. Pregnancy Related Bleeding
Preterm Labor (<37 completed weeks from last menstrual period)
Premature Rupture of Membranes

6. Third Trimester Bleeding
Placenta Previa
Placental Abruption
Uterine Scar Disruption
Vasa Previa
Friable cervix

7. Third Trimester Bleeding
Gentle Speculum exam is OK, but avoid a digital cervical exam unless an ultrasound reveals no Placenta Previa

8. Important Systemic Complaints
Headache
Hypertension (>140/90)
Shortness of Breath (P.E, A.F.E., Cardiomyopathy)
Leg Pain/Swelling

9. Hypertension Chronic Hypertension Gestational Hypertension
Pre-eclampsia
Chronic Hypertension with Superimposed Pre-eclampsia

10. Pre-eclampsia Severe Hypertension >160/105
IV Labetalol or Hydralazine
Lower BP to reduce risk of CVA
Prevent seizures with Magnesium Sulfate
Expedite delivery

11. Intrapartum Assessment
Presentation / Malpresentation
Ultrasound for position
Cervical Dilation
Fetal Heart Rate ( BPM)

12. Delivery
Gentle back pressure on fetal head to control the delivery and reduce perineal trauma

13. Shoulder Dystocia Avoid Excessive Downward Traction !!!
Flex maternal legs way back
Rotate fetal body to oblique position
Try to deliver posterior arm

14. Breech Avoid temptation to pull
Allow maternal pushing to deliver to the level of the scapulae, with fetus facing downwards.
Gently sweep arms out
Keep fetal chin flexed, to deliver the head

15. Postpartum Care Active Management of the Third Stage
10 Units of Pitocin IM
Fundal massage to firm up the uterine muscle
Gentle traction on the umbilical cord to tell when the placenta has separated

16. Inspect cervix, vagina, and perineum for lacerations
Postpartum Care
Inspect cervix, vagina, and perineum for lacerations

17. Postpartum Complications
Hemorrhage ( >500 ml blood loss)
DIC
Seizures

18. Perimortem Cesarean
Immediate surgical delivery of a viable fetus if no maternal heart rate for 4 minutes