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P Section 5 Obstetric Emergencies
P Section 5 Obstetric Emergencies
Query labour
If no progress with
labour consider Patient in
No
transporting patient labour
Yes
Birth imminent or
No
travel time too long
Yes
Go to Cord
Cord
Complication Yes
complication
CPG
No
Go to
Breech
Breech Birth Yes
birth
CPG
No
Support baby
throughout delivery
Go to
Neonate Baby
No
Resuscitation stable
CPG
Yes
Go to
Primary Mother
No
Survey stable
CPG
Yes
5/6.5.2
05/08 Basic & Advanced Life Support – Neonate (< 4 weeks) P AP
From
Childbirth Birth
CPG
Term gestation
Amniotic fluid clear Yes
No
Request
ALS
Initiate mobilisation of 3 to 4
practitioners / responders
on site to assist with cardiac Provide warmth Provide warmth
arrest management Position; Clear airway if necessary Dry baby
Dry, stimulate, reposition
Assess respirations,
heart rate & colour Breathing, HR > 100
Apnoeic or HR < 100
OBSTETRIC EMERGENCIES
Breathing, HR > 100 but Cyanotic
Give Supplementary O2
Persistent
CPR 3 : 1 No
Cyanosis
Compressions : Ventilations
Yes
HR < 60
Assess Heart
Rate
HR 60 to 100 S5
CPR (ratio 3:1) for 30 sec
Breathing well, HR > 100
Assess Heart
HR 60 to 100 Breathing well, HR > 100
Rate
HR < 60
Continue CPR
Consider
NaCl 0.9%, 10 mL/kg IV/IO
5/6.5.3
05/08 Haemorrhage in Pregnancy Prior to Delivery P AP
Do not examine
abdomen or vagina
Oxygen therapy
Patient is
Yes haemodynamically No
unstable
OBSTETRIC EMERGENCIES
Request
ALS
Reassess
Go to
Shock
CPG
S5
Reference: Sweet, BR, 2000, Mayes’ Midwifery, 12th Edition, Bailleire Tindall
2nd stage of
labour complete
Estimate
blood loss
Oxygen therapy
Syntometrine, 1 mL IM
(if not already administered)
Mother is
Yes haemodynamically No
unstable
Request
ALS
Postpartum Haemorrhage
External massage of the uterus
OBSTETRIC EMERGENCIES
administration of
Syntometrine
AP Consider
inserting a urinary
catheter
Go to
Shock
CPG
S5
Reference: Sweet, BR, 2000, Mayes’ Midwifery, 12th Edition, Bailleire Tindall
Cord
complication
Oxygen therapy
Cord around
baby’s neck Cord rupture Prolapsed cord
Apply additional
Attempt to slip the cord Mother to adopt
clamps to cord
over the baby’s head knee chest position
No
Maintain cord temperature
Clamp cord in two places and and moisture
cut between both clamps
Go to
Childbirth In labour No
CPG
Yes
Consider
Nifedipine, 20 mg, PO
S5
Reference: Sweet, BR, 2000, Mayes’ Midwifery, 12th Edition, Bailleire Tindall
Katz Z et al, 1988, Management of labor with umbilical cord prolaps: A 5 year study. Obstet. Gynecol. 72(2): 278-281
Duley, LMM, 2002, Clinical Guideline No 1(B), Tocolytic Drugs for women in preterm labour, Royal College of Obstetricians and gynaecologists
5/6.5.6
05/08 Breech Birth P AP
Breech birth
presentation
Oxygen therapy
Yes Successful
No
delivery
No
OBSTETRIC EMERGENCIES
Nape of neck
anteriorly visible at No
vulva
Breech Birth
Go to
Consider Childbirth Yes
CPG
Entonox
Successful
Yes delivery after 5
contractions
No