Emergent Delivery for Certified Emergency Nursing (CEN)

Emergent Delivery

Definition/Etiology:

Defined as delivery of a baby after rapid labor, usually less than 3 hours in an unexpected setting

Pathophysiology:

• First stage of labor (Dilation): starts with cervical dilation and ends when cervix is dilated to 10cm
• Second stage of labor (Expulsion): starts when cervix is dilated to 10cm and ends with the delivery of the neonate
• Third stage of labor (Placental): starts with the delivery of the neonate and ends with delivery of the placenta.

Clinical Presentation:

• Rapidly progressing stages of labor
• Amniotic fluid rupture
• Crowning
• Desire to bear down

Collaborative Management:

• Pelvic Exam
• IV fluids
• Pitocin
• Lab work including a type and screen if time permits
• Get ready to catch!

Evaluation | Patient Monitoring | Education:

Hemodynamic monitoring:
Signs of shock for mom. Evaluate for postpartum hemorrhage and don’t forget that fundal massage

Fetal/toco monitoring:

• Don’t forget fetal heart rate should be between 110-160.
• Less than 110 is fetal bradycardia (WE ARE WORRIED)
  • Look for cause such as cord prolapse, maternal seizures, paracervical block

Keep that baby warm after delivery
APGAR Score at 1 and 5 minutes = intervention as indicated

Linchpins: (Key Points)

• Emergent delivery is happening now, no time to transport to an OB facility
• You have two patients (even when they are one) so make sure you are monitoring both
• Happy moms and babies are clean, warm and dry.
• Transport is key but both need to be stable prior to going.