Emergency Delivery

Michael J. VanRooyen Julia B. VanRooyen

Prehospital Management Emergency .Qepa.rtment.prepare.d.ne.s.s Evaluating the Pregnant Patient

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Physical Examination

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Third.-T.rime?.ter ..Bleeding Placenta.Prev.i.a

Placental. .Abruption

Emergency Delivery Complications of. Qelivery

Shoulder Dystocia

Breech.. Presentation

Preterm.Delive.ry

Postpartum.Care Chapter References

The anxiety experienced by the emergency physician caring for a woman in active labor is not simply due to infrequent experience with normal deliveries in routine practice but also to awareness of the potential for serious and rarely fatal complications of labor. In addition, the initial management of such third-trimester emergencies as preeclampsia, eclampsia, and hemorrhage has major consequences for maternal and child survival. It is therefore important for emergency physicians to be prepared for actively laboring patients or for patients presenting during late pregnancy.

Despite advances in prenatal care and nearly ubiquitous availability of obstetric units in the United States, precipitous deliveries do occur with some frequency in emergency departments (ED). Out-of-hospital delivery may occur because patients are poorly educated, have had no prenatal care, lack transportation, residence in a remote location, or experience premature labor or delivery. A relatively recent and controversial practice is intentional precipitous labor, in which a woman desiring to avoid hospital charges delays care until the final stages of labor.

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