Emergency Department Preparedness

Every ED should be prepared for emergency delivery by preparing a basic delivery kit ( T§b!e l03:l) and having an infant warmer/isolette and supplies for neonatal resuscitation (see Chap 9, on neonatal resuscitation). Medications for emergency delivery are listed in Table 103-2. Because of the relative infrequency of ED

delivery, extra care must be taken to educate physicians and nursing staff through periodic didactic and equipment orientation sessions.

TABLE 103-1 Equipment and Supplies for Emergency Delivery*

TABLE 103-2 Medications for Emergency Delivery and Indications for Use

EVALUATING THE PREGNANT PATIENT

Any pregnant woman beyond 20 weeks gestation who arrives in the ED with signs of active labor should be carefully evaluated to determine the condition of both mother and fetus. An important component of this is the medical and obstetric history of the patient, including parity and estimated date of delivery (EDD). If the last menstrual period (LMP) is known and a pregnancy wheel is not available, the EDD can be calculated by adding 9 months and 7 days to the LMP. Although useful for providing a rough estimate, ultrasound examination late in the third trimester is not an accurate predictor of gestational age, as estimates of EDD can vary up to 3 weeks. Fundal height also provides a rapid estimate of gestational age in the patient who does not recall her LMP or EDD. Fundal height is measured in centimeters (centimeters = weeks of gestation ± 2 weeks) from the pubic symphysis to the top of the fundus as palpated by the examiner. This measurement can lead to overestimation in obese patients. One must obtain pertinent medical information on such matters as allergies, medications, drug and alcohol use, and prenatal care as well as to elicit any past history of complications with prior deliveries or precipitous labor.

Every patient presenting with signs of active labor should receive immediate monitoring of maternal vital signs and fetal heart rate. Maternal blood pressure should be monitored, and Doppler heart tones are helpful to confirm normal fetal heart rate (120 to 160 beats per minute). A persistently slow fetal heart rate (less than 100 beats per minute) is an indicator of fetal distress, and emergent obstetric consultation is necessary.

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