Prehospital Management

Regardless of the reason for precipitous delivery, this and other third-trimester emergencies require preparedness by both hospital and prehospital providers. Emergency medical system (EMS) personnel must be trained to recognize active labor and manage the precipitous delivery appropriately. Pregnancy-related complications that may occur in the prehospital setting include preeclampsia, eclampsia, maternal hemorrhage, and complications of labor such as cord prolapse and fetal distress. Prehospital personnel need to be aware of available obstetric and neonatal units in the system's catchment area. The development of specialty centers has led to a significant decline in neonatal mortality, particularly among infants weighing less than 1500 g at birth. High-risk maternal units have proliferated as well. As a consequence, transport of pregnant patients for reasons of maternal bleeding, eclampsia or preeclampsia, fetal distress, multiple gestations, fetal anomalies, and other maternal health problems including traumatic injuries has increased markedly. The most common reason for the transport of patients to tertiary care centers is simple premature rupture of membranes.

Prehospital units transporting patient in active labor should be prepared by carrying sterile delivery packs and medical supplies and medications for maternal and neonatal emergencies. The transport team should be trained to assist in the precipitous delivery of an infant and educated in the use of basic obstetric supplies. Prehospital protocols should be reviewed often so that EMS personnel remain prepared for the rare but potentially catastrophic pregnancy-related event.

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