Preterm delivery is a major cause of precipitous childbirth and is often the cause of emergency delivery. Preterm infants also more often present in the breech position, which is associated with a greater incidence of infant morbidity and mortality. Carefully control the delivery to reduce the likelihood of trauma to the fragile preterm infant. Deliver the infant slowly and immediately dry and warm it while performing the initial assessment, as the premature infant is much more likely to require resuscitation. The decision to initiate resuscitative efforts in the ED is often difficult, as patients may deliver extremely premature fetuses of unknown gestational age. One sign of extreme prematurity is eyelids that are still fused. In general, even very premature deliveries (18 to 22 weeks) should receive initial resuscitative efforts until determination of viability is made.
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