• Timothy C Stallard and Bo Burns.
• Department of Emergency Medicine, Health Science Center, Texas A&M University System, Temple, TX, USA. tstallard@swmail.sw.org
• Emerg. Med. Clin. North Am. 2003 Aug 1;21(3):679-93.

AbstractThe emergency department is a suboptimal location for delivery, and the greater prevalence of complicated presentations and emergency deliveries results in higher morbidity and mortality. Any woman greater than 20 weeks' gestation in labor is considered medically unstable and should be triaged quickly. Fetal viability occurs after 24 to 26 weeks' gestation. Placenta previa and abruption should be considered in a woman in labor with ongoing bleeding, and ultrasound evaluation should be performed emergently. Continuous fetal monitoring is the best method to assess for heart rate variations, accelerations, or decelerations. After the fetus crowns, a finger sweep can exclude the presence of a cord prolapse or nuchal cord. Set up a safety net by notifying appropriate specialists when a complicated delivery is suspected. In shoulder dystocia, generous episiotomy, drainage of the bladder, McRobert's maneuver, and suprapubic pressure may all help disengage the anterior shoulder. With a cord prolapse, the mother is instructed not to push, and the presenting part is elevated off of the cord. Perimortum cesarean delivery is performed with gestational age greater than 24 to 26 weeks. The supine position can lead to aortocaval compression. Perimortum cesarean delivery should be performed within 4 minutes of maternal cardiopulmonary arrest.

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