Podcast 880: OB Delivery in the ED

<p dir="ltr"><strong>Contributor: Meghan Hurley MD</strong></p> <p dir="ltr"><strong>Educational Pearls:</strong></p> <p dir="ltr">Pearls about labor:</p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Labor is split into 3 stages.</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Stage 1 starts when the first persistent contractions are felt and goes up until the cervix is fully dilated and the mother starts pushing. Stage 1 is split into two phases: the latent phase (cervix is dilated from 0-4 cm), and the active phase (cervix dilates from 4-10 cm). The latent phase can take between 6 and 12 hours with contractions happening every 5 to 15 minutes. The active phase usually lasts 4-8 hours with contractions occurring as close as every 3 minutes.</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Stage 2 is the birth itself, lasting between 20 minutes and 2 hours.</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Stage 3 is the delivery of the placenta and typically takes 30 minutes. </p> </li> </ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">37 weeks gestational age is the cutoff for preterm.</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Placenta previa: Condition when the placenta overlies the cervix. Classically presents as painless vaginal bleeding in the 3rd trimester. If suspected placenta previa, avoid a speculum exam. Placenta previa can be confirmed on ultrasound. </p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">If the baby is crowning in the ER then the baby should be delivered in the ER. The ideal presentation on crowning is head first (Vertex), specifically ‘left occiput anterior’. In this position, the baby is head first and the head is facing towards the gurney at a slight angle. If the baby is coming out in a breech position then the provider should “elevate the presenting part” by maintaining pressure on the baby as the mother is wheel