Delivery complications include the following topics: breech delivery; limb presentation; cord prolapse; and shoulder dystocia.
Breech presentation: The fetus whose presenting part is the buttocks and/or feet.
Most fetuses with persistent breech presentation are delivered by cesarean delivery, which is associated with a clinically significant decrease in perinatal/neonatal mortality and neonatal morbidity compared with vaginal delivery
Breech can be frank, complete, or footling - treatment is the same
Single limb presentation: This is a critical presentation which is immediately life threatening to both mother and neonate. Rapid conveyance is indicated.
Cord prolapse: The cord is the primary presenting part. This is immediately life threatening to the fetus and requires rapid recognition and conveyance.
Shoulder dystocia: The anterior shoulder of the fetus is impacted against the symphysis pubis of the mother.
All cases of delivery complications must be conveyed to the closest, most appropriate facility, unless birth is imminent. Certain complications are a surgical emergency and require rapid conveyance with notification, as specialty services may be required.
Smaller facilities, although ill equipped to handle complex deliveries, can often safely perform caesarean sections, which can be lifesaving for both the mother and the neonate.
Immediate conveyance of limb presentation and cord prolapse patients is indicated.
It is suggested to attempt to deliver breech and shoulder dystocia patients in the field initially. After 10 minutes, provide rapid conveyance as the timeline to neonatal mortality increases. Rapid conveyance without attempting delivery leads to increased neonatal mortality.
First Responder (FR) Interventions
Provide position of comfort for patient
Keep patient warm and prevent heat loss
Emergency Medical Responder (EMR) & All License Levels Interventions