Precipitous birth not occurring on a labor and delivery unit
- Vanessa A Barss, MD, FACOG
Vanessa A Barss, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Associate Clinical Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Section Editors
- Susan M Ramin, MD
Susan M Ramin, MD
- Section Editor — Obstetrics
- The American Board of Obstetrics and Gynecology (ABOG)
- Robert S Hockberger, MD, FACEP
Robert S Hockberger, MD, FACEP
- Section Editor — Adult Signs and Symptoms
- Emeritus Professor of Medicine
- David Geffen School of Medicine at UCLA
The term precipitate or precipitous labor has been defined as a labor that lasts no more than three hours from onset of regular contractions to delivery. Each year, hundreds of deliveries in the United States occur precipitously in emergency departments and medical and surgical hospital rooms, as well as outside of the hospital setting in homes and cars. In most of these cases, labor and delivery results in good outcomes in the absence of physician/midwife intervention or a traditional delivery site. This topic will review the key points for assisting women during an imminent delivery of a fetus in cephalic presentation. It is intended for healthcare providers who do not perform obstetrical deliveries as part of their usual practice.
Several videos that show how to deliver a baby are available online. Clinicians who may find themselves in this situation may want to periodically review one of these films (eg, www.operationalmedicine.org/ed2/Video/delivery_of_a_baby_video.htm).
ASSESSMENT AND PREPARATION
●Call for help. There are two patients in an obstetrical delivery, the mother and the infant; each should have at least one healthcare provider. An obstetrician and pediatrician or family practitioners should be summoned, if available.
●Ask the woman her gravidity and parity. Find out if she has any obstetrical or medical problems, such as twin gestation, preterm fetus, previous cesarean delivery, fetal anomalies, maternal bleeding diathesis or other medical conditions that may complicate delivery or immediate newborn care. Also ask if she has a headache, scotomata, or epigastric pain, which are signs of preeclampsia. Lastly, find out if and when her "bag of waters" ruptured.
- ASSESSMENT AND PREPARATION
- EQUIPMENT AND SUPPLIES
- Intravenous access
- Instructions to the mother
- Controlling and guiding the delivery
- Newborn care and assessment
- Clamping and cutting the umbilical cord
- Delivery of the placenta
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS