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Critical Care Guidelines
Consider known malpresentation of fetus (i.e. breech, shoulder dystocia etc.)
Consider contacting obstetrician for consult
Supplemental oxygen as required (maintain SpO
Consider establishing IV access if further treatment required
General principles for managing delivery of child:
Delivery should be controlled so as to allow a slow controlled delivery of the infant.
Support the infant’s head as needed
Check the umbilical cord surrounding the neck. If it is present, slip it over the head. If unable to free the cord from the neck, double clamp the cord and cut between the clamps.
Grasping the head with hands over the ears, gently pull down to allow delivery of the anterior shoulder.
Gently pull up on the head to allow delivery of the posterior shoulder.
Slowly deliver the remainder of the infant.
Clamp the cord 2 inches from the abdomen with 2 clamps and cut the cord between the clamps.
Calculate and record the APGAR scores at 1 and 5 minutes.
Refer to NRP guidelines for neonatal assessment and resuscitation
General Principles for care of mother:
The placenta will deliver spontaneously, usually within 5 minutes of the infant. Do not force the placenta to deliver.
Massaging the uterus may facilitate delivery of the placenta and decrease bleeding by facilitating uterine contractions
Consider TXA in uncontrolled vaginal bleeding
Consider manual in utero pressure and packing