February 20, 2017

Episode 85.0 – Challenging Deliveries

11 minutes

This week we discuss three common complications of delivery: cord prolapse, nuchal cord and shoulder dystocia.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_85_0_Final_Cut.m4a

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Tags: Cord Prolapse, Nuchal Cord, Obstetrics, Shoulder Dystocia

Show Notes

Take Home Points

If you have a patient with a cord prolapse, elevate the presenting part to take pressure off the cord, place the patient in trendelenburg and fill the bladder. Then, redline it to the OR for a c-section.

Nuchal cord is common but likely not too dangerous. Just gently unwrap the umbilical cord and the fetus should be just fine

Shoulder dystocia isn’t common but it’s a true emergency as the fetus can suffer severe hypoxia or death. You’ve got a bout 5 minutes to deliver. Immediately call for help from OB, place a foley catheter to drain the bladder and place the mom’s legs so that her knees are pressed into her chest. This helps to open up the pelvis and give more room for the shoulder to be delivered. If that doesn’t work, you can try the wood’s screw maneuver or place the mom on all 4s. If you’ve got an OR ready, pushing the head back in is also an option but only if you have an OR available

Read More

Core EM: Shoulder Dystocia

emDocs: The Complicated Delivery: What You Can Do

Del Portal DA et al. Emergency department management of shoulder dystocia. J Emerg Med. 2014 Mar;46(3):378-82. PMID: 24360351

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