Obstetric and Newborn Emergencies

1. Assessing the Pregnant Patient

You're gathering the same handful of facts on every OB call. How many weeks pregnant. How many prior pregnancies and deliveries. Is there bleeding or fluid leaking. Are there contractions, and how far apart. Is there an urge to push, or a feeling like she needs to have a bowel movement. Were there complications this pregnancy.

That last question about the urge to push is going to matter more than it sounds like it should. So does one more finding you check for directly: crowning, the baby's head visible at the vaginal opening.

Delivery is imminent when contractions are about 2 minutes apart or less. It's also imminent when the patient reports an urge to push, or a feeling of needing to move her bowels. Or crowning is visible. Any one of those three, on its own, changes your plan. Imminent delivery means you deliver on scene. You don't put a crowning patient in a moving ambulance.

Position matters too, and it's a separate problem from timing. After roughly 20 weeks, the growing uterus is heavy enough to compress the vena cava when the patient lies flat. That vein carries blood back to the heart. So compressing it drops the blood returning to the heart, and blood pressure drops with it. That's supine hypotensive syndrome. So you transport a pregnant patient tilted to her left side, or with the right hip elevated. You do that after roughly 20 weeks, regardless of what else is going on.