Fetal Heart Tones Down

Lateral positioning (either left or right

IV fluid bolus of LR, if appropriate for pt
Stop pitocin
O2 Administration via mask at 10 L/min. Considered
if: minimal to absent variability and/or recurrent late
decels or prolonged decels (discontinue asap based
on fetal status).
Call for help
Vaginal Exam, unless pt has placenta previa
Fetal Scalp Electrode, if not contraindicated
Assess uterine activity
Consider Terbutaline per physician order
Documentation: Describe FHR pattern, what did you
do, who did you notify, maternal education, discuss
POC w/ Dr. & patient

Shoulder Dystocia

Risk Factors:
Turtling sign with pushing
LGA/Big baby/Diabetic Mom
If Shoulder Dystocia likely:
Multiple step stools in room for delivery
Get extra help
Note time of delivery of head
Note maneuvers performed/clinician that performed maneuvers
McRoberts Maneuverpull pt legs back
REALLY far
Suprapubic pressurepressure on the lower
abdomen on the opposite side the head is facing to disengage the anterior shoulder
Clearly state, I am performing ______
Wood screw maneuver CORK Screw?
Delivery of the posterior arm
Zavinelli maneuverpush head back up; go
for c/s (poor survival rate)
Gaskin Maneuver (knee-chest position)
Call Code Neo when Shoulder Dystocia confirmed

Shoulder Dystocia cont.

Documentation
Time of delivery of head
Time of delivery of shoulder (note seconds
from time of head delivery)
Time of delivery of infant (note seconds from
time of head delivery
All care providers present
Maneuvers performed, times performed, and
clinician who performed them
Was infant vigorous at delivery
Discuss w/ physicianall information must
correlate

Neonatal Code

Assess Baby (Color, RR, Tone, HR)

Dry & Stimulate (if no meconium)
Place O2 Sat Probe
Check Pulse
Check Respiratory Effort
Pull Emergency NICU button
Begin NRP
If HR < 100: Begin PPV
PPV Pace: 40-60 breaths per min
Breathe-2-3
For 30 seconds, then Reassess
If HR < 60: Begin Chest Compressions
3:1 ratio of Compressions to Breaths
Follow NRP Guidelines
*PINK CODE CARTS ARE FOR INFANTS

Maternal Collapse

Check clock5 minutes to deliver baby!

Wedge momdisplace uterus
Check pulse and breath sounds
Call for helpYell, Code Button in room, or Code
Blue
Get ADULT code cart
Apply AED pads
If shocking mom, unplug FSE!!!
Unplug everything else from the monitors as
well
Start Chest Compressions 30:2 (continue chest
compressions even during delivery of baby)
Prepare for emergency c/s of baby at bedside if no
maternal pulse

Cord Prolapse
Risk Factors:
Head not well applied to cervix.(Ballotable head floats up when you push on it)
Preterm labor
Polyhydramnios
Breech/Malpresentation

What do you do?

SVE immediately to identify prolapsed cord
Keep hand in! You push up on the presenting
part to keep it from cutting off circulation to
the cord.
Do not touch cord.
CALL FOR HELP!
Turn pt to hands-knees or trendelenburg
Move to stat delivery
Emergent OB Code

Postpartum Hemorrhage

Aggressive fundal massage, provide support above

symphysis pubis to prevent uterine prolapse
Trendeleburg position
CALL FOR HELP
Q5min V/Sassess for tachycardia, hypotension
Oxygen 10L/min via mask, if applicable
Assess LOC
Stay with your pt
Make sure babys safeplace in crib
Speak clearly; state peoples names when communicating with them
Document times and measures taken
Straight cath bladder, if applicable
Physician may manually remove clots from uterus
or retained placenta
Multiple large bore IV access w/ bags of fluids
Labwork: CBC, Clotting Factors, Type & Cross, if
ordered per physician
Physicians may consider D&C for retained placenta

Postpartum Hemorrhage Cont.

Weigh your chux/pads (zero the scale first)

Document amount of blood loss
Steady trickles of bright red blood that continue may indicate a cervical laceration that
will need repainr
Medications
Pitocin (Oxytocin)
IVcan give up to 40 units per L
IMcan give 20 units (10 units in each
thigh)- Lauries email from 02/04 says 10
units
Cytotec (Misoprostol)
800-1000 mcg rectally (only post-delivery)
Methergine
Dose 0.2 mg IM
Contraindicated with HTN or preeclampsia
Breastfeeding: If on oral therapy when milk
comes in, patient needs to pump and dump up
to 12 hours after last dose IS this right?
Hemabate
250 mcg deep IM
Contraindicated with asthma
Causes diarrhea; request order for Lomotil

Postpartum Hemorrhage Cont.

Risk Factors
Uterine atony
Multigravida
Multiple gestation
Hx of PPH
Lengthy IOL/time on Pitocin
Received Magnesium
Full bladder
Cervical laceration
Retained placental products
Clotting disorders