Labor and Delivery in the Emergency Department Follow-up
- Author: Thomas E Benzoni, DO; Chief Editor: Mark A Clark, MD more...
Transfer
- A specific body of law governs transfer of patients in labor. It is too large to review here. Please see the article on COBRA Laws and EMTALA. The original statute was passed as a part of a much larger bill, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Consequently, the acronym COBRA was used frequently in medical literature when referring to the statute. This statute is also titled the Emergency Medical Treatment and Active Labor Act (EMTALA). Since the latter name is more specific and descriptive, it has become the preferred acronym for referring to the statute. The full text of the statute can be found in any public library's reference section under 42 U.S.C.A. Section 1395dd et seq.[3]
- When it is deemed necessary to transfer a patient in labor because of anticipated risks to the neonate, it is generally best to transport her before delivery. This will normally give the neonate the optimal environment pending arrival at the facility that has the needed equipment and personnel available.
- Stabilization must be achieved. Labor should usually be arrested (eg, terbutaline, magnesium sulfate, ritodrine). Care is coordinated with the receiving facility and physician.
Complications
- Several items, including the umbilical cord and placenta previa, can be felt at initial vaginal examination.
- Umbilical cord compression: Have someone insert a sterile gloved hand into the vagina, into the cervix, and against the pelvic wall, while maintaining space between the index and middle fingers for the cord to pass uncompressed. This individual should accompany the patient and stay in this position until the operating surgeon or obstetrician directs otherwise.
- Placenta previa: Copious vaginal bleeding usually heralds placenta previa. The mother may be aware of this condition prior to admittance to the ED. Do not perform a vaginal examination in a patient who is bleeding vaginally and in labor. Order an immediate ultrasonography, type and cross-match blood, and alert a surgeon and an obstetrician.
- Stillbirth may occasionally occur; despite everyone's best efforts, a child may be born without signs of life.
- Psychological support for the parents is mandatory. Grieving occurs, with all of its potential for pathologic processes.
- If available, a clergyperson should visit the parents.
- Recommend a support group to the parents.
Prognosis
Childbirth is a natural process.
Patient Education
- For excellent patient education resources, visit eMedicine's Pregnancy and Reproduction Center. Also, see eMedicine's patient education article Labor Signs.
National Center for Health Statistics. Vital Stats Births. Available at http://www.cdc.gov/nchs/datawh/vitalstats/VitalStatsbirths.htm. Accessed April 11, 2008.
CDC. Healthier mothers and babies. MMWR Morb Mortal Wkly Rep. Oct 1 1999;48(38):849-58. [Medline]. [Full Text].
Frew S. MedLaw. Available at www.medlaw.com.
[Guideline] ACOG Committee on Ethics. Innovative practice: Ethical Guidelines. [Full Text].
Danforth DN. Obstetrics and Gynecology. 4th ed. Philadelphia, Pa: Harper and Row; 1982.
Mifsud AJ, Efstratiou A, Charlett A. Early-onset neonatal group B streptococcal infection in London: 1990-1999. BJOG. Sep 2004;111(9):1006-11. [Medline].
Willson JR. Atlas of Obstetric Technic. 2nd ed. St Louis, Mo: Mosby; 1969.
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