Labor and Delivery in the Emergency Department
- Author: Thomas E Benzoni, DO; Chief Editor: Mark A Clark, MD more...
Background
Few events cause more stress for the full time emergency physician than a pregnant woman at full term who is ready to deliver in the ED. This article discusses the delivery of a newborn in the ED; for a more general discussion of full-term obstetric delivery, see eMedicine article Labor and Delivery, Normal Delivery of the Newborn.
Pathophysiology
Pregnancy and delivery are natural processes that have been occurring for millennia. For millennia, delivery of the pregnant woman was the province of nonmedical (such as there was) personnel. As medical care progressed, nurses began the systematic medicalization of prenatal, delivery, and postnatal care (nurse-midwifery). This transition began in Europe, eventually crossing the Atlantic.
In the United States, one of the earliest, most reputable and still active groups is Frontier Nursing Service. Physicians have become involved only in the relatively recent past. Therefore, attendance to the natural course is mandatory; interventions are indicated only in the event of deviations from the natural or expected course.
Epidemiology
Frequency
United States
The precise incidence of ED deliveries of pregnant full-term patients is unknown. In 2005, 14 births occurred per 1000 total population. Fertility rates (births per 1000 women aged 15-44 y) decreased to 66.7. Approximately 80% received prenatal care in the first trimester.[1]
Mortality/Morbidity
The infant death rate for 2004 was 6.78 per 1000 live births.[1] The maternal death rate in 1997 was 7.7 per 100,000 births (37.1 in 1960).[2]
Race
The numbers of members of racial groups who receive prenatal care differ and are correlated to the probability of their seeking care in the ED.
- In 2005, 57% of all mothers sought care in the first trimester.[1]
- The percentage of white mothers seeking any prenatal care was 99.5%, with the percentage of black mothers close behind at 98.7%.[1]
Age
Fertility rate statistics have 15 years as the lower cutoff point. However, laboratory testing should be performed to rule out pregnancy when any female capable of reproduction (potentially as young as 9 y) presents with abdominal complaints and when pregnancy cannot be ruled out at physical examination.
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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