BIRTH COMPLICATIONS

Pre-Term Labour

• Pre-term Labour is defined as birth between 20-37 weeks gestation.
• Assess gestation and whether birth is imminent.
• If birth is imminent, prepare for birth on scene and notify EOC.
• If birth is not imminent, pre-alert the nearest obstetric unit or ED with obstetrics onsite.
• If the mother is visibly pregnant or the fundus is palpable at the umbilicus, the gestation is likely to be over 20 weeks.
• Any pregnancy over 20 weeks without antenatal care requires safeguarding through EBS.
• Signs of preterm labour include: regular contractions, period-type pain or pressure in the vagina, membrane rupture, backache. Bleeding after 20 weeks is a RED FLAG.
• If birth is not imminent, reassess the mother continuously en route.
• Survival focused care: Applicable for gestation 21+6 weeks and below.
• Comfort care: Applicable for gestation 22 weeks and above, gestation unknown and eyes fused, gestation unknown and eyes not fused.

Cord Prolapse

• Cord prolapse is when the umbilical cord exits the vagina prior to birth.
• This commonly occurs with membrane rupture, especially in cases of pre-term labour, breech presentation, or multiple births.
• The cord may be visible at the vaginal opening or felt by the woman.
• Inspection with consent is necessary for diagnosis.
• Cord prolapse is a TIME CRITICAL EMERGENCY.
• Risks: The presenting part (head or buttocks) compressing the cord can cause fetal hypoxia, leading to brain damage or death.
• Management: Pre-alert the nearest obstetric unit, minimise handling of the cord, gently replace it to the vulva using a clean dry pad, avoid re-inserting the cord into the vagina.
• Assist the mother into an exaggerated SIMs position while transferring to the ambulance.
• If there's a delay in transferring the mother to the ambulance, consider the knees-chest position (not for conveying).

Multiple Births

• A lower threshold for conveyance is recommended if birth isn't imminent.
• If birth occurs on scene, clamp the cord of the first twin immediately.
• Thermoregulation is crucial due to the likelihood of pre-term/smaller babies.
• There may be several minutes to hours between the birth of the first baby and subsequent babies.
• Do not delay on scene.

Breech Birth

• Breech birth occurs when the buttocks or feet present first.
• It is more common in pre-term births and multiple births.
• The longer the time from the birth of the buttocks to complete delivery, the greater the risk of hypoxic injury.
• Interventions may be required if the birth is slow.
• If the feet come out first and are not immediately followed by the buttocks, this is an emergency (Footling breech) and requires rapid transport to hospital.
• Use the Maternity Action Tool checklist for management.
• Prepare for NLS and/or PPH, and call for additional support (second crew, APP-CC, CTM, IRO).
• Keep hands POISED, ready to intervene or receive the baby.
• Set a timer as a delay indicates intervention is required.

Shoulder Dystocia

• Shoulder dystocia occurs when the baby's head is born but the shoulders become stuck on the mother's pelvic bone, preventing the birth of the baby's body.
• It's diagnosed if, after the head is born, the body is not born within the next two contractions.
• Axial Traction: Apply steady pressure in a straight line (not upward or downward).
• Use the Maternity Action Tool checklist for management.
• Prepare for NLS and PPH.
• Early pre-alert is essential.
• Document the time of the head delivery and any maneuvers performed.
• Avoid encouraging the woman to push or apply upward/downward/excessive traction.

Summary

• Birth complications can be unpredictable, so call for help early in maternity cases.
• Utilize the maternal assessment and obstetric emergencies cards on JRCALC+ to guide management.
• Do not request a midwife during an obstetric emergency; this will delay care (unless the patient declines transfer).
• Datix all birth complications.

This quiz covers the vital aspects of pre-term labour, including definitions, assessment criteria, and emergency actions required when faced with imminent birth situations. It also addresses the management of cord prolapse and associated complications. Test your knowledge on these critical obstetric emergencies!