Labor and Delivery in the Emergency Department
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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 the Medscape article Normal Delivery of the Infant.
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.
The precise incidence of US ED deliveries of pregnant full-term patients is unknown. In 2015, 3,978,497 births were registered in the United States. The fertility rate (births per 1000 women aged 15-44 y) was 62.5 births per 1000 women. Additionally, 8.07% had low birthweight, 9.63% were preterm, and 40.3% of mothers were unmarried. The cesarean delivery rate declined in 2015, to 32% of all US births. [1]
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.
Childbirth is a natural process.
For patient education resources, visit the Pregnancy Center. Also, see the patient education article Labor Signs.
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Mathews TJ. Births: Final Data for 2015. National Vital Statistics Reports. January 5, 2017. Available at https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_01.pdf.
National Center for Health Statistics. Infant Health. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/nchs/fastats/infant-health.htm. March 31, 2017; Accessed: July 26, 2017.
Centers for Disease Control and Prevention. Pregnancy-Related Deaths. Available at http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/Pregnancy-relatedMortality.htm. July 7, 2017; Accessed: July 26, 2017.
Frew S. MedLaw. Available at http://www.medlaw.com.
[Guideline] ACOG Committee on Ethics. Innovative Practice: Ethical Guidelines. Available at http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Innovative-Practice-Ethical-Guidelines. Reaffirmed 2015; Accessed: July 26, 2017.
Danforth DN. Obstetrics and Gynecology. 4th ed. Philadelphia, Pa: Harper and Row; 1982.
Willson JR. Atlas of Obstetric Technic. 2nd ed. St Louis, Mo: Mosby; 1969.
Thomas E Benzoni, DO, MT(ASCP) Attending Staff, Department of Emergency Medicine, Methodist Medical Center; Medical Director, Iowa Disaster Medical Assistance Team, Iowa Department of Health (IA DMAT IDPH)
Thomas E Benzoni, DO, MT(ASCP) is a member of the following medical societies: American College of Emergency Physicians, Iowa Medical Society, American College of Osteopathic Emergency Physicians, American Osteopathic Association
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Mark Zwanger, MD, MBA
Mark Zwanger, MD, MBA is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.
Mark A Clark, MD Medical Director, Block Island Medical Center; Assistant Clinical Professor, Department of Emergency Medicine, St Luke’s-Roosevelt Hospital Center
Mark A Clark, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors
Disclosure: Nothing to disclose.
Assaad J Sayah, MD, FACEP Senior Vice President and Chief Medical Officer, Cambridge Health Alliance
Assaad J Sayah, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society
Disclosure: Nothing to disclose.
Labor and Delivery in the Emergency Department
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