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Activation and room setup
Delivery readiness
Immediate OB and anesthesia notification
If no OB available, senior ED clinician lead and rapid transfer planning
If gestational age uncertain and birth imminent, treat as viable until proven otherwise
Neonatal team notification
If no neonatal team, assign airway clinician to newborn station
If anticipated preterm or meconium or maternal instability, add second neonatal helper
Two stations
Maternal bed with left uterine displacement
Newborn warmer with resuscitation equipment
Hemorrhage readiness
Massive hemorrhage protocol criteria visible
Uterotonics and TXA at bedside
Time zero documentation
Time of crowning
Time of birth
Maternal stabilization
Maternal priorities
Airway and breathing threats
If altered mental status or seizure, airway plan and magnesium pathway
If hypoxemia, oxygen with target SpO2 per clinical context
Circulation threats
Two large bore IV lines
If hypotension or ongoing heavy bleeding, early blood products
Positioning
Left uterine displacement
Supine hypotension trigger
If dizziness or pallor or SBP drop, immediate tilt and fluids
Analgesia options
Local anesthetic for perineal repair if needed
Avoid deep sedation if imminent birth unless airway controlled
Delivery preparation
Birth sequence
Supplies
Sterile gloves and drapes
Bulb syringe
Two clamps and scissors
Towels and hat
Perineal support
Controlled head delivery
Avoid traction on fetal head
Cord management
If vigorous newborn, delayed clamping 30 to 60 s when feasible
If nonvigorous or resuscitation needed, immediate clamping for transfer to warmer
Placenta planning
No traction on cord without uterine support
If placenta not delivered by 30 min or bleeding heavy, urgent OB escalation
Neonatal readiness
Newborn resuscitation core
Golden minute goal
Positive pressure ventilation by 60 s if apneic or gasping or HR < 100 per min (AHA neonatal resuscitation guidance)
Rising heart rate as primary marker of effective ventilation (Canadian Paediatric Society NRP FAQ)
Equipment checks
Warmth source on
Bag mask and PEEP capable device
Supraglottic airway available for rescue ventilation (AHA neonatal resuscitation guidance)
Pulse oximeter and ECG leads
Compression threshold
If HR < 60 per min after 30 s effective ventilation, chest compressions (AHA 2020 neonatal resuscitation)
Critical complication triggers
Immediate escalation triggers
Shoulder dystocia
Head delivered with turtle sign
Failure of shoulders to deliver with routine gentle traction
Breech at perineum
Buttocks or feet presenting
Umbilicus delivered without rapid progress
Cord prolapse
Cord visible or palpable with presenting part high
Postpartum hemorrhage
Ongoing brisk bleeding
Uterine atony
Shock index rising
Maternal collapse
Syncope or seizure or severe dyspnea
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.