Emergency deliveryMANAGEMENT

PEDIATRIC-SPECIFIC PRESENTATIONS · 12 SECTIONS

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473 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Bronchiolitis Croup Emergency delivery Febrile seizure Intussusception Kawasaki disease Neonatal jaundice Neonatal sepsis Nursemaid's elbow Pediatric fever 0 to 28 days Pediatric fever 29 to 60 days Pediatric fever 61 to 90 days Pyloric stenosis

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

01Approach to the Critical Patient/attcp71

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

02History/hx41

Imminent delivery screen

›Time critical OB history

›Gravida para

›Prior cesarean delivery

›Prior postpartum hemorrhage

›Gestational age estimate

›Last menstrual period or due date

›Ultrasound dating if known

›Current labor timeline

›Contraction frequency

›Rupture of membranes timing

›Urge to push

›Complication symptoms

›Heavy vaginal bleeding

›Severe headache or visual symptoms

›Right upper quadrant pain

›Fever

›Fetal concerns

›Decreased fetal movement

›Known breech or placenta previa

Infection and prophylaxis considerations

›Infectious risks

›Group B strep status

›If unknown and delivery imminent, neonatal monitoring pathway

›Maternal fever or chorioamnionitis concern

›Prolonged rupture of membranes

›Foul smelling fluid

›Bloodborne precautions

›HIV status if known

›Hepatitis B status if known

Medication and comorbidity context

›Maternal factors

›Anticoagulant use

›Timing of last dose

›Hypertensive disorders

›Prior preeclampsia

›Current antihypertensives

›Diabetes

›Insulin use

›Allergies

›Ergot allergy

›Prostaglandin allergy

›Asthma

›Carboprost avoidance trigger

03Physical Exam/exam36

Maternal assessment

›Maternal status

›Vital signs trend

›Shock index

›Temperature

›Mental status

›Seizure activity

›Agitation from hypoxia or hemorrhage

›Abdominal exam

›Uterine tone

›Uterine tenderness

›Pelvic exam readiness

›Active bleeding amount

›Perineal anatomy

›Post delivery checks

›Fundal height and firmness

›Laceration inspection with lighting

Fetal and delivery assessment

›Delivery findings

›Presentation

›Vertex

›Breech

›Shoulder presentation concern

›Station

›Crowning

›Visible presenting part

›Cord

›Nuchal cord visibility

›Cord prolapse

›Amniotic fluid

›Meconium stained fluid

›Malodorous fluid

PITFALLS

›Common misses

›Underestimation of blood loss

›Quantitative blood loss preferred over visual estimation (SOGC Guideline No. 431 2022)

›Failure to check for genital tract lacerations

›Failure to reassess uterine tone after uterotonic dosing

›Excess traction on fetal head during shoulder dystocia

04Differential Diagnosis/ddx29

Causes of maternal instability during emergency delivery

›Life threatening etiologies

›Hemorrhagic

›Postpartum hemorrhage due to uterine atony ICD-10 O72.1

›Traumatic hemorrhage lacerations ICD-10 O70

›Retained placenta ICD-10 O73

›Uterine inversion ICD-10 O71.2

›Hypertensive

›Eclampsia ICD-10 O15

›Severe preeclampsia ICD-10 O14.1

›Thromboembolic

›Pulmonary embolism ICD-10 O88.2

›Amniotic fluid embolism ICD-10 O88.1

›Infectious

›Chorioamnionitis ICD-10 O41.1

›Sepsis ICD-10 O85

›Cardiopulmonary

›Peripartum cardiomyopathy ICD-10 O90.3

Delivery complications

›Obstetric emergencies

›Shoulder dystocia ICD-10 O66.0

›Breech delivery complication ICD-10 O32.1

›Cord prolapse ICD-10 O69.0

›Precipitous labor ICD-10 O62.3

›Placental abruption ICD-10 O45

›Placenta previa ICD-10 O44

Neonatal compromise

›Neonatal differentials

›Prematurity ICD-10 P07

›Neonatal depression at birth ICD-10 P21

›Meconium aspiration ICD-10 P24.0

›Neonatal sepsis risk ICD-10 P36

05Laboratory Tests/lt31

Maternal hemorrhage and preeclampsia panel

›Maternal critical labs

›Complete blood count for hemorrhage and anemia

›Hemoglobin trend over time

›Platelets for coagulopathy and HELLP screening

›Type and screen

›Type and crossmatch if ongoing bleeding or high risk

›Rh status documentation

›Coagulation tests

›INR

›aPTT

›Fibrinogen for severe hemorrhage suspicion

›Metabolic tests

›Creatinine for severe preeclampsia

›AST and ALT for HELLP

›Point of care glucose

›Glucose in mmol/l

Infection assessment

›Infectious workup

›Blood cultures if maternal fever and sepsis concern

›Antibiotics timing documentation

›Lactate in mmol/l for shock physiology

›Trend with resuscitation response

Neonatal related testing

›Newborn considerations

›Cord blood gases if available and neonatal depression

›pH

›pCO2 in mmHg

›pO2 in mmHg

›Glucose screening per local newborn pathway

›At risk infants

›Preterm

›Small for gestational age

›Infant of diabetic mother

06Diagnostic Tests/dt36

Scoring Systems

›Bedside scoring and thresholds

›Shock index

›HR divided by SBP

›Rising value as hemorrhage trigger

›Maternal early warning score system

›Escalation trigger for abnormal vitals trend

›ICU consult trigger for persistent abnormal score

›Neonatal resuscitation decision points

›Apnea or gasping at birth

›Heart rate thresholds 100 and 60 per min (AHA neonatal resuscitation guidance)

MRI

›MRI indications postpartum

›Neurologic deficit after delivery

›Stroke evaluation when CT nondiagnostic

›Suspected spinal epidural hematoma with neuraxial anesthesia history

›Urgent neurosurgery pathway

›Contraindications

›Unstable patient requiring ongoing resuscitation

›CT indications postpartum

›Suspected pulmonary embolism

›CT pulmonary angiography if stable and no contraindication

›Suspected intraabdominal hemorrhage not explained by genital tract findings

›CT abdomen pelvis if stable after initial control attempts

›Head CT

›Severe headache with focal deficit or seizure not typical for eclampsia response

Ultrasound

›Point of care ultrasound

›Fetal presentation confirmation

›Breech identification

›Transverse lie identification

›Placental location screening

›If heavy bleeding before delivery, previa suspicion

›Postpartum uterus assessment

›Retained products suspicion

›Uterine inversion identification

›Maternal shock evaluation

›IVC volume assessment

›Cardiac function and pericardial effusion

07Disposition/dispo27

Maternal disposition

›Level of care decisions

›Labor and delivery admission

›Any delivery in ED

›Any ongoing bleeding

›Operating room activation

›Uncontrolled hemorrhage

›Suspected uterine inversion not corrected rapidly

›Retained placenta with hemorrhage

›ICU admission triggers

›Persistent hypotension despite resuscitation

›Massive transfusion activation

›Respiratory failure

›Transfer criteria

›No obstetric capability and ongoing risk

›Stabilize then transport with uterotonic and blood products if needed

Newborn disposition

›Neonatal level of care

›Routine nursery observation

›Vigorous term infant

›Normal transition

›NICU evaluation

›Preterm

›Resuscitation beyond routine drying and stimulation

›Persistent respiratory distress

›Infection monitoring pathway

›Maternal fever

›Prolonged rupture of membranes

›Unknown GBS with no intrapartum prophylaxis

08Treatment/t115

Uncomplicated vertex delivery steps

›Normal delivery care

›Head delivery support

›Controlled extension

›Perineal support

›Nuchal cord management

›If loose, slip over head

›If tight and impeding delivery, clamp and cut

›Shoulder delivery

›Gentle downward traction for anterior shoulder

›Gentle upward traction for posterior shoulder

›Newborn transition

›Warm and dry and stimulate

›Hat and skin to skin when stable

›Active management of third stage

›Oxytocin for hemorrhage prevention (FIGO 2022)

Shoulder dystocia management

›Shoulder dystocia algorithm

›Immediate actions

›Call for help and timer

›Avoid fundal pressure

›First line maneuvers

›McRoberts maneuver as initial approach (ACOG referenced summary)

›Suprapubic pressure with McRoberts

›Direction toward posterior aspect of anterior shoulder to rotate into oblique position (NHS Scotland 2022)

›Second line maneuvers

›Posterior arm delivery consideration after McRoberts and suprapubic pressure (AAFP 2020)

›Internal rotational maneuvers

›Rubin maneuver

›Woods corkscrew maneuver

›Rescue maneuvers

›All fours position

›Clavicle fracture intentional avoidance preference

›Post event care

›Neonatal assessment for brachial plexus injury

›Maternal laceration assessment

Breech delivery emergency maneuvers

›Breech at perineum

›General principles

›Hands off until umbilicus delivered when feasible

›Avoid traction on fetal abdomen

›Arm delivery

›Lovset maneuver for nuchal arms

›Head delivery

›Mauriceau Smellie Veit maneuver for head flexion (NHS Scotland 2020)

›Suprapubic pressure assistance for flexion when needed

›Cord compression time sensitivity

›Rapid progression after umbilicus delivery

Postpartum hemorrhage pathway

›PPH initial actions

›Quantitative blood loss measurement (SOGC Guideline No. 431 2022)

›Uterine atony first steps

›Bimanual uterine massage and compression

›Bladder drainage

›Cause framework

›Tone

›Trauma

›Tissue

›Thrombin

Uterotonics and hemostatic medications

›Uterotonic and antifibrinolytic regimen

›Oxytocin

›Initiate 10 IU IM for treatment or prevention options (FIGO 2022)

›Initiate 20 to 40 IU in 1000 mL crystalloid infusion protocol per local guideline (FIGO 2022)

›Adverse effects

›Hypotension with rapid IV bolus

›Methylergonovine

›Initiate 0.2 mg IM

›Contraindications

›Hypertension or preeclampsia

›Carboprost

›Initiate 250 micrograms IM

›Repeat every 15 to 90 min as needed

›Maximum 2 mg total

›Contraindications

›Asthma

›Misoprostol

›Initiate 800 micrograms sublingual when injectable uterotonics unavailable per WHO referenced in midwifery guideline (Ontario Midwives 2024)

›Tranexamic acid

›Initiate 1 g IV as soon as possible and within 3 h of birth for clinically diagnosed PPH (WHO recommendation)

›Repeat 1 g IV if bleeding continues after 30 min or restarts within 24 h (WHO recommendation summary)

Hemorrhage escalation and procedures

›Escalation interventions

›IV access and resuscitation

›Balanced transfusion strategy if massive hemorrhage

›Calcium replacement per massive transfusion protocol

›Laceration management

›Direct pressure and suturing for identified tears

›Vaginal wall packing if diffuse oozing and awaiting OB

›Uterine tamponade

›Balloon tamponade device if available

›Foley balloon as temporizing option

›Uterine inversion

›Immediate manual replacement

›Tocolysis consideration if trapped cervix

›Uterotonic after replacement for tone

›Retained placenta

›OB removal pathway

›Antibiotic prophylaxis per local guideline

Neonatal resuscitation medications and advanced steps

›Neonatal resuscitation escalation

›Positive pressure ventilation

›Begin within 60 s for apnea or gasping or HR < 100 per min (AHA neonatal resuscitation guidance)

›Ventilation corrective steps if no chest rise

›Mask adjustment

›Reposition airway

›Suction mouth then nose

›Open mouth

›Pressure increase

›Alternative airway

›Chest compressions

›Initiate if HR < 60 per min after 30 s effective ventilation (AHA 2020 neonatal resuscitation)

›Ratio 3 to 1 with coordinated ventilation

›Epinephrine

›Umbilical venous catheter preferred

›IV or IO dose range 0.01 to 0.03 mg per kg using 1 mg in 10 mL concentration (NRP medication card)

›ET route as bridge if no vascular access

›Higher dosing required per NRP summary guidance

›Post resuscitation

›Glucose monitoring

›Temperature maintenance

›NICU consult for ongoing respiratory support

09Special Populations/sp28

Pregnancy

›Pregnancy specific considerations

›Viability and gestational age uncertainty

›Treat as potentially viable with neonatal readiness

›If extreme prematurity suspected, neonatal consult and goals of care discussion when feasible

›Medication safety

›Avoid methylergonovine in hypertensive disorders

›Avoid carboprost in asthma

›Rh alloimmunization prevention

›Rh negative status trigger for Rh immune globulin pathway per local protocol

›Trauma informed care

›Consent for pelvic exams when possible

›Support person and chaperone

Geriatric

›Advanced maternal age considerations

›Higher baseline hemorrhage risk

›Lower threshold for crossmatch and hemorrhage protocol

›Comorbidity burden

›Cardiac disease monitoring with fluid and transfusion

›Hypertensive disorders prevalence

›Early magnesium pathway if seizure or severe features

Pediatrics

›Adolescent pregnancy considerations

›Consent and privacy requirements per jurisdiction

›Social work involvement when appropriate

›Higher risk contexts

›Limited prenatal care

›Nutrition and anemia

›Newborn care planning

›Feeding support

›Safe discharge environment screening

10Background/b25

Epidemiology

›Context

›Precipitous labor definition

›Delivery within 3 h of labor onset ICD-10 O62.3

›Postpartum hemorrhage significance

›Major cause of maternal morbidity and mortality

›Shoulder dystocia frequency

›Unpredictable and can occur without risk factors

Pathophysiology

›Mechanisms

›Uterine atony

›Failure of myometrial contraction leads to continued bleeding

›Trauma

›Cervical or vaginal lacerations with firm uterus

›Tissue

›Retained placental fragments prevent uterine contraction

›Thrombin

›Coagulopathy worsens bleeding and limits uterotonic response

›Neonatal transition failure

›Inadequate lung aeration as primary driver of bradycardia

Therapeutic Considerations

›Evidence based principles

›Oxytocin first line for PPH prevention and treatment (FIGO 2022)

›Combined uterotonic therapy reduces PPH risk more than oxytocin alone (review data)

›Early TXA improves outcomes when given within 3 h for PPH (WHO recommendation)

›Ventilation is the key neonatal resuscitation intervention

›Delayed ventilation increases risk of death (AHA neonatal resuscitation guidance)

›Chest compressions reserved for persistent bradycardia after effective ventilation (AHA 2020)

11Patient Discharge Instructions/pdi24

copy discharge instructions

›Post delivery discharge guidance

›Expected course

›Vaginal bleeding similar to heavy period then tapering

›Cramping with uterine involution

›Return immediately criteria

›Soaking more than 1 pad per hour for 2 h

›Passing large clots

›Dizziness or fainting

›Fever

›Severe headache or vision changes

›Chest pain or shortness of breath

›Severe abdominal pain

›Wound care

›Perineal hygiene

›Sitz baths if recommended

›Follow up

›Obstetric follow up within 1 week if any complication

›Routine postpartum visit scheduling

›Newborn red flags

›Poor feeding

›Lethargy

›Breathing difficulty

›Fever or hypothermia

›Jaundice progression

12References/r10

Clinical guidelines and key sources

›Evidence sources

›American Heart Association neonatal resuscitation guidance and updates (AHA 2020 and 2023 focused update)

›Neonatal Resuscitation Program practice resources and medication card (PHSA NRP resources)

›WHO recommendation on tranexamic acid for postpartum hemorrhage

›FIGO recommendations on postpartum hemorrhage management and uterotonic dosing

›SOGC Guideline No. 431 postpartum hemorrhage and hemorrhagic shock considerations

›AAFP shoulder dystocia management review

›NHS Scotland shoulder dystocia guideline

›NHS Scotland intrapartum breech delivery guidance

›Project instruction source

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.