Editing Maternal and Newborn Nursing (section)

=== Obstetric emergencies ===

* '''Umbilical cord prolapse''' - suspect with sudden prolonged deceleration or variable decelerations right after rupture of membranes, especially with a high presenting part, malpresentation, polyhydramnios, or a long cord. '''Actions: call for help, place a gloved hand in the vagina and hold the presenting part off the cord, place the patient in knee-chest or steep Trendelenburg or exaggerated Sims position, give oxygen, stop oxytocin, and prepare for emergency cesarean birth. Do not attempt to push the cord back in.''' If the cord is visible, keep it moist with warm sterile saline gauze. The nurse's hand stays in place until delivery.
* '''Shoulder dystocia''' - the head delivers and retracts against the perineum (turtle sign). '''McRoberts maneuver''' (hyperflex the maternal thighs sharply onto the abdomen) plus '''suprapubic''' pressure. '''Never apply fundal pressure''', which worsens impaction and risks uterine rupture. Watch for postpartum hemorrhage and for neonatal brachial plexus injury or clavicle fracture.
* '''Uterine rupture''' - sudden severe abdominal pain often described as tearing, loss of fetal station, an abnormal fetal heart rate or loss of tracing, cessation of contractions, and signs of shock. Highest concern with a prior classical uterine incision or trial of labor after cesarean. Immediate surgical delivery.
* '''Amniotic fluid embolism''' - abrupt hypoxia and respiratory distress, cardiovascular collapse, and DIC, typically in labor or just after birth. Care is immediate cardiopulmonary resuscitation and support, oxygen, and massive transfusion.
* '''Chorioamnionitis''' - maternal fever, maternal and fetal tachycardia, uterine tenderness, foul-smelling fluid. Antibiotics and delivery.