Valerie Dobiesz - Manual of Obstetric Emergencies

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Library of Congress Cataloging-in-Publication Data

ISBN-13: 978-1-4963-9906-9 |eISBN: 9781496399076

ISBN-10: 1-4963-9906-4

Library of Congress Control Number: 2020900688

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This book is dedicated to all the future mothers and babies we hope will be positively impacted by this book. We would not be here, both literally and figuratively, without our own mothers, Jeannine Marie Antoinette Paquin Dobiesz and Kathleen (Kitty) Kerrigan, and we thank them for that.

Death, taxes and childbirth! Theres never any convenient time for any of them.

Margaret Mitchell, Gone with the Wind

Talk about a dream, try to make it real

Bruce Springsteen

Preface

It is with great pride and immense joy that we present the first edition of the Manual of Obstetric Emergencies. This book represents the culmination of years of dedication and effort to improve maternal health in the emergency setting and a unique collaboration of physicians from emergency medicine and obstetrics and gynecology. Our collective goal is to provide a valuable and practical evidence-based resource for health care providers to access in their time of need when caring for both pregnant women throughout the pregnancy continuum as well as neonates after a precipitous delivery.

As emergency medicine providers, we are taught to manage normal uncomplicated births during our clinical training with the complex cases being immediately relegated to our obstetrics colleagues. The reality is that post training when we are working in our clinical practices we may be called upon to manage the most complicated of deliveries with little time to prepare. Births in the emergency department are low frequency but high-risk events. Our hope is that this manual will benefit the providers, mothers, and neonates who find themselves in these unplanned situations.

As hospitals across the United States are losing obstetric services or closing, the chance of a precipitous delivery in the emergency department will likely increase. Less than half of women in rural areas are within 30 minutes of a hospital providing obstetric services. Practitioners working in these emergency settings may be called upon to manage very complex obstetric emergencies without any advanced warning, training, or practice.

We present to you a practical guide regarding the management of hypertensive emergencies, preterm labor, multiple gestation, postpartum hemorrhage, complicated deliveries, and neonatal resuscitation among other important topics. Our friends and colleagues from emergency medicine and obstetrics and gynecology have shared their time, talent, and expertise to help create this excellent resource and for this, we are eternally grateful.

The target audience for this manual is any practitioner providing care in the prehospital or emergency setting. While management options such as fetal monitoring are the foundation of care on a labor and delivery unit, we focus less on this intervention as it is not widely available in the emergency setting. We understand that transfer to a location with comprehensive obstetric and neonatal services is always the best option for the mother and infant, however, there are times when that is not possible, or if possible, may be delayed. We aspire to help optimize the care of pregnant women in your care during these crucial times.

Improving maternal health, especially the care provided in the emergency setting, is paramount and the driving force for creating this book. It is essential to have knowledgeable and well-trained health care providers in order to achieve this goal as the stakes are high when there are two patients involved. We hope this will be a useful resource and guide and that you and your patients will be forever grateful you had it at your disposal.

Valerie A. Dobiesz
Boston, Massachusetts
Kathleen A. Kerrigan
Springfield, Massachusetts

Acknowledgments

This book would not be possible without the love and support of my wonderful family. I want to thank my husband Timothy, who is such a supportive partner in all my adventures. A special thanks to my extraordinary children, Camille, Isabelle, Celeste, and Julian. You inspire me every day and I am eternally grateful for your love, support, and encouragement. I have been blessed with many formative teachers and mentors and for that I am thankful. To Dr. Ron Walls I owe a particular debt of gratitude for his active mentoring and sponsorship in making this book possible. Thank you and I promise to pay it forward.