Obstetric emergency

You are a paramedic in your first-year post-qualification, working with a graduate who has only been on road for 2 months. You are dispatched to a 28-year-old female, with imminent delivery. The information you have is:
  • G3: P1, 41 weeks gestation
  • Membranes ruptured 2 hours ago at home
  • The onset of regular painful contractions 30 minutes ago, she called the hospital and was advised to come in; it’s approximately a 20-minute drive from her home.
  • She is unable to move herself to the car between contractions as she has developed a sudden and overwhelming urge to push. Her partner calls 000.
  • You are 15 km from the location with a 9-minute response time
  • Backup 15 minutes away and dispatched at the same time
  • Unremarkable antenatal history, except for well-controlled gestational diabetes
  • Regular check-ups with the general practice nurse and midwife.
  • Previous normal singular vaginal births.

On arrival, you find the woman, Sophie, lying on her bed actively pushing and the baby’s head is beginning to crown. Her partner, Tom, is relieved to see you. You only have time to place your equipment down before the head is birthed with Sophie’s next push.

On the next contraction you then recognize:

  • there is no restitution of the head
  • the chin is firmly on the perineum and retracting
  • Sophie continues to push with significant pain

1) Provide a definition and overview of the obstetric condition the patient is presenting with?

2) List and discuss the pertinent risk factors that this patient has when considering the presenting condition.

3) Describe one of the maneuvers or actions that is linked with this obstetric emergency and provide a pathophysiological rationale?

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