Critical Care Obstetrics part 14 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Neonatal Resuscitation administer adequate chest compressions. However regardless of the method used those responsible for chest compressions and for continued ventilation of the infant must position themselves so that they do not interfere with one another. It is helpful for a third team member to monitor for palpable pulses during compressions. It is currently recommended that chest compressions occur 90 times a minute with ventilation interposed after every third compression. Thus in a 2- second period 3 compressions and 1 breath are given. This provides 90 compressions and 30 respirations in each minute. Intermittently chest compressions should be stopped to check for a spontaneous heart rate. If the spontaneous heart rate is greater than 60 beats min compressions may be stopped. If well-coordinated chest compressions and ventilation do not raise the infant s heart rate above 60 beats min within 30 seconds support of the cardiovascular system with medications is indicated. Medications If the heart rate remains below 60 min despite ventilation and chest compression the first action should be to ensure that ventilations and compressions are well coordinated and optimal and 100 oxygen is being used before proceeding with medications. Epinephrine is indicated when in the rare infant positive-pressure ventilation and chest compressions fail to correct the neonatal bradycardia. Where the infant appears to be in shock there is evidence of blood loss and the infant is not responding to resuscitation volume expanders may be indicated. Clearly the best choice for giving epinephrine or volume expanders is via an umbilical venous catheter. If while preparing for placement of the venous catheter epinephrine is needed it can be given via an endotracheal tube. Resuscitative placement of the umbilical vein catheter differs from postresuscitative placement. The umbilical catheter is inserted slightly past the level of the skin - only to the point where blood is first able to be
