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Clinical Indications: updated 02/2009

    Imminent delivery with crowning

Any patient over 20 weeks of gestation should be taken to an OB Facility.


    1. Delivery should be controlled so as to allow a slow controlled delivery of the infant. This will
    prevent injury to the mother and infant.

    2. Support the infant's head as needed.

    3. Check the umbilical cord surrounding the neck. If it is present, slip it over the head. If unable
    to free the cord from the neck, double clamp the cord and cut between the clamps.

    4. Suction the airway with a bulb syringe.

    5. Grasping the head with hands over the ears, gently pull down to allow delivery of the anterior

    6. Gently pull up on the head to allow delivery of the posterior shoulder.

    7. Slowly deliver the remainder of the infant.

    8. Clamp the cord 2 inches from the abdomen with 2 clamps and cut the cord between the

    9. Record APGAR scores at 1 and 5 minutes.

    10. Follow the Newly Born Protocol for further treatment.

    11. The placenta will deliver spontaneously, usually within 5 minutes of the infant. Do not force
    the placenta to deliver.

    12. Massaging the uterus may facilitate delivery of the placenta and decrease bleeding by
    facilitating uterine contractions.

    13. Continue rapid transport to the hospital.

Certification Requirements:

    Maintain knowledge of the indications, contraindications, technique, and possible
    complications of the procedure. Assessment of this knowledge may be accomplished via
    quality assurance mechanisms, classroom demonstrations, skills stations, or other
    mechanisms as deemed appropriate by the local EMS System.

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