Patient Safety Alert

When responding to a female of childbearing age where the nature of the call is suggestive that a baby has been delivered, the following actions must be taken by the crew on arrival at the property:

1. Complete primary survey as usual, following DRCABCDE approach, providing any immediate interventions to sustain life as necessary.
2. Take history of condition.
3. Perform thorough search of the property for any items/tissue/blood which the patient has passed PV. Examine these products with care to ascertain whether a foetus has been delivered.
4. Should a foetus be discovered, use the following guidance to determine your actions:

If known or suspected 24 or more weeks of gestation	Resuscitate and rapidly transport to hospital
If known or suspected less than 24 weeks of gestation with signs of life	Support signs of life and rapidly transport to hospital
If known or suspected less than 24 weeks gestation with no signs of life	Arrange dignity and support for mother and family members and convey mother and foetus to hospital

 

Assessing for signs of life MUST include auscultation of heart sounds alongside assessment of the baby’s primary survey.

Nature of calls which may indicate delivery (list not exhaustive): PV bleed, miscarriage, pre-term delivery, delivery, birth, labour, obstetric emergency

Exceptions: signs unequivocally associated with death - foetal maceration (when the child is still born and died more than a day before birth as indicated by the skin loosening and sloughing off when touched). 

Regardless of resuscitation decisions, all foetal tissue must be conveyed to hospital. This should be done in a dignified manner using a cuddle pocket for a foetus who shows no signs of life.

Please see JRCALC/clinical manual app/emergency birth in the community cards for further reference. 

If you have any further concerns, please contact your LOM for assistance.

Appendix 1 – Approximate Size of Baby by Gestational Age