PRACTICE PARTNER
heart rate did not increase to above 100 bpm until
14 minutes of age and yet the infant was not inten-
sively monitored until the transport team arrived.
The anesthetist transferred care to the pediatrician,
but appears to have left the infant’s bedside 25
minutes after birth, well before the arrival of the
pediatrician at 75 minutes after birth. This is a very
critical period in which close assessment, supportive
care and a decision about instituting therapeutic
hypothermia often needs to be made.
• It is recognized that this delivery took place in a
Level 1 hospital and that quick access to person-
nel that are skilled and experienced in resuscitation
and the care of a sick newborn may be problematic.
However, it is important that any hospital provid-
ing obstetrical services have staff attending deliveries
that are fully certified in NRP and assigned to care
for the infant. In addition, when circumstances arise
that carry with them increased risk of delivering a
compromised infant, there should be attempts to
mobilize individuals with special skills in neonatal
resuscitation to attend the birth.
Recommendations:
1. The SOGC should consider developing a guide-
line for difficult Cesareans, particularly including
difficult extraction of the fetus, to better prepare
obstetrical caregivers for these emergency
situations.
2. At the time of the “surgical check list”, obstetrical
care providers should discuss the possibility of
difficult extraction and put a plan in place on how
to approach it.
3. Those responsible for quality of care for mater-
nal-newborn services at any hospital must en-
sure that staff is adequately trained and acces-
sible to provide full resuscitative efforts to any
newborn as prescribed by Neonatal Resuscitation
Program (NRP).
4. Obstetrical and neonatal care providers are re-
minded of the need to document events related
to the management of newborns accurately and
contemporaneously. MD
• The documentation of events surrounding the birth of
this infant was inconsistent and at times, incomplete.
ISSUE 3, 2017 DIALOGUE
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