Pearls for Transporting High Risk OB

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Specializes in HEMS 6 years.

Title says it all !

I'm a flight nurse in the U.S. and would like to hear from the experts on high risk OB. If you have any "pearls" to share, and what you, as a receiving RN want done and what you want to know. I realize the topic is broad, so if you want to tell me your pet peeves that's ok too !

Thank You,

Rio

ps: I've been through NRP and clinical rotations in the NICU/L&D a few times.

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Lay the patient on her side, not her back.

Have doc's preferred antiseizure med immediately available

18 gauge IV

Get standing orders for antibiotics for preterm labor - it's given to the mom, but studies have shown babies with abx on board fair better in the NICU

If the baby delivers itself, put it skin to skin with mom as she is the best radiant warmer. You can administer blow by and do vitals on mom's chest. If the baby is crying, you have time. If the baby is flaccid and not breathing, then pull the baby for bagging and chest compressions if appropriate.

Most docs will say not to touch the cord or cut it. People have even waited a week or more for the placenta and cord to gently pull off the baby, so waiting 30 minutes won't hurt.

Have pitocin, methergine, and hemabate ready for post partum hemmorhage. The hemmorhage will occur after the placenta delivers. After the placenta delivers is when the most hemodynamic changes occur for mom.

Forgive yourself if a baby delivers or dies enroute. You really can't stop nature from occuring.

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Lay the patient on her side, not her back.

Have doc's preferred antiseizure med immediately available

18 gauge IV

Get standing orders for antibiotics for preterm labor - it's given to the mom, but studies have shown babies with abx on board fair better in the NICU

If the baby delivers itself, put it skin to skin with mom as she is the best radiant warmer. You can administer blow by and do vitals on mom's chest. If the baby is crying, you have time. If the baby is flaccid and not breathing, then pull the baby for bagging and chest compressions if appropriate.

Most docs will say not to touch the cord or cut it. People have even waited a week or more for the placenta and cord to gently pull off the baby, so waiting 30 minutes won't hurt.

Have pitocin, methergine, and hemabate ready for post partum hemmorhage. The hemmorhage will occur after the placenta delivers. After the placenta delivers is when the most hemodynamic changes occur for mom.

Forgive yourself if a baby delivers or dies enroute. You really can't stop nature from occuring.

:yeahthat:

And can't stress enough, skin to skin, skin to skin, skin to skin, under warm blankets on Mom. We have had two moms and babes brought in by squad in the last two months. Neither baby was skin to skin. They were 95 and 96 degrees rectally. :nono:

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Specializes in NICU, PICU, educator.

I can say in the almost 20 years I have been where I am, we have never had a high risk mom deliver enroute that was being transferred from another facility. If mom is going to deliver, she stays put, delivers and then we sent the NICU team for baby and if mom needs higher care then the OB's go separately. Will you be having a doc with you? We send the OB fellows out with the team to get moms and the NICU fellow and a NICU nurse for the baby with the transport team.

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Due to COBRA laws, you can't transport unstable patients BETWEEN facilities. However, flight nurses often will transport from the field, and that is where I've seen the most complications enroute.

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Specializes in HEMS 6 years.
Due to COBRA laws, you can't transport unstable patients BETWEEN facilities. However, flight nurses often will transport from the field, and that is where I've seen the most complications enroute.

hmmmmm.... we transport high risk OB interfacility ie: preterm labor, placenta previa ,PIH, abruptio placenta, pulmonary embolism etc...

Meds we carry (besides ACLS, RSI, cardiac etc..) for OB: Terbutaline, Pitocin, Mag. Sulfate, Labetalol, Hydralizine, phenergan, zofran....

In fact ALL our patients are unstable, yes we do scenes calls (about 50/50) but medical scene calls are rare as are OB in the field (for us). We are transporting inter-facility from a lower level of care to a higher level of care, and that meets COBRA requirements.

All our flights are strictly monitored for appropriate utilization ie: insurance doesn't pay for transporting stable patients. At least in my neck of the woods.

Oh yeah ! SKIN TO SKIN ! What a great tip, TY !

It would be rare we'd have opportunity to use it in the air transport enviro, but I like it non the less. More a ground transport issue. If we did, please NO, have imminent delivery in flight, our plan is to land, deliver baby and then continue transport.

thanks again ! there must be more ?

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Specializes in Maternal - Child Health.
Due to COBRA laws, you can't transport unstable patients BETWEEN facilities. However, flight nurses often will transport from the field, and that is where I've seen the most complications enroute.

I think you might mean EMTALA, which governs the initial care, stabilization and transport of ER and OB patients.

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Specializes in HEMS 6 years.
I think you might mean EMTALA, which governs the initial care, stabilization and transport of ER and OB patients.

EMTALA, Emergency Medical Treatment and Active Labor Act was enacted in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

EMTALA only applies to hospitals participating in Medicare.

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I work in a high risk OB setting, I wish that when a pt is transported with Magnesium Sulfate, whether it be PTL or preeclampsia, that the referring hospital would make sure that a foley is in place. We sometimes have pts that come by ground transport, been in the ambulance for 2.5-3 hours and no foley . . .their poor bladders are about to burst when they get to us! That's my main soapbox . . . I'm stepping off now.

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RNKitty, we also transfer high risk between facilities, but if something imminent is going to happen, we instruct the paramedics/EMTs to pull over for immediate assessment/intervention and/or divert to the nearest acute facility.

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As a nurse who has been on the side deciding to transfer a patient from a level I to a level III, or deliver and then transfer, my concept of a "stable" patient is one who has a chance of making it to the receiving facility before delivery. I actually do realize that patients are transferred because they are high risk.

I have also been in the ambulance praying for the patient not to deliver until we get there. Now I work "there" in a level III, and the only patient that gets transferred out is the baby who needs ECMO.

Of COURSE we transport interfacility. However, some patients are coming from the field. Sheesh.

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