When the stork arrives unannounced - seven years of emergency deliveries in a non-obstetric general hospital.
BACKGROUND
Emergency department deliveries are uncommon in the Singapore setting, but when they do occur, the emergency physician has to be able to deliver the child safely, perform neonatal resuscitation if needed, and try to prevent any birth trauma to the child or complications of delivery in the mother. We present our experience of emergency room deliveries spanning 7 years in a community hospital without obstetric or neonatal backup.


METHODS
This is a retrospective case series. A search was made through our electronic medical records system for patients presenting in labour or with deliveries from March 1997 to October 2004. They were studied for demographic and social factors, gravidity and parity, as well as any complications (during birth and in the immediate post-delivery period) in both parent and child.


RESULTS
Twenty-three patients presented to our emergency department with labour contractions, and 14 progressed to vaginal deliveries. Twelve were single mothers who had hidden their pregnancies, while another 2 married patients had unsuspected pregnancies. No neonate needed resuscitation or airway support, but there were 4 patients without episiotomy who sustained perineal tears, and another 2 patients in whom the placenta could not be delivered. A child (born to a single mother without antenatal care) had a low Apgar score, but improved with oxygen and suctioning.


CONCLUSIONS
An emergency department in a non-obstetric hospital should have in place adequate preparations to cater for the occasional unexpected emergency delivery and the associated need for neonatal resuscitation. In our series, there was a high proportion of concealed (hidden) and "unaware" pregnancies presenting in labour. Prompt referral to a maternity hospital with neonatal care should be made for any complications.
Goh
S H
SH
Accident & Emergency Department, Changi General Hospital, Singapore. Siang_Hiong_Goh@cgh.com.sg
Tiah
L
L
Lai
S M
SM
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004635:Emergency Medicine / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006764:Hospitals, Community / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D007752:Obstetric Labor, Premature / Q000453:epidemiology*; D036801:Parturition; D011247:Pregnancy; D012151:Resuscitation; D012189:Retrospective Studies; D018570:Risk Assessment; D012846:Singapore / Q000453:epidemiology