Obstetric emergencies require the EMT to recognize the stages of labor, signs of imminent delivery, and several specific complications. Labor progresses through the first stage (cervical dilation), the second stage (delivery of the baby), and the third stage (delivery of the placenta). Imminent delivery is signaled by crowning (the baby's head visible at the vaginal opening), a strong urge to push, and contractions less than 2 minutes apart. If the umbilical cord is wrapped around the newborn's neck (nuchal cord), the EMT gently attempts to slip the cord over the head; if it is too tight, the cord is clamped and cut. Before cutting, two clamps are placed on the cord, cutting between them at approximately 4 and 6 inches from the newborn's abdomen.
Immediately after birth, the newborn is dried, warmed, positioned, suctioned if needed, and stimulated to breathe. Resuscitation is guided by heart rate: a newborn heart rate above 100 bpm indicates adequate perfusion; below 100 bpm after initial stimulation, positive pressure ventilation is begun; below 60 bpm despite ventilation, chest compressions are added. Newborn status is then assessed using the APGAR score at 1 and 5 minutes after birth, evaluating Appearance, Pulse, Grimace, Activity, and Respiration. Complications include prolapsed umbilical cord, in which the mother is positioned with hips elevated or in knee-chest position and the EMT inserts gloved fingers to relieve pressure on the cord without pushing it back in, and breech birth, where the buttocks or feet present first. Preeclampsia is pregnancy-induced hypertension with headache, visual disturbances, and edema; placental abruption causes painful vaginal bleeding with dark blood from premature placental separation; placenta previa produces painless bright red bleeding because the placenta covers or nears the cervix.
Pediatric patients differ from adults in important ways. The pediatric airway has a proportionally larger tongue, smaller airway diameter, a more anterior and superior larynx, and a floppy epiglottis, all of which make airway management more challenging. Slight padding under the shoulders helps maintain a neutral sniffing position because infants have a large occiput. The leading cause of cardiac arrest in children is respiratory failure, in contrast to adults where cardiac causes predominate, so prompt recognition and management of respiratory distress is critical. The Pediatric Assessment Triangle provides a rapid visual evaluation based on appearance, work of breathing, and circulation to the skin, while age-appropriate vital sign norms are essential because children vary significantly by age. Common pediatric respiratory complaints include croup (a viral upper airway infection with seal-bark cough and stridor) and epiglottitis (a bacterial, life-threatening infection with drooling, tripod positioning, and stridor); in suspected epiglottitis, the EMT avoids examining the throat or agitating the child, which could trigger complete airway obstruction.
The leading cause of pediatric trauma death is head injury, and Sudden Infant Death Syndrome (SIDS) refers to the sudden, unexplained death of an infant under one year, usually during sleep. Signs of respiratory distress in infants include nasal flaring, grunting, retractions, and see-saw breathing. Red flags for child abuse include injuries inconsistent with the stated mechanism, injuries in various stages of healing, patterned bruising, and delayed care-seeking; EMTs have a legal obligation to report suspected abuse or neglect to appropriate authorities per state law.