• Vol. 34 No. 7, 432–436
  • 15 August 2005

When the Stork Arrives Unannounced – Seven Years of Emergency Deliveries in a Non-obstetric General Hospital

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ABSTRACT

Introduction: 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. Materials and 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.


Emergency department (ED) deliveries are uncommon in the Singapore setting, as patients presenting with labour to the ED are sent to the obstetric suites in Kandang Kerbau Women’s and Children’s Hospital (KKH), National University Hospital (NUH) and Singapore General Hospital upon arrival. The same applies to the various private hospitals with obstetric services in Singapore. Tan Tock Seng Hospital and Alexandra Hospital do not have obstetric services, but are in close proximity to KKH and NUH respectively. However, Changi General Hospital (CGH), which is a community hospital located in the east of Singapore, has no immediate access to obstetric delivery or paediatric services. Residents in the eastern part of Singapore can take between 20 to 30 minutes, depending on traffic conditions, to travel to our designated maternity hospital (KKH). As such, we have encountered patients in the surrounding residential areas coming into our ED in advanced stages of labour. Our emergency physicians have 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 decided to study the demographics and outcomes of emergency room deliveries spanning 7 years in our community hospital, without obstetric and neonatal backup.

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