Position patient in the dorsal lithotomy position
Put on personal protective equipment
Prepare suction, airway equipment, and warmer for infant
Call for OB, NICU, pediatrics
Call for additional staff members
Divide team into maternal team and infant team (to receive infant after<unk> 
Infant's head bulges the perineum
If prolapsed cord is present, elevate the presenting fetal part, place patient in Trendelenburg position, and call OB stat
Gentle digital stretching with a lubricated finger may prevent tears and lacerations
Support the perineum with a sterile towel and place the other hand over the occiput to promote fetal head extension
Check for nuchal cord
If present, slip finger between infant's neck and cord and attempt to reduce cord by pulling over infant's head
If unable to reduce cord, clamp or cut cord if infant's face can be cleared from perineum with immediate suction
If present, slip finger between infant's neck and cord and attempt to reduce cord by pulling over infant's head
If unable to reduce cord, clamp or cut cord if infant's face can be cleared from perineum with immediate suction
If unable to reduce cord, clamp or cut cord if infant's face can be cleared from perineum with immediate suction
Position hands on either side of the head and exert a gentle downward force
Maintain position of hands and apply a small amount of upward traction
Controlled expulsion helps to prevent perineal lacerations
Hold the infant securely
Position in a manner that facilitates the flow of blood from the placenta to the infant
Stimulate and dry the infant
Clamp then cut the umbilical cord 3cm distal to insertion at umbilicus with sterile scissors
ACOG recommends delaying cord clamping until 30-60 seconds after<unk> 
If uncomplicated<unk>  with clear airway and good respiratory support, mother may hold child immediately (skin to skin)
If mother or infant is unstable, pass infant to receiving team
Place infant in a warm incubator
Check APGAR scores at 1, 5, and 10 minutes after<unk> 
See newborn resuscitation for complications
ACOG recommends delaying cord clamping until 30-60 seconds after<unk> 
Place infant in a warm incubator
Check APGAR scores at 1, 5, and 10 minutes after<unk> 
See newborn resuscitation for complications
Placental<unk> 
Maintain manual suprapubic pressure
Provide gentle cord traction and allow spontaneous placental separation
Placenta usually<unk>  within 10-30 minutes
Avoid excessive cord traction to prevent uterine inversion
Signs of placental separation
Abrupt lengthening of cord
Sudden gush of blood
Cephalad migration of uterus
Inspect for missing placental segments and normal cord insertion and vessels
Normal cord should have 3 vessels
If placenta is not intact, there may be retained products of conception in the uterus requiring manual or surgical removal
Start oxytocin 20U-40U in 1L NS at 200-500 mL/hr or give oxytocin 10U IM in a patient without IV access
Administering oxytocin prevents 40% of PPH
Avoid excessive cord traction to prevent uterine inversion
Signs of placental separation
Abrupt lengthening of cord
Sudden gush of blood
Cephalad migration of uterus
Inspect for missing placental segments and normal cord insertion and vessels
Normal cord should have 3 vessels
If placenta is not intact, there may be retained products of conception in the uterus requiring manual or surgical removal
Abrupt lengthening of cord
Sudden gush of blood
Cephalad migration of uterus
Normal cord should have 3 vessels
If placenta is not intact, there may be retained products of conception in the uterus requiring manual or surgical removal
Administering oxytocin prevents 40% of PPH
1st hour after placental<unk> 
Palpate abdomen and check for the achievement of uterine firmness and contraction
Period of time with highest risk for postpartum hemorrhage (>500 mL blood)
Emergent delivery
IVF maintenance
Umbilical cord prolapse
Resuscitative hysterotomy
Breech delivery
Neonatal resuscitation
Shoulder dystocia
Delayed sequence intubation