What equipment and logistics should a well-equipped labour room have to ensure a safe and successful delivery?

Equipment and Logistics of Labour Room

A well-equipped labour room must have immediately available airway management equipment, hemorrhage control resources, and cardiopulmonary resuscitation capabilities to prevent maternal and neonatal mortality. 1

Essential Monitoring Equipment

All labour and delivery units must have the following monitoring equipment immediately available:

• Cardiorespiratory monitor with strip recorder for continuous maternal vital sign assessment 1
• Pulse oximeter with sensors and probe sizes appropriate for obstetric patients 1
• Blood pressure measurement devices including sphygmomanometer, Doppler blood pressure device, and blood pressure cuffs (neonatal, infant, child, and adult sizes) 1
• Qualitative carbon dioxide detector to confirm endotracheal tube placement during emergency airway management 1
• Thermometer or rectal probe capable of measuring temperatures from 25°C to 44°C for both hypothermic and hyperthermic measurements 1
• Defibrillator with both pediatric (4.5 cm) and adult (8 cm) paddles or corresponding adhesive pads 1

Airway Management Equipment

Basic airway management equipment must be immediately available during all deliveries and neuraxial analgesia procedures: 1

Basic Airway Equipment

• Clear oxygen masks (standard and non-rebreathing) in neonatal, infant, child, and adult sizes 1
• Portable oxygen regulators and canisters 1
• Oropharyngeal airways (sizes 0-5) 1
• Nasopharyngeal airways (12F through 30F) 1
• Nasal cannulae (child and adult sizes) 1
• Bag-valve-mask resuscitator, self-inflating (450-mL and 1000-mL sizes) 1
• Suction catheters—flexible (6F, 8F, 10F, 12F, 14F, and 16F) 1
• Yankauer suction tip and bulb syringe 1

Advanced Airway Equipment for Difficult Airway Management

A portable storage unit for difficult airway management must be readily available in the operative area of labour and delivery units: 1

• Rigid laryngoscope blades of alternate design and size including straight or Miller (0,1,2, and 3) and Macintosh (2 and 3) 1
• Videolaryngoscopic devices 1
• Endotracheal tubes of assorted sizes: uncuffed (2.5,3.0,3.5,4.0,4.5.0,5.5, and 6.0 mm) and cuffed (6.5,7.0,7.5,8.0, and 9.0 mm) 1
• Endotracheal tube guides including semirigid stylets (infant, pediatric, and adult), light wands, and forceps designed to manipulate the distal portion of the endotracheal tube 1
• Laryngeal mask airways (sizes 1.5,2.5,3,4, and 5) for emergency nonsurgical airway ventilation 1
• Magill forceps (pediatric and adult) 1
• Equipment suitable for emergency surgical airway access (e.g., cricothyrotomy kit) 1

Critical pitfall: The most experienced provider available should manage the airway during emergencies, as difficult airways are common in pregnancy due to physiological changes including airway edema and reduced functional reserve capacity. 2, 3 If tracheal intubation fails, immediately ventilate with mask and cricoid pressure or use a supraglottic airway device; if ventilation is impossible, create a surgical airway without delay. 1, 4

Hemorrhage Management Resources

Institutions providing obstetric care must have resources immediately available to manage hemorrhagic emergencies: 1

• Large-bore IV catheters (14-24 gauge) 1
• Fluid warmer 1
• Forced-air body warmer 1
• Equipment for infusing IV fluids and blood products rapidly including hand-squeezed fluid chambers, hand-inflated pressure bags, and automatic infusion devices 1
• Rate-limiting infusion device and tubing 1
• IV fluid and blood warmers 1
• Availability of blood bank resources with immediate access to type-specific or O negative blood 1
• Massive transfusion protocol 1

Cardiopulmonary Resuscitation Equipment

Basic and advanced life-support equipment must be immediately available in the operative area of all labour and delivery units: 1, 3, 4

If cardiac arrest occurs during labour and delivery, initiate standard ACLS protocols with pregnancy-specific modifications: 1

• Maintain manual left lateral uterine displacement throughout all resuscitation efforts 3, 4
• Begin hysterotomy within 4 minutes if maternal circulation is not restored, with the goal of completing delivery within 5 minutes of arrest onset 3, 4

Vascular Access Equipment

• Butterfly needles (19-25 gauge) 1
• Catheter-over-needle devices (14-24 gauge) 1
• Intraosseous needles (may be satisfied by standard bone needle aspiration needles) 1
• Arm boards 1
• Umbilical vein catheters (size 5F feeding tube may be used) 1
• Seldinger technique vascular access kit 1

Specialized Procedure Trays

The following specialized trays must be readily available: 1

• Tube thoracotomy with water seal drainage capability including chest tubes (8F through 40F) 1
• Lumbar puncture tray 1
• Obstetric pack 1
• Newborn kit with umbilical vessel cannulation supplies 1
• Venous cutdown tray 1
• Needle cricothyrotomy tray 1
• Surgical airway kit (may include tracheostomy tray or surgical cricothyrotomy tray) 1

Additional Essential Equipment

• Nasogastric/feeding tubes (5F through 18F) 1
• Pediatric urinary catheters 1
• Infant and standard scales 1
• Heating source (may be met by infrared lamps or overhead warmer) 1
• Towel rolls, blanket rolls, or equivalent for positioning 1
• Pediatric restraining devices 1
• Resuscitation board 1
• Sterile linen 1
• Length-based resuscitation tape or precalculated drug or equipment list based on weight 1

Cervical Immobilization and Fracture Management

• Cervical immobilization equipment in sizes to fit infants, children, adolescents, and adults (use of sandbags is discouraged as they may cause injury if the patient must be turned) 1
• Extremity splints and femur splints 1

Logistical Requirements

Equipment, facilities, and support personnel available in the labour and delivery operating suite must be comparable to those available in the main operating suite. 1

Personnel requirements include:

• Physicians, specialized nurses, respiratory therapists, radiology technicians, and laboratory technicians continuously available to provide ongoing care and address emergencies 1
• Neonatologists, neonatal nurses, and respiratory therapists for level III facilities caring for high-risk deliveries 1

Support services must include:

• Portable x-ray machine and blood gas analyzer 1
• Advanced imaging capabilities (CT, MRI, and echocardiography) with interpretation available on an urgent basis for level III facilities 1
• Pharmacy support with pediatric expertise 1
• Social services and pastoral care 1

Critical pitfall: Failure to recognize the need for specialized equipment and personnel for difficult airway management can lead to adverse outcomes. 2 Never underestimate the physiological changes of pregnancy that complicate airway management during emergency cesarean delivery. 2, 4