OBSTETRICS AND GYNECOLOGY

Home

Lesson Objective:
Indicate procedures for emergency (pre -hospital) childbirth.

Home

OVERVIEW
Anatomy Review Beginning of Labor Predelivery Emergencies Preparing for Delivery Delivering the Baby

Home

OVERVIEW cont.
Postdelivery Care Resuscitation of the Newborn Abnormal Deliveries & Complications Gynecologic Emergencies

Home

Anatomy Review
Fetus Uterus Placenta Umbilical

Cord Amniotic Sac Cervix

Home

The Stages of Labor

1st Stage - 1st contraction until cervix is fully dilated. 2nd Stage - full dilation until birth. 3rd Stage - birth of baby, until delivery of placenta

Home

Signs of Labor
Beginning of regular contractions Bloody show Rupture of the amniotic sac (water breaks)

Home

Predelivery Emergencies
Miscarriage Seizures Vaginal

Bleeding Trauma

Home

Miscarriage

Delivery of fetus & placenta before 20 weeks Danger - bleeding & infection

Home

Treatment
Initial assessment History & physical exam Ask if she is pregnant Ask date of last cycle

Home

Treatment
Apply external vaginal pads Collect tissues Transport

Home

Seizures

Eclampsia - related to high blood pressure

Home

Treatment
Initial assessment HX & vitals Transport on left side Monitor airway & give O2 Transport

Home

Vaginal Bleeding
Early pregnancy - may be normal Later stages of pregnancy Placenta abruptio - placenta separates prematurely Placenta previa - placenta develops over & covers the mouth of the uterus

Home

Placenta abruptio placenta separates prematurely

Placenta previa placenta develops over & covers the mouth of the uterus
Home

Treatment
BSI Initial assessment History and physical exam Ask patient if she has any pain.

Home

Treatment
Transport on left side Sterile pad or sanitary napkin Save any tissue Transport

Home

Trauma
Severe bleeding Injury to fetus

Home

Treatment
Initial assessment O2 Place on left side Control external bleeding Transport

Home

Preparing for Delivery

Assessing the need for emergency delivery

First decision - whether or not you have time to transport?

Home

Decision based on three factors:

Is

the delivery imminent Hospital cannot be reached due to a natural disaster, weather, or traffic conditions No transportation is available

Home

Equipment
Surgical

scissors-1 pair Hemostats or cord clamps-3 Umbilical tape/sterile cord Small rubber bulb syringe Towels-5

Home

Equipment
1

dozen 2 x 10 gauze sponges Rubber gloves Baby blanket-1 Sanitary napkins Plastic bag

Home

Delivering The Baby

Position and support
Flat, sturdy surface Lie with knees drawn up and spread apart Elevate buttocks with blankets

Home

Position and support

Create sterile field One towel under buttocks One between her legs One across her abdomen Partner at head Reassure/comfort Assist airway

Home

Delivering the Head

Place fingers on bony part of skull If amniotic sac does not break, or has not broken: Use clamp to puncture Push away from nose and mouth

Home

Delivering the Head

Umbilical cord around neck? Slip over shoulder Clamp and cut it

Home

Delivering the Body

Support head and body Grasp feet Support with both hands Baby will be slippery Do not squeeze neck or chest
Home

Home

Post Delivery Care

Initial care of baby
Set baby down Same level or lower than birth canal On side with head slightly lower than body Continue to aspirate

Home

Initial care of the baby

Wrap in blanket Warm prior if possible Leave only face expose If not breathing, perform CPR

Home

Cutting the Umbilical cord

Clamp with two clamps Four fingers width from the baby Two to six inches apart Cut between clamps
Home

Apgar score
1

and 5 minutes Healthy baby will score 10 Five areas

Home

APGAR
Appearance - pink shortly after birth Pulse- greater than 100/min Grimace - crying, or withdrawing in response to stimuli Activity - resistance or muscle tone when attempts are made to straighten legs Respirations - regular and rapid

Home

Delivery of Placenta

Normal Delivery
Within

a few minutes of babys birth Usually less than 250 ml blood loss Record delivery time Take to hospital
Home

Delivery of Placenta
Provide prompt transport If not delivered within 30 minutes 250ml of bleeding occurs before delivery of placenta Significant bleeding occurs after delivery of placenta Do not pull cord!

Home

Home

Click for Video

Home

Resuscitation of Newborn
Assessing the baby Respirations Pulse Artificial Ventilation Use BVM 40- 60 breaths per minute

Home

Resuscitation of Newborn

Chest compressions Heart rate is < 60 bpm, or between 60- 80 bpm and not rising Both thumbs on middle third of the sternum or one thumb over the other

Home

Abnormal Deliveries
Prolapsed umbilical cord

Cord comes out before baby Do not replace! Danger: Decreased O2 to the baby
Home

Treatment
Place mother with legs and buttocks elevated Exert gentle counter pressure with gloved hand Wrap moistened sterile towel around cord Oxygen Keep warm Transport

Home

Breech Delivery

Presenting part buttocks or feet

Treatment Position and drape mother Allow buttocks and feet to deliver Support legs and trunk

Home

Treatment

Head usually delivers on its own If not within 3 minutes of buttocks and trunk, do not pull! Cup hand over babys face/mouth and transport Head delivers- procedures the same
Home

Limb Presentation
Presenting part single arm, leg, or foot Cannot successfully deliver in the field

Home

Treatment
Give mother O2 Place mother on back, head lower than pelvis Cover with sterile towel Transport

Home

Multiple Births
1st baby is small Abdomen still large Contractions about 10 minutes after first baby

Home

Treatment
Cut cord on first baby Follow normal delivery procedures May be considered premature

Home

Premature Infants

Premature - born before 8th month or weighing less than 5 1/2 lbs. Judge weight Thinner, smaller, redder than full term Head larger

Home

5 important steps in management

Keep warm 90-95 degrees F Keep mouth, nose, and throat clear Make sure cord not bleeding Apply additional clamps or ties Slightest bleeding serious

Home

5 important steps in management

Increase O2 in enviroment Make tent over head Aim O2 at top of tent Do not administer directly Avoid infection Use sterile equipment Avoid unnecessary handling

Home

Gynecologic Emergencies
Trauma to external genetalia
Treat

as other bleeding and soft tissue injuries O2 Never pack vagina Transport

Home

Alleged Sexual Assault and Rape

Patient may refuse assistance

Home

Treatment
BSI Airway Nonjudgmental

attitude during

SAMPLE Crime scene protection

Home

Treatment
Examine genitalia only if profuse bleeding Use same sex providers if possible Discourage bathing, voiding, or cleaning wounds

Home

The End

Home