OBSTETRICS AND GYNECOLOGY

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

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

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

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Anatomy Review
Fetus Uterus Placenta Umbilical

Cord Amniotic Sac Cervix

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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

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

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Predelivery Emergencies
Miscarriage Seizures Vaginal

Bleeding Trauma

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Miscarriage

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

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

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Treatment
Apply external vaginal pads Collect tissues Transport

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Seizures

Eclampsia - related to high blood pressure

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

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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

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Placenta abruptio placenta separates prematurely

Placenta previa placenta develops over & covers the mouth of the uterus
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Treatment
BSI Initial assessment History and physical exam Ask patient if she has any pain.

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

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Trauma
Severe bleeding Injury to fetus

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

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Preparing for Delivery

Assessing the need for emergency delivery

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

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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

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Equipment
Surgical

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

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Equipment
1

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

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Delivering The Baby

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

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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

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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

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Delivering the Head

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

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Delivering the Body

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

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Initial care of the baby

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

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Cutting the Umbilical cord

Clamp with two clamps Four fingers width from the baby Two to six inches apart Cut between clamps
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Apgar score
1

and 5 minutes Healthy baby will score 10 Five areas

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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

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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
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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!

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The End

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