Obstetrics - EmergenciesObstetrics - Emergencies

Normal Events of PregnancyNormal Events of Pregnancy OvulationOvulation

FertilizationFertilization Distal third of Distal third of

fallopian tubefallopian tube

ImplantationImplantation UterusUterus

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Specialized Structures of PregnancySpecialized Structures of Pregnancy

PlacentaPlacenta Umbilical cordUmbilical cord Amniotic sac and fluidAmniotic sac and fluid

.

PlacentaPlacenta Transfer of gasesTransfer of gases

Transport other nutrientsTransport other nutrients

Excretion of wastesExcretion of wastes

Hormone productionHormone production

ProtectionProtection

Umbilical CordUmbilical Cord Connects placenta Connects placenta

to fetusto fetus

2 arteries and 1vein2 arteries and 1vein

.

Amniotic Sac and FluidAmniotic Sac and Fluid Membrane surrounding Membrane surrounding

fetusfetus Fluid from fetus: Urine, Fluid from fetus: Urine,

secretionssecretions Accumulates rapidlyAccumulates rapidly 175-225 mL by 15th 175-225 mL by 15th

weekweek About 1 L at birth About 1 L at birth

Rupture of membraneRupture of membrane Watery dischargeWatery discharge

Fetal Growth and DevelopmentFetal Growth and Development

First 8 weeks of pregnancyFirst 8 weeks of pregnancy EmbryoEmbryo

After that and until birthAfter that and until birth FetusFetus

Fetal Growth and DevelopmentFetal Growth and Development

Term InfantTerm Infant

Anytime after 37 but before 42 weeksAnytime after 37 but before 42 weeks

Most weigh 6.6 to 7.9 poundsMost weigh 6.6 to 7.9 pounds Average 40 wks from fertilization to deliveryAverage 40 wks from fertilization to delivery 90-day periods (trimesters)90-day periods (trimesters) Gestation – time from fertilization until birth (avg. Gestation – time from fertilization until birth (avg.

is 266 days or 8.86 mos)is 266 days or 8.86 mos)

.

OVULATIONOVULATION FundusFundus

Top of uterusTop of uterus

Site where fertilized Site where fertilized egg normally egg normally implantsimplants

Human Embryo and Fetus atHuman Embryo and Fetus at35 Days35 Days

Human Embryo and Fetus atHuman Embryo and Fetus at49 Days49 Days

Human Embryo and FetusHuman Embryo and Fetusat End of 1st Trimester at End of 1st Trimester

Human Embryo and Fetus atHuman Embryo and Fetus at4 Months 4 Months

.

PregnancyPregnancy Term Infant

Anytime after 37 but before 42 weeksMost weigh 6.6 to 7.9 pounds

Obstetrical TerminologyObstetrical Terminology GravidaGravida

All current and past pregnanciesAll current and past pregnancies

Para Para Number of past pregnancies viable to deliveryNumber of past pregnancies viable to delivery

AntepartumAntepartum Period before deliveryPeriod before delivery

GestationGestation Period of intrauterine fetal developmentPeriod of intrauterine fetal development

Grand multiparaGrand multipara Seven deliveries or moreSeven deliveries or more

Obstetrical TerminologyObstetrical Terminology MultiparaMultipara

Two or more deliveriesTwo or more deliveries

NatalNatal Connected with birthConnected with birth

NulliparaNullipara Has never deliveredHas never delivered

PerinatalPerinatal——occurring occurring At or near time of birthAt or near time of birth

PostpartumPostpartum Period after deliveryPeriod after delivery

Obstetrical TerminologyObstetrical Terminology Prenatal Prenatal

Before birthBefore birth

PrimigravidaPrimigravida Pregnant for first timePregnant for first time

PrimiparaPrimipara Gave birth onceGave birth once

TermTerm Pregnancy at 40 weeks’ gestationPregnancy at 40 weeks’ gestation

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Maternal Changes During PregnancyMaternal Changes During Pregnancy

Cessation of menstruationCessation of menstruation

Enlargement of uterusEnlargement of uterus

Other changes affect: Other changes affect: Genital tractGenital tract BreastsBreasts Gastrointestinal systemGastrointestinal system Cardiovascular systemCardiovascular system Respiratory systemRespiratory system MetabolismMetabolism

Obstetrical History Obstetrical History Length of gestationLength of gestation Parity and gravidityParity and gravidity Previous cesarean delivery Previous cesarean delivery Maternal lifestyle Maternal lifestyle Infectious disease statusInfectious disease status Previous gynecological or obstetrical Previous gynecological or obstetrical

complications complications PainPain

Obstetrical HistoryObstetrical History Quantity, character of vaginal bleedingQuantity, character of vaginal bleeding

Abnormal vaginal dischargeAbnormal vaginal discharge

““Show” Show” Expulsion of mucous plug in early laborExpulsion of mucous plug in early labor

Rupture of membranesRupture of membranes

General health and prenatal careGeneral health and prenatal care

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Obstetric HistoryObstetric History Allergies, medications takenAllergies, medications taken

Use of narcotics within 4 hrsUse of narcotics within 4 hrs

Urge to bear down Urge to bear down

Sensation of imminent bowel movement Sensation of imminent bowel movement

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Physical ExaminationPhysical Examination Chief complaint determines examChief complaint determines exam

Rapidly identify acute surgical or life-threatening Rapidly identify acute surgical or life-threatening conditions or imminent deliveryconditions or imminent delivery

Take appropriate management stepsTake appropriate management steps

Physical ExaminationPhysical Examination Evaluate general appearance and skin colorEvaluate general appearance and skin color

Assess vital signs and reassess Assess vital signs and reassess

Examine abdomen for previous scars and Examine abdomen for previous scars and any gross deformityany gross deformity

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Evaluation of Uterine SizeEvaluation of Uterine Size 8-10 weeks8-10 weeks

Uterine contour irregular Uterine contour irregular

12-16 weeks12-16 weeks Uterus above symphysis Uterus above symphysis

pubispubis

24 weeks24 weeks Uterus at level of umbilicusUterus at level of umbilicus

TermTerm Uterus near xiphoid Uterus near xiphoid

processprocess

Fetal MonitoringFetal Monitoring Fetal heart soundsFetal heart sounds

Auscultate between 16 and 40 wks by Auscultate between 16 and 40 wks by stethoscope, fetoscope, or Dopplerstethoscope, fetoscope, or Doppler

Benefits of fetal monitoringBenefits of fetal monitoring ProcedureProcedure Normal fetal heart rate: 120-160 bpmNormal fetal heart rate: 120-160 bpm

Fetoscope Fetoscope

Doppler Doppler

Sites for Auscultation ofSites for Auscultation ofFetal Heart TonesFetal Heart Tones

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General Management of OB PatientGeneral Management of OB Patient

If birth not imminent, care for healthy patient often If birth not imminent, care for healthy patient often can be limited to basic treatment modalitiescan be limited to basic treatment modalities

In absence of distress or injury, transport in position In absence of distress or injury, transport in position of comfort:of comfort:

Usually left lateral recumbentUsually left lateral recumbent ECG monitoring, oxygen, and fetal monitoring may be ECG monitoring, oxygen, and fetal monitoring may be

indicatedindicated Based on assessment Based on assessment IV access in some patientsIV access in some patients

DELIVERYDELIVERY PresentationPresentation

Fetal part that emerges Fetal part that emerges firstfirst

Normal is the head, Normal is the head, face downface down

Abnormal – face up Abnormal – face up (baby’s face can get (baby’s face can get caught in mom’s pubic caught in mom’s pubic bones), buttocks, leg(s), bones), buttocks, leg(s), arm(s)arm(s)

Cesarean SectionCesarean Section

Performed when Performed when mom or fetus in mom or fetus in dangerdanger

If in mom’s history, If in mom’s history, ask why section ask why section done.done.

May give you clues May give you clues as to past delivery as to past delivery complicationscomplications

Cesarean SectionCesarean SectionCommon causesCommon causes

Placenta previaPlacenta previaAbruptio placentaAbruptio placentaLabor that didn’t Labor that didn’t progressprogressEclampsiaEclampsiaFetal distressFetal distressBreech presentationBreech presentationProlapsed cordProlapsed cord

Cephalopelvic Cephalopelvic disproportion – baby disproportion – baby too large for mom’s too large for mom’s pelvic openingpelvic openingActive herpes lesionsActive herpes lesionsRarely, old C-section Rarely, old C-section scar can weakenscar can weaken

Complications of PregnancyComplications of Pregnancy TraumaTrauma

Medical conditionsMedical conditions

Pregnancy itselfPregnancy itself

Prior disease processesPrior disease processes Aggravated by pregnancyAggravated by pregnancy

Nuchal CordNuchal Cord

Nuchal CordNuchal Cord Occurs in roughly Occurs in roughly

25% of all deliveries25% of all deliveries Cord wrapped Cord wrapped

around neckaround neck Can lead to Can lead to

decreased blood flow decreased blood flow of infantof infant

Trauma in PregnancyTrauma in Pregnancy Causes of maternal injuryCauses of maternal injury

Vehicular crashesVehicular crashes FallsFalls Penetrating objectsPenetrating objects

Greatest risk of fetal deathGreatest risk of fetal death Fetal distress and intrauterine demise caused by Fetal distress and intrauterine demise caused by

trauma to mother or her deathtrauma to mother or her death

Trauma in PregnancyTrauma in Pregnancy Assess and intervene for motherAssess and intervene for mother

Fetal death from maternal traumaFetal death from maternal trauma

Pregnant trauma patient needs physician Pregnant trauma patient needs physician evaluationevaluation

AssessmentAssessment Signs of shock can be slow to developSigns of shock can be slow to develop Decreased fetal movement/HR may indicate shockDecreased fetal movement/HR may indicate shock

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Trauma in PregnancyTrauma in Pregnancy ManagementManagement

OxygenateOxygenate Prepare for laborPrepare for labor Aggressive resuscitation if arrestAggressive resuscitation if arrest Immobilize and transport Immobilize and transport

• Left lateral recumbant positionLeft lateral recumbant position

• Manual uterine displacementManual uterine displacement

Medical Conditions Medical Conditions Pregnancy can mask or aggravate:Pregnancy can mask or aggravate:

AppendicitisAppendicitis CholecystitisCholecystitis HypertensionHypertension DiabetesDiabetes InfectionInfection Neuromuscular disordersNeuromuscular disorders Cardiovascular diseaseCardiovascular disease

PreeclampsiaPreeclampsia Unknown causeUnknown cause

Often healthy, normotensive primigravidaOften healthy, normotensive primigravida• After twentieth week, often near termAfter twentieth week, often near term

Preeclampsia and EclampsiaPreeclampsia and Eclampsia Diagnosis of preeclampsiaDiagnosis of preeclampsia

HypertensionHypertension• Blood pressure >140/90 mm HgBlood pressure >140/90 mm Hg• Acute rise of 20 mm Hg in systolic pressureAcute rise of 20 mm Hg in systolic pressure

OROR• 10 mm Hg rise in diastolic pressure over prepregnancy 10 mm Hg rise in diastolic pressure over prepregnancy

levelslevels ProteinuriaProteinuria Excessive weight gain with edemaExcessive weight gain with edema

Treat hypertension, prevent seizuresTreat hypertension, prevent seizures

EclampsiaEclampsia Same signs and symptoms plus seizures or comaSame signs and symptoms plus seizures or coma

Tonic-clonic activityTonic-clonic activity

Often begins as oral twitchingOften begins as oral twitching

Often apnea during seizureOften apnea during seizure

Can initiate laborCan initiate labor

EclampsiaEclampsia——ManagementManagement Left lateral recumbent positionLeft lateral recumbent position

Minimize stimulationMinimize stimulation

Oxygen and ventilation assistanceOxygen and ventilation assistance

If seizures:If seizures: Monitor vital signsMonitor vital signs

Gestational Diabetes MellitusGestational Diabetes Mellitus Mother can’t metabolize carbohydratesMother can’t metabolize carbohydrates

Excess glucose goes to fetusExcess glucose goes to fetus Stored as fatStored as fat

TreatmentTreatment Glucose monitoringGlucose monitoring DietDiet ExerciseExercise InsulinInsulin

Vaginal BleedingVaginal Bleeding Abortion (miscarriage)Abortion (miscarriage)

Ectopic pregnancyEctopic pregnancy

Abruptio placentaeAbruptio placentae

Placenta previaPlacenta previa

Uterine ruptureUterine rupture

Postpartum hemorrhagePostpartum hemorrhage

AbortionAbortion Termination of pregnancy from any cause before 20Termination of pregnancy from any cause before 20thth

week of gestationweek of gestation Later is known as Later is known as preterm birthpreterm birth

Common classifications of abortionCommon classifications of abortion

Determine:Determine: Onset of pain and bleedingOnset of pain and bleeding Amount of blood lossAmount of blood loss If any tissue passed with bloodIf any tissue passed with blood

ManagementManagement

Ectopic PregnancyEctopic Pregnancy Ovum implants outside uterusOvum implants outside uterus

CommonCommon

Predisposing factors Predisposing factors

Classic triad of symptomsClassic triad of symptoms Abdominal painAbdominal pain

• Shoulder painShoulder pain Vaginal bleedingVaginal bleeding AmenorrheaAmenorrhea

• May not be presentMay not be present

Ectopic PregnancyEctopic Pregnancy Can result in frank Can result in frank

shockshock

True emergencyTrue emergency

Requires rapid Requires rapid transport for surgerytransport for surgery

Manage for Manage for hemorrhagic shockhemorrhagic shock

Third-Trimester BleedingThird-Trimester Bleeding 3% of pregnancies3% of pregnancies

Never normalNever normal

Most often due to:Most often due to: Abruptio placentaeAbruptio placentae Placenta previaPlacenta previa Uterine ruptureUterine rupture

Abruptio PlacentaeAbruptio Placentae Partial or complete detachment of normally Partial or complete detachment of normally

implanted placenta at more than 20 weeks’ implanted placenta at more than 20 weeks’ gestationgestation

Predisposing factorsPredisposing factors TraumaTrauma Maternal hypertensionMaternal hypertension PreeclampsiaPreeclampsia MultiparityMultiparity Previous abruptionPrevious abruption

Abruptio PlacentaeAbruptio Placentae Sudden vaginal bleeding in 3Sudden vaginal bleeding in 3rdrd trimester trimester

PainPain Abdomen may be tender or rigidAbdomen may be tender or rigid

May be minimal bleeding with shockMay be minimal bleeding with shock Most of hemorrhage may be hiddenMost of hemorrhage may be hidden

Contractions may be presentContractions may be present

If fetal heart tones absent, fetal death is likelyIf fetal heart tones absent, fetal death is likely

Placenta PreviaPlacenta Previa Placental implantation in lower uterine Placental implantation in lower uterine

segment, encroaching on or covering cervical segment, encroaching on or covering cervical osos

1 in 300 deliveries1 in 300 deliveries More common in preterm birthMore common in preterm birth

Painless, bright red bleedingPainless, bright red bleeding Increases if labor beginsIncreases if labor begins Fetal compromiseFetal compromise

Placenta PreviaPlacenta Previa More common with:More common with:

Increased maternal ageIncreased maternal age MultiparityMultiparity Previous cesarean sectionPrevious cesarean section Previous placenta previaPrevious placenta previa

.

Uterine RuptureUterine Rupture Spontaneous or traumatic rupture of uterine wallSpontaneous or traumatic rupture of uterine wall

CausesCauses Previous scar opensPrevious scar opens TraumaTrauma Prolonged or obstructed laborProlonged or obstructed labor

Rare but accounts for 5%-15% maternal deathsRare but accounts for 5%-15% maternal deaths 50% of fetal deaths50% of fetal deaths

Uterine RuptureUterine Rupture Sudden abdominal painSudden abdominal pain

““Tearing”Tearing”

Active laborActive labor

Early signs of shockEarly signs of shock

Vaginal bleedingVaginal bleeding May be hiddenMay be hidden

Management of 3Management of 3rdrd Trimester Bleeding Trimester Bleeding Prevent shockPrevent shock

Do not examine patient vaginallyDo not examine patient vaginally May increase bleeding and start laborMay increase bleeding and start labor

Emergency care Emergency care ABCsABCs Left lateral recumbent positionLeft lateral recumbent position Check fundal heightCheck fundal height

Labor and DeliveryLabor and Delivery Process by which infant is Process by which infant is

bornborn Uterus progressively more Uterus progressively more

irritableirritable Cervix begins to dilate:Cervix begins to dilate:

Complete dilation is 10 Complete dilation is 10 cmcm

Amniotic sac ruptureAmniotic sac rupture Fetus and then placenta are Fetus and then placenta are

expelledexpelled

Parturition Parturition

Stages of LaborStages of Labor 11stst Stage: Stage: Onset of contractions Onset of contractions

to full dilation of to full dilation of cervix(10cm)cervix(10cm)

Usually 8-12hrs, prior Usually 8-12hrs, prior 6-8hrs6-8hrs

Amniotic sac usually Amniotic sac usually ruptures toward endruptures toward end

Stages of LaborStages of Labor

22ndnd Stage: Stage: Complete dilation to Complete dilation to

delivery of babydelivery of baby 1-2hrs 11-2hrs 1stst time time 30min<less 230min<less 2ndnd

Mom wants to bear Mom wants to bear down/BMdown/BM

Crowning imminent Crowning imminent deliverydelivery

Stages of LaborStages of Labor 33rdrd Stage: Stage: Delivery of infant to Delivery of infant to

the delivery of the delivery of placentaplacenta

5-60 min5-60 min

Signs and Symptoms ofSigns and Symptoms ofImminent DeliveryImminent Delivery

Prepare for delivery if:Prepare for delivery if: Regular contractions lasting 45-60 sec at 1-2 min Regular contractions lasting 45-60 sec at 1-2 min

intervalsintervals Urge to bear down or sensation of bowel movementUrge to bear down or sensation of bowel movement Large amount of bloody showLarge amount of bloody show Crowning occursCrowning occurs Mother believes delivery is imminentMother believes delivery is imminent

Signs and Symptoms ofSigns and Symptoms ofImminent DeliveryImminent Delivery

Do not delay or restrain delivery except for cord Do not delay or restrain delivery except for cord presentationpresentation

If complications are anticipated or abnormal delivery If complications are anticipated or abnormal delivery occurs, medical direction may recommend expedited occurs, medical direction may recommend expedited transport to a medical facilitytransport to a medical facility

Preparing for deliveryPreparing for delivery

Delivery equipmentDelivery equipment

.

Prehospital Delivery EquipmentPrehospital Delivery Equipment

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Assisting with DeliveryAssisting with Delivery Assist in natural events of childbirthAssist in natural events of childbirth

Responsibilities of EMS crew:Responsibilities of EMS crew: Prevent uncontrolled deliveryPrevent uncontrolled delivery Protect infant from cold stress after birthProtect infant from cold stress after birth

Assisting with a Normal DeliveryAssisting with a Normal Delivery

Delivery procedureDelivery procedure

Evaluating infantEvaluating infant

Cutting umbilical cordCutting umbilical cord

Delivery of placentaDelivery of placenta

Fundal massage to promote uterine contractionFundal massage to promote uterine contraction

Normal DeliveryNormal DeliveryWhen crowning, apply gentle pressure to infant’s head

Normal DeliveryNormal DeliveryExamine neck for looped umbilical cord

Normal DeliveryNormal DeliverySupport infant’s head as it rotates for shoulder presentation

.

Normal DeliveryNormal DeliveryGuide infant’s head downward to deliver anterior shoulder

Normal DeliveryNormal DeliveryGuide head upward to release posterior shoulder

DeliveryDeliveryAfter delivery and evaluation of infant, clamp and cut cord

Postpartum HemorrhagePostpartum Hemorrhage >500 mL of blood loss after delivery >500 mL of blood loss after delivery

Immediate or delayed 24 hrsImmediate or delayed 24 hrs

Risk factorsRisk factors Uterine atony from laborUterine atony from labor Grand multiparityGrand multiparity TwinsTwins Placenta previaPlacenta previa Full bladderFull bladder

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Postpartum HemorrhagePostpartum Hemorrhage Control external hemorrhageControl external hemorrhage

Massage uterusMassage uterus

Encourage infant to breast feedEncourage infant to breast feed

Administer oxytocinAdminister oxytocin

Don’t attempt vaginal examDon’t attempt vaginal exam

Rapid transportRapid transport

Delivery ComplicationsDelivery Complications Maternal factorsMaternal factors

AgeAge No prenatal careNo prenatal care LifestyleLifestyle Preexisting illnessPreexisting illness Previous OB historyPrevious OB history Intrapartum disordersIntrapartum disorders

Delivery ComplicationsDelivery Complications Fetal factorsFetal factors

Lack of fetal well-beingLack of fetal well-being Decreased fetal movementDecreased fetal movement History of heart rate abnormalitiesHistory of heart rate abnormalities Fetal immaturityFetal immaturity Fetal growthFetal growth

Cephalopelvic Disproportion Cephalopelvic Disproportion Difficult labor because of:Difficult labor because of:

Small pelvisSmall pelvis Oversized fetusOversized fetus Fetal abnormalitiesFetal abnormalities

• Hydrocephalus, conjoined twins, fetal tumorsHydrocephalus, conjoined twins, fetal tumors

Often primigravida experiencing strong, frequent Often primigravida experiencing strong, frequent contractions for long periodcontractions for long period

Cephalopelvic Disproportion Cephalopelvic Disproportion Prehospital carePrehospital care

Maternal oxygen administrationMaternal oxygen administration IV access for fluid resuscitation if neededIV access for fluid resuscitation if needed Rapid transport to receiving hospitalRapid transport to receiving hospital

Abnormal PresentationAbnormal Presentation Most infants born head firstMost infants born head first

Cephalic or vertex presentationCephalic or vertex presentation Rarely abnormal presentationRarely abnormal presentation

Breech presentationBreech presentation ManagementManagement

Shoulder dystociaShoulder dystocia ManagementManagement

Shoulder presentation (transverse presentation)Shoulder presentation (transverse presentation) ManagementManagement

Breech Presentations Breech Presentations

Abnormal PresentationAbnormal Presentation Cord presentation (prolapsed cord)Cord presentation (prolapsed cord)

Elevate mother’s hipsElevate mother’s hips Maternal oxygenMaternal oxygen Have mother pant with contractionsHave mother pant with contractions Apply moist, sterile dressing to cordApply moist, sterile dressing to cord Gently push infant back into vaginaGently push infant back into vagina

• Elevate presenting partElevate presenting part

• Maintain during transportMaintain during transport

Other Abnormal PresentationsOther Abnormal Presentations Face or browFace or brow

Occiput posterior presentationOcciput posterior presentation Face upFace up

Increased perinatal morbidity and mortalityIncreased perinatal morbidity and mortality

Early recognition criticalEarly recognition critical

Abnormal PresentationAbnormal Presentation Prehospital managementPrehospital management

Recognition of potential complicationsRecognition of potential complications Maternal support and reassuranceMaternal support and reassurance Rapid transport for definitive careRapid transport for definitive care

Premature Birth Premature Birth Birth at <37 weeks of gestationBirth at <37 weeks of gestation

Care of premature infantCare of premature infant Keep warmKeep warm Suction mouth and nares oftenSuction mouth and nares often Monitor cord for oozingMonitor cord for oozing Administer oxygenAdminister oxygen

• Monitor for need to assist ventilationsMonitor for need to assist ventilations Gently transportGently transport

Multiple GestationMultiple Gestation More than one fetusMore than one fetus

Associated complicationsAssociated complications Premature labor and deliveryPremature labor and delivery Premature rupture of membranesPremature rupture of membranes Abruptio placentaeAbruptio placentae Postpartum hemorrhagePostpartum hemorrhage Abnormal presentationAbnormal presentation

Delivery procedureDelivery procedure

Multiple GestationMultiple Gestation Delivery procedureDelivery procedure

Deliver first twin as normal birthDeliver first twin as normal birth Cut and clamp cordCut and clamp cord Second twin delivery within 30-45 minSecond twin delivery within 30-45 min

• Medical direction may recommend transportMedical direction may recommend transport

Keep warmKeep warm Monitor for severe postpartum hemorrhageMonitor for severe postpartum hemorrhage

.

Precipitous DeliveryPrecipitous Delivery Rapid spontaneous deliveryRapid spontaneous delivery

Less than 3 hrs from onset of labor to birthLess than 3 hrs from onset of labor to birth

Overactive uterine contractions and little Overactive uterine contractions and little maternal soft tissue or bony resistancematernal soft tissue or bony resistance

Apply gentle counterpressure to headApply gentle counterpressure to head

Uterine InversionUterine Inversion Rare serious complication of childbirthRare serious complication of childbirth

Uterus turns inside outUterus turns inside out After contraction, sneezing, coughingAfter contraction, sneezing, coughing IatrogenicIatrogenic

Signs and symptomsSigns and symptoms Profuse postpartum hemorrhageProfuse postpartum hemorrhage Severe lower abdominal painSevere lower abdominal pain

Uterine InversionUterine Inversion ManagementManagement

Position patient supinePosition patient supine Push fundus up through cervical canal orPush fundus up through cervical canal or Cover with moist sterile dressingsCover with moist sterile dressings Rapid transportRapid transport Medical direction may advise use of analgesicsMedical direction may advise use of analgesics

Pulmonary EmbolismPulmonary Embolism Pregnancy, labor, or postpartum periodPregnancy, labor, or postpartum period

Common cause of maternal deathCommon cause of maternal death

Often blood clot from pelvisOften blood clot from pelvis

More common with cesarean deliveryMore common with cesarean delivery

Pulmonary EmbolismPulmonary Embolism Signs and symptomsSigns and symptoms

DyspneaDyspnea Sharp chest paiinSharp chest paiin Tachycardia, tachypneaTachycardia, tachypnea Hypotension possibleHypotension possible

ManagementManagement ABCsABCs ECG and IVECG and IV TransportTransport

Fetal Membrane Disorders Fetal Membrane Disorders Premature rupture of membranesPremature rupture of membranes

Amniotic sac rupture before laborAmniotic sac rupture before labor ““Trickle” or sudden gush of fluid from vaginaTrickle” or sudden gush of fluid from vagina Infection possible if delivery delayedInfection possible if delivery delayed Transport Transport

Fetal Membrane Disorders Fetal Membrane Disorders Amniotic fluid embolismAmniotic fluid embolism

Amniotic fluid gains access to maternal circulation:Amniotic fluid gains access to maternal circulation:• During labor or deliveryDuring labor or delivery• Immediately after deliveryImmediately after delivery

Signs and symptomsSigns and symptoms Same as for pulmonary embolismSame as for pulmonary embolism High mortality High mortality

ManagementManagement As for pulmonary embolismAs for pulmonary embolism

ConclusionConclusionObstetrical emergencies can develop Obstetrical emergencies can develop

suddenly and become life threatening. The suddenly and become life threatening. The paramedic must be prepared to recognize paramedic must be prepared to recognize

and manage these events.and manage these events.

Questions?Questions?