obstetrics and gynecology
TRANSCRIPT
ChapterChapter
Obstetrics andObstetrics and
GynecologyGynecology
TwentyTwenty
ChapterChapter
How to deal with predelivery
emergencies Normal and abnormal deliveries How to treat gynecological
emergencies
TwentyTwenty CORE CONCEPTSCORE CONCEPTS
Anatomy of PregnancyAnatomy of Pregnancy
PPREDELIVERYREDELIVERYEMERGENCIESEMERGENCIES
Complete patient assessment.Complete patient assessment. Base treatment on assessment.Base treatment on assessment. Bring fetal tissue to hospital.Bring fetal tissue to hospital. Give emotional support Give emotional support to mother. to mother.
MiscarriageMiscarriage(Spontaneous Abortion)(Spontaneous Abortion)
Complete patient assessment.Complete patient assessment. Base treatment on assessment.Base treatment on assessment. Administer high-concentrationAdminister high-concentration
oxygen.oxygen. Handle gently at all times.Handle gently at all times.
Seizures during PregnancySeizures during Pregnancy
CCHILDBIRTHHILDBIRTH
Childbirth Delivery KitChildbirth Delivery Kit
Name, age, due dateName, age, due date First delivery?First delivery? Contractions or pain?Contractions or pain? Bleeding or discharge?Bleeding or discharge? Crowning?Crowning?
(Continued)(Continued)
Predelivery EvaluationPredelivery Evaluation
Frequency/duration ofFrequency/duration of contractions? contractions?
Urge to move bowels?Urge to move bowels? Need to push?Need to push? Rock-hard abdomen?Rock-hard abdomen?
Predelivery EvaluationPredelivery Evaluation
Based on evaluationBased on evaluation Number of prior birthsNumber of prior births Distance to hospitalDistance to hospital Complications expectedComplications expected
Transport DecisionTransport Decision
Use body substance isolation.Use body substance isolation. Keep mother out of bathroom.Keep mother out of bathroom. Do not hold mother’s kneesDo not hold mother’s knees together.together.
(Continued)(Continued)
Delivery PrecautionsDelivery Precautions
Do not examine vagina internally.Do not examine vagina internally. Consider limitations of sceneConsider limitations of scene
Contact medical direction perContact medical direction per local protocol.local protocol.
on field delivery.on field delivery.
Delivery PrecautionsDelivery Precautions
Apply gloves, mask, eyeApply gloves, mask, eye protection, gown.protection, gown.
Control the scene to provide:Control the scene to provide:• A safe delivery areaA safe delivery area• Privacy, comfortPrivacy, comfort
(Continued)(Continued)
Delivery ProceduresDelivery Procedures
Have mother lie supine, kneesHave mother lie supine, knees drawn up and spread apart. drawn up and spread apart.
Elevate hips with blanket Elevate hips with blanket and pillow. and pillow.
(Continued)(Continued)
Delivery ProceduresDelivery Procedures
Create sterile field around vaginal opening.Create sterile field around vaginal opening.
Crowning ofCrowning ofInfant’s HeadInfant’s Head
Prevent explosivePrevent explosivedelivery of the head.delivery of the head.
If amniotic sac has not broken,If amniotic sac has not broken, puncture sac and pull it away puncture sac and pull it away from baby’s face. from baby’s face. Determine if umbilical cord is Determine if umbilical cord is around baby’s neck. If so, around baby’s neck. If so, clamp and cut cord. clamp and cut cord.
(Continued)(Continued)
Delivery ProceduresDelivery Procedures
Suction mouth, Suction mouth, then nose.then nose.
Aid in birth of Aid in birth of upper shoulder.upper shoulder.
Support the trunk.Support the trunk.
Support the legs.Support the legs.
Wipe blood, mucus from noseWipe blood, mucus from nose and mouth. and mouth.
Suction again.Suction again. Warmth is critical!Warmth is critical! Wrap baby in warm towel,Wrap baby in warm towel,
head lower than trunk.head lower than trunk.(Continued)(Continued)
Delivery ProceduresDelivery Procedures
Assign partner to initial careAssign partner to initial care and monitoring. and monitoring.
Keep infant level with vagina Keep infant level with vagina until cord is cut. until cord is cut.
Delivery ProceduresDelivery Procedures
(Continued)(Continued)
Clamp or tie cord; then cut.Clamp or tie cord; then cut.
Observe for delivery of Observe for delivery of placenta. placenta.
When placenta delivers, placeWhen placenta delivers, place in plastic bag for transport in plastic bag for transport to hospital. to hospital.
Delivery ProceduresDelivery Procedures
Delivering the PlacentaDelivering the Placenta
Cover vaginal opening with Cover vaginal opening with sterile pad. sterile pad.
Lower motherLower mother’s knees; help her to s knees; help her to hold them together. hold them together.
Record time of delivery.Record time of delivery.
(Continued)(Continued)
After-Delivery ProceduresAfter-Delivery Procedures
A loss of 500cc is well tolerated.
VaginalVaginal
BleedingBleeding If blood loss is excessive, massage the uterus.
Treat for shock.
After-Delivery ProceduresAfter-Delivery Procedures
Massage uterus to control bleeding.Massage uterus to control bleeding.
CCARE OF THEARE OF THENEWBORNNEWBORN
Position, dry, wipe, wrap.Position, dry, wipe, wrap. Repeat suctioning.Repeat suctioning. Cover the head.Cover the head.
(Continued)(Continued)
Care of the NewbornCare of the Newborn
Suctioning the NewbornSuctioning the Newborn
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APGAR
Color: No central cyanosis
Greater than 100/minute
Vigorous and crying
Good extremity motion
Normal, crying
Normal AssessmentNormal AssessmentFindings Findings —— Newborn Newborn
AAppearanceppearancePulsePulseGrimaceGrimaceActivityActivityRespiratory effortRespiratory effort
RRESUSCITATIONESUSCITATIONOF THE NEWBORNOF THE NEWBORN
Inverted Pyramid of Neonatal Inverted Pyramid of Neonatal ResuscitationResuscitation
Resuscitation of the NewbornResuscitation of the Newborn
Drying. Warming. Positioning.Suction. Tactile Stimulation.
Oxygen
Intubation
Medi-cations
Bag-Mask Ventilation
ChestCompressions
Stimulating the Newborn to BreatheStimulating the Newborn to Breathe
If shallow, slow, or absent:If shallow, slow, or absent:• Provide artificial ventilations,Provide artificial ventilations, 40 – 60/minute.40 – 60/minute.• Reassess after 30 seconds.Reassess after 30 seconds.• Continue as necessary.Continue as necessary.
Breathing EffortBreathing Effort
Heart RateHeart Rate If less thanIf less than 100 100/minute:/minute:
• Provide artificial ventilations,Provide artificial ventilations, 40 – 60/minute. 40 – 60/minute.• Reassess after 30 seconds.Reassess after 30 seconds.• If no improvement, continueIf no improvement, continue ventilations. ventilations.
(Continued)(Continued)
Heart RateHeart Rate If less thanIf less than 60–80/ 60–80/minute andminute and not responding to ventilation: not responding to ventilation:
• Start chest compressions at rate of Start chest compressions at rate of 120/min.120/min.
• Deliver compressions to the depth Deliver compressions to the depth of 1/3 to 1/2 the depth of the of 1/3 to 1/2 the depth of the patient’s chest.patient’s chest.
(Continued)(Continued)
Heart RateHeart Rate
If at any time the heart rate is lessIf at any time the heart rate is lessthanthan 60 60, begin ventilations and , begin ventilations and compressions immediately.compressions immediately.
ColorColor
If central (trunk) cyanosis isIf central (trunk) cyanosis ispresent with adequate breathingpresent with adequate breathingand heart rate, administer and heart rate, administer blow-by oxygen. blow-by oxygen.
Tell new EMT-Bs that it is not uncommon to find patients and family members very nervous. This will make the patient exam and decision making very difficult. The patient or her family may want to rush to the hospital, or they may feel that there just isn’t enough time. Encourage new EMT-Bs to carefully and objectively examine the patient and history as the basis for a transport decision. Assure the patient and family that you are equipped to evaluate the situation and handle delivery at home or in the ambulance.
PPRECEPTOR RECEPTOR PPEARLEARL
AABNORMALBNORMALDELIVERIESDELIVERIES
Abnormal Delivery: Prolapsed CordAbnormal Delivery: Prolapsed Cord
Patient Patient CARECARE
Prolapsed CordProlapsed Cord
Emergency Care StepsEmergency Care Steps
Complete patient assessment.Complete patient assessment. Give high-concentration oxygen.Give high-concentration oxygen. Position mother with hips elevatedPosition mother with hips elevated or head down. or head down.
(Continued)(Continued)
Patient Patient CARECARE
Prolapsed CordProlapsed Cord
Emergency Care StepsEmergency Care Steps
Insert sterile-gloved hand into Insert sterile-gloved hand into vagina,vagina, pushing the fetus away from the pushing the fetus away from the pulsating cord. pulsating cord. Transport rapidly.Transport rapidly.
Care for Prolapsed CordCare for Prolapsed Cord
AABNORMALBNORMALDELIVERY: BREECH DELIVERY: BREECH
PRESENTATIONPRESENTATION
Patient Patient ASSESSMENTASSESSMENT
Breech PresentationBreech Presentation
Signs and SymptomsSigns and Symptoms
Baby’s buttocks or lower extremitiesBaby’s buttocks or lower extremities presenting presenting Greater risk with prolapsed cordGreater risk with prolapsed cord
Patient Patient CARECARE
Breech PresentationBreech Presentation
Emergency Care StepsEmergency Care Steps
Place mother on oxygen.Place mother on oxygen. Transport immediately.Transport immediately. Place mother in head-down positionPlace mother in head-down position with hips elevated. with hips elevated.
Abnormal Delivery:Abnormal Delivery:Limb PresentationLimb Presentation
Patient Patient ASSESSMENTASSESSMENT
Limb PresentationLimb Presentation
Signs and SymptomsSigns and Symptoms
Baby’s limb protrudes fromBaby’s limb protrudes from birth canal. birth canal.
Patient Patient CARECARE
Limb PresentationLimb Presentation
Emergency Care StepsEmergency Care Steps
Transport immediately on recognition.Transport immediately on recognition. Place mother in head-down positionPlace mother in head-down position with hips elevated. with hips elevated. Place mother on oxygen.Place mother on oxygen.
Patient Patient ASSESSMENTASSESSMENT
MeconiumMeconium
Signs and SymptomsSigns and Symptoms
Green or brown amniotic fluidGreen or brown amniotic fluidindicates presence of fecal matter.indicates presence of fecal matter.
Suggests fetal distress during labor. Suggests fetal distress during labor.
Patient Patient CARECARE
MeconiumMeconium
Emergency Care StepsEmergency Care Steps
Do not stimulate before suctioning.Do not stimulate before suctioning. Suction.Suction. Maintain airway.Maintain airway. Ventilate if necessary.Ventilate if necessary. Transport as soon as possible.Transport as soon as possible.
CCOMPLICATIONSOMPLICATIONSOF CHILDBIRTHOF CHILDBIRTH
Complications ofComplications ofChildbirthChildbirth
MeconiumMeconium Multiple BirthsMultiple Births Premature BirthsPremature Births
Delivery procedure is theDelivery procedure is the same for each. same for each. Prepare for multiple Prepare for multiple resuscitations. resuscitations.
Call for assistance.Call for assistance.
Multiple BirthsMultiple Births
Always at risk of hypothermia.Always at risk of hypothermia.
Usually requires resuscitation.Usually requires resuscitation.• Should be performed unlessShould be performed unless physically impossible. physically impossible.
Premature BirthsPremature Births
GGYNECOLOGICALYNECOLOGICALEMERGENCIESEMERGENCIES
Complete patient assessment.Complete patient assessment. Base treatment on assessment.Base treatment on assessment. Apply external vaginal pads.Apply external vaginal pads. Transport.Transport.
Vaginal BleedingVaginal Bleeding(Late in Pregnancy)(Late in Pregnancy)
Treat like any soft-tissue injury.Treat like any soft-tissue injury. Never pack vagina.Never pack vagina. Administer oxygen.Administer oxygen. Perform ongoing assessment.Perform ongoing assessment.
Trauma–External GenitaliaTrauma–External Genitalia
Complete patient assessmentComplete patient assessment and care. and care. Maintain nonjudgmentalMaintain nonjudgmental attitude. attitude. Psychological care is required.Psychological care is required.
(Continued)(Continued)
Sexual AssaultSexual Assault
Preserve potential evidence.Preserve potential evidence. Discourage patient fromDiscourage patient from bathing, voiding. bathing, voiding. Fulfill reporting Fulfill reporting requirements. requirements.
Sexual AssaultSexual Assault
1. Describe how to deal with predelivery 1. Describe how to deal with predelivery emergencies. emergencies.
2. List three abnormal deliveries and how 2. List three abnormal deliveries and how they are handled in the field. they are handled in the field.
3. How should sexual assault be managed 3. How should sexual assault be managed in the field? in the field?
RREVIEW QUESTIONSEVIEW QUESTIONS