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Home OBSTETRICS AND GYNECOLOGY Home Lesson Objective: Lesson Objective: Indicate procedures for emergency (pre -hospital) childbirth.

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Presentation on theme: "Home OBSTETRICS AND GYNECOLOGY Home Lesson Objective: Lesson Objective: Indicate procedures for emergency (pre -hospital) childbirth."— Presentation transcript:

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2 Home OBSTETRICS AND GYNECOLOGY

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

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

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

6 Home n Fetus n Uterus n Placenta n Umbilical Cord n Amniotic Sac n Cervix Anatomy Review

7 Home The Stages of Labor n 1st Stage - 1st contraction until cervix is fully dilated. n 2nd Stage - full dilation until birth. n 3rd Stage - birth of baby, until delivery of placenta

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

9 Home Predelivery Emergencies n Miscarriage n Seizures n Vaginal Bleeding n Trauma

10 Home Miscarriage n Delivery of fetus & placenta before 20 weeks n Danger - bleeding & infection

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

12 Home Treatment n Apply external vaginal pads n Collect tissues n Transport

13 HomeSeizuresSeizures n Eclampsia - related to high blood pressure

14 Home Treatment n Initial assessment n HX & vitals n Transport on left side n Monitor airway & give O 2 n Transport

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

16 Home n Placenta abruptio - placenta separates prematurely n Placenta previa - placenta develops over & covers the mouth of the uterus

17 HomeTreatmentTreatment n BSI n Initial assessment n History and physical exam u Ask patient if she has any pain.

18 HomeTreatmentTreatment n Transport on left side n Sterile pad or sanitary napkin n Save any tissue n Transport

19 HomeTraumaTrauma n Severe bleeding n Injury to fetus

20 HomeTreatmentTreatment n Initial assessment n O 2 n Place on left side n Control external bleeding n Transport

21 Home Preparing for Delivery Assessing the need for emergency delivery n First decision - whether or not you have time to transport?

22 Home n Decision based on three factors: u Is the delivery imminent u Hospital cannot be reached due to a natural disaster, weather, or traffic conditions u No transportation is available

23 Home Equipment n Surgical scissors-1 pair n Hemostats or cord clamps-3 n Umbilical tape/sterile cord n Small rubber bulb syringe n Towels-5

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

25 Home Delivering The Baby Position and support n Flat, sturdy surface n Lie with knees drawn up and spread apart n Elevate buttocks with blankets

26 Home Position and support n Create sterile field u One towel under buttocks u One between her legs u One across her abdomen n Partner at head u Reassure/comfort u Assist airway

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

28 Home Delivering the Head n Umbilical cord around neck? u Slip over shoulder u Clamp and cut it

29 Home Delivering the Body n Support head and body n Grasp feet n Support with both hands u Baby will be slippery u Do not squeeze neck or chest

30 Home

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

32 Home Initial care of the baby n Wrap in blanket u Warm prior if possible u Leave only face expose n If not breathing, perform CPR

33 Home Cutting the Umbilical cord n Clamp with two clamps u Four fingers width from the baby u Two to six inches apart n Cut between clamps

34 Home Apgar score n 1 and 5 minutes n Healthy baby will score 10 n Five areas

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

36 Home Delivery of Placenta n Normal Delivery u Within a few minutes of babys birth u Usually less than 250 ml blood loss u Record delivery time u Take to hospital

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

38 Home

39 Click for Video

40 Home Resuscitation of Newborn n Assessing the baby u Respirations u Pulse n Artificial Ventilation u Use BVM u breaths per minute

41 Home Resuscitation of Newborn n Chest compressions u Heart rate is < 60 bpm, or between bpm and not rising u Both thumbs on middle third of the sternum or one thumb over the other

42 Home Abnormal Deliveries Prolapsed umbilical cord n Cord comes out before baby n Do not replace! n Danger: Decreased O 2 to the baby

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

44 Home Breech Delivery n Presenting part - buttocks or feet n Treatment u Position and drape mother u Allow buttocks and feet to deliver u Support legs and trunk

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

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

47 Home Treatment n Give mother O 2 n Place mother on back, head lower than pelvis n Cover with sterile towel n Transport

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

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

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

51 Home 5 important steps in management n Keep warm u degrees F n Keep mouth, nose, and throat clear n Make sure cord not bleeding u Apply additional clamps or ties u Slightest bleeding serious

52 Home 5 important steps in management n Increase O 2 in enviroment u Make tent over head u Aim O 2 at top of tent u Do not administer directly n Avoid infection u Use sterile equipment u Avoid unnecessary handling n Increase O 2 in enviroment u Make tent over head u Aim O 2 at top of tent u Do not administer directly n Avoid infection u Use sterile equipment u Avoid unnecessary handling

53 Home Gynecologic Emergencies Trauma to external genetalia u Treat as other bleeding and soft tissue injuries u O 2 u Never pack vagina u Transport

54 Home Alleged Sexual Assault and Rape Patient may refuse assistance

55 Home Treatment u BSI u Airway u Nonjudgmental attitude during SAMPLE u Crime scene protection

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

57 Home The End The End


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