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Presentation on theme: "OBSTETRICS AND GYNECOLOGY"— Presentation transcript:


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

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

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

5 Anatomy Review Fetus Uterus Placenta Umbilical Cord Amniotic Sac

6 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

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

8 Predelivery Emergencies
Miscarriage Seizures Vaginal Bleeding Trauma

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

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

11 Treatment Apply external vaginal pads Collect tissues Transport

12 Seizures Eclampsia - related to high blood pressure

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

14 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

15 Placenta abruptio - placenta separates prematurely
Placenta previa - placenta develops over & covers the mouth of the uterus

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

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

18 Trauma Severe bleeding Injury to fetus

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

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

21 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

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

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

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

25 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

26 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

27 Delivering the Head Umbilical cord around neck? Slip over shoulder
Clamp and cut it

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


30 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

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

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

33 Apgar score 1 and 5 minutes Healthy baby will score 10 Five areas

34 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

35 Delivery of Placenta Normal Delivery
Within a few minutes of baby’s birth Usually less than 250 ml blood loss Record delivery time Take to hospital

36 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!


38 Click for Video

39 Resuscitation of Newborn
Assessing the baby Respirations Pulse Artificial Ventilation Use BVM breaths per minute

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

41 Prolapsed umbilical cord
Abnormal Deliveries Prolapsed umbilical cord Cord comes out before baby Do not replace! Danger: Decreased O2 to the baby

42 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

43 Breech Delivery Presenting part - buttocks or feet Treatment
Position and drape mother Allow buttocks and feet to deliver Support legs and trunk

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

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

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

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

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

49 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

50 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

51 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

52 Gynecologic Emergencies
Trauma to external genetalia Treat as other bleeding and soft tissue injuries O2 Never pack vagina Transport

53 Alleged Sexual Assault and Rape
Patient may refuse assistance

54 Treatment BSI Airway Nonjudgmental attitude during SAMPLE
Crime scene protection

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

56 The End


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