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CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Chapter 27 Obstetric and.

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Presentation on theme: "CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Chapter 27 Obstetric and."— Presentation transcript:

1 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Chapter 27 Obstetric and Gynecological Emergencies

2 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Childbirth and Obstetric Emergencies Gynecological Emergencies Enrichment 27Topics

3 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Anatomy of Pregnancy –Uterus –Cervix –Placenta –Umbilical cord –Amniotic sac –Vagina 27 Childbirth and Obstetrical Emergencies

4 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Anatomy of Pregnancy –A full-term pregnancy lasts approximately 280 days from the first day of the last menstrual cycle. –Each three-month period of the approximately nine- month pregnancy is referred to as a “trimester.” –Toward the end of the third trimester, the baby should move into a head down position in preparation for birth. 27 Childbirth and Obstetrical Emergencies

5 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Stages of Labor –Labor describes the process of birth. –Normal labor is divided into three stages: Dilation Expulsion Placental –The length of each stage varies from woman to woman and depends on a variety of circumstances. 27 Childbirth and Obstetrical Emergencies

6 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Stages of Labor –First Stage: Dilation Begins with first uterine contraction and ends when the cervix is completely dilated. “Bloody” show. Rupture of amniotic sac. Contractions increase in frequency and intensity. May last longer for woman having first child. 27 Childbirth and Obstetrical Emergencies

7 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Stages of Labor –Second Stage: Expulsion Begins with complete cervical dilation and ends with delivery of the baby. Contractions are close together and last longer. Mother has urge to “push.” Perineum may tear. Crowning. 27 Childbirth and Obstetrical Emergencies

8 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Stages of Labor –Third Stage: Placental Begins once the baby is delivered and ends when the placenta is expelled. Placenta typically delivered 5 to 20 minutes after the baby. Gush of blood. Uterus becomes smaller. Umbilical cord lengthens. Maternal urge to push. 27 Childbirth and Obstetrical Emergencies

9 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Delivery –Scene Size-Up Gather clues prior to physically touching the patient. –Dispatch information. –High index of suspicion - any female of childbearing age (12 to 50 years) may be experiencing an obstetric emergency. –Patient appears pregnant on approach. Take the appropriate BSI precautions. 27 Childbirth and Obstetrical Emergencies

10 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Delivery –Initial Assessment Perform the initial assessment on the mother as you would any other patient. –Mental status –Airway –Breathing –Circulation Identify and correct any life threatening conditions within the ABCs. 27 Childbirth and Obstetrical Emergencies

11 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Delivery –Focused History and Physical Exam Get a SAMPLE history including the OPQRST. –Ask patient if she is pregnant. –Is the patient experiencing any pain or discomfort? –When was the patient’s last menstrual period? –Has there been any unusual vaginal bleeding or discharge? –What is the baby’s due date? Some women, especially in early pregnancy, may not know that they are pregnant. Maintain a high index of suspicion 27 Childbirth and Obstetrical Emergencies

12 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Delivery –Focused History and Physical Exam Get a SAMPLE history including the OPQRST. –Has the patient ever been pregnant before? –If the patient has been pregnant before, how many pregnancies? –How many pregnancies resulted in live births? –Where the previous pregnancies vaginal or by caesarian section? –Any complications with the previous pregnancies? 27 Childbirth and Obstetrical Emergencies

13 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Delivery –Focused History and Physical Exam If the patient is experiencing abdominal pain or contractions, perform a focused exam of abdomen and vaginal area. –Rigidity of abdomen –Bloody show or crowning in vaginal region Obtain baseline vital signs. –Pulse and respirations normally increased in pregnancy –Blood pressure normally decreased 27 Childbirth and Obstetrical Emergencies

14 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Delivery –Consider a predelivery emergency if the patient is pregnant and experiencing any of the following: Abdominal pain Vaginal bleeding or passage of tissue Weakness or dizziness Altered mental status Seizures Excessive swelling of the face or extremities Abdominal trauma Shock (hypoperfusion) 27 Childbirth and Obstetrical Emergencies

15 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Emergency Medical Care –Provide the same basic medical care that you would to any other patient with a similar complaint. Assure a patent airway. Assure adequate breathing. –Provide high flow oxygen if breathing is adequate. –Provide positive pressure ventilation with a bag mask, reservoir, and high flow oxygen if the breathing is inadequate. –Care for vaginal bleeding. –Treat the patient for shock (hypoperfusion) if present. 27 Childbirth and Obstetrical Emergencies

16 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Emergency Medical Care –If the patient is in cardiac arrest, provide vigorous resuscitation and rapid transport to the hospital. Baby may be able to be saved via emergency caesarian section. 27 Childbirth and Obstetrical Emergencies

17 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Emergency Medical Care –If the patient is in her third trimester, watch for supine hypotensive syndrome. Pressure of the enlarged uterus and the weight of the baby compress the vena cava. Blood return to the heart is reduced, causing the female to become relatively hypotensive. Place the mother in a sitting or the left (or right) lateral recumbent position if supine hypotensive syndrome is present. Transport in this position. 27 Childbirth and Obstetrical Emergencies

18 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Emergency Medical Care –Ongoing Assessment Perform the ongoing assessment en route to the hospital. Repeat vital signs. Continually look for signs of developing shock (hypoperfusion). 27 Childbirth and Obstetrical Emergencies

19 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Specific Predelivery Emergencies –Spontaneous Abortion A spontaneous abortion (miscarriage) is the delivery of the fetus and placenta before the fetus can live on its own (typically after the 20th week). –Causes include genetic abnormalities, uterine abnormality, infection, drugs, maternal disease(s). 27 Childbirth and Obstetrical Emergencies

20 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Specific Predelivery Emergencies –Spontaneous Abortion The signs and symptoms of a spontaneous abortion include: –Cramping like abdominal pain –Moderate to severe vaginal bleeding which is typically bright or dark red (Do not mistake a spontaneous abortion for a heavy period.) –Passage of tissue or clots 27 Childbirth and Obstetrical Emergencies

21 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Specific Predelivery Emergencies –Spontaneous Abortion Emergency Medical Care –Assure the ABCs. –Provide high flow oxygen. –Provide supportive care. –Do not pack the vagina to control bleeding. –Transport all clots and tissue with the patient to the hospital. 27 Childbirth and Obstetrical Emergencies

22 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Specific Predelivery Emergencies –Seizures Seizures during pregnancy can be a life threatening condition for both the mother and fetus. –Provide emergency care as you would for any other seizure patient. –Make sure to protect the mother from injuring herself. –Transport patient on her left side if seizure occurs during the third trimester. –Transport in a calm, quiet manner. 27 Childbirth and Obstetrical Emergencies

23 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Specific Predelivery Emergencies –Vaginal Bleeding Vaginal bleeding may occur any time during pregnancy and may represent a life threatening condition for both the mother and fetus. –Treat the patient as you would any other person suffering from blood loss. –Look for shock (hypoperfusion). –Place sanitary napkins over the vaginal opening but do not pack the vaginal canal. –Transport as soon as possible. 27 Childbirth and Obstetrical Emergencies

24 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Specific Predelivery Emergencies –Trauma to a Pregnant Woman Moderate to severe blunt force to the abdomen, especially late in pregnancy, can damage or injure the fetus as well as the mother. –Treat the mother as any other trauma patient. –Assure the ABCs and provide high flow oxygen. –If immobilized, tilt the longboard to the left, especially late in pregnancy. –Provide rapid transport to the closest appropriate medical facility. 27 Childbirth and Obstetrical Emergencies

25 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Normal Delivery –Perform the scene size-up, initial assessment, and focused history and physical exam as you would for any other patient. Make sure to assess the abdomen and vaginal area if the patient is in active labor. 27 Childbirth and Obstetrical Emergencies

26 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Normal Delivery –Determine whether the patient can be transported or delivery is imminent and will have to occur on scene: Crowning has occurred. Contractions are less than 2 minutes apart and lasting from 60 to 90 seconds. Mother feels the baby’s head moving down the birth (vaginal) canal. Mother has a strong urge to push. Patient’s abdomen is very hard. 27 Childbirth and Obstetrical Emergencies

27 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Normal Delivery –Preparation for a Field Delivery Take appropriate BSI. Avoid touching the vaginal area prior to actual delivery. Do not allow the mother to use the bathroom. Do not hold the mother’s legs together to delay delivery. Obtain the obstetrics kit. Stay calm and provide reassurance to the mother. 27 Childbirth and Obstetrical Emergencies

28 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Normal Delivery –Emergency Medical Care Position the mother on her back with head supported and legs flexed. Create a sterile environment around the vaginal opening. Continually assess for crowning. Gently place your gloved fingers on the bony part of the infant’s skull when it crowns. Tear the amniotic sac if not already ruptured. Determine the position of the umbilical cord. 27 Childbirth and Obstetrical Emergencies

29 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Normal Delivery –Emergency Medical Care (continued) Remove fluids from the newborn’s airway by suctioning the mouth then nose with a bulb syringe. Support the newborn’s body with your hands as he is delivered. Grasp the feet as they are born. Clean then suction the newborn’s mouth and nose with a bulb syringe. Dry, wrap, warm, and position the newborn. 27 Childbirth and Obstetrical Emergencies

30 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Normal Delivery –Emergency Medical Care (continued) Assign your partner to monitor and complete the initial care of the newborn. Clamp, tie, and cut the umbilical cord. 27 Childbirth and Obstetrical Emergencies

31 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Normal Delivery –Emergency Medical Care (continued) Observe for delivery of the placenta. Wrap the delivered placenta. Place one or two sanitary napkins over the vaginal opening. Record the time of delivery and transport the mother, baby, and placenta to the hospital. 27 Childbirth and Obstetrical Emergencies

32 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Normal Delivery –Emergency Medical Care Delivery summary 27 Childbirth and Obstetrical Emergencies

33 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –If you encounter any one of the following conditions, anticipate and prepare for an abnormal delivery: Any fetal presentation other than the normal crowning of the baby’s head Abnormal color or smell of the amniotic fluid Labor before the 38th week of pregnancy Recurrence of contractions after the first baby is born (indicating multiple births) 27 Childbirth and Obstetrical Emergencies

34 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Prolapsed Cord After rupture of the amniotic sac, the umbilical cord rather than the head is the presenting part. –The umbilical cord may be compressed between the baby and the wall of the vagina. –Umbilical cord compression cuts off the supply of oxygen-rich blood to the baby and is a true emergency! 27 Childbirth and Obstetrical Emergencies

35 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Prolapsed Cord Emergency Care: –Position the mother in the “knee-chest” position. –Insert a sterile gloved hand into the vaginal canal and gently lift the presenting part off of the umbilical cord. –Cover the umbilical cord with a sterile towel moistened with saline solution. –Transport the mother rapidly. 27 Childbirth and Obstetrical Emergencies

36 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Breech Birth A breech birth occurs when the fetal buttocks or lower extremities are the presenting parts instead of the head. –Delivery may be prolonged. –There is increased risk of delivery related trauma to both mother and baby. 27 Childbirth and Obstetrical Emergencies

37 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Breech Birth Emergency Care: –Position mother in a supine head-down position with her pelvis elevated. –Transport immediately. –Birth may still occur. 27 Childbirth and Obstetrical Emergencies

38 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Limb Presentation A limb presentation occurs when one arm or leg is the first to protrude from the birth canal. –Surgery is frequently required for delivery. Provide the following care: –Provide high flow oxygen. –Position the mother in a supine head-down position. –Never pull on the presenting part. –Do not attempt delivery. 27 Childbirth and Obstetrical Emergencies

39 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Multiple Births (e.g. twins, triplets) Suspect multiple births if: –Abdomen still very large following delivery of the first baby. –Strong uterine contractions continue after the first delivery. –Uterine contractions start again about 10 minutes after the first delivery. –The baby’s size is small in relation to the mother’s abdomen. 27 Childbirth and Obstetrical Emergencies

40 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Multiple Births Emergency Medical Care –Provide care as you would for any other delivery. –Be prepared to care for more than one newborn. –Call for assistance early! –Anticipate and prepare for complications since one third of second deliveries are breech. –Expect and manage significant hemorrhage. –Babies of multiple births tend to be low in birth weight and may require significant resuscitation. –If second baby has not delivered within 10 minutes of the first, transport immediately. 27 Childbirth and Obstetrical Emergencies

41 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Meconium The passing of fetal bowel contents (meconium) may occur during birth and indicate a difficult labor for the baby. –The normally clear clear amniotic fluid appears cloudy to greenish to yellow. –Aspiration of the meconium into the baby’s lungs can result in aspiration pneumonia. 27 Childbirth and Obstetrical Emergencies

42 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Meconium Emergency care: –Do not stimulate the baby before suctioning the mouth and nose! –Attempt to clear the baby’s mouth and nose before taking his or her first breath. –Transport as soon as possible while assuring a patent airway and adequate ventilation. 27 Childbirth and Obstetrical Emergencies

43 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Premature Birth An infant is considered premature if he or she is born before the 38th week of pregnancy or is less than 5 pounds. Due to decreased development, premature babies are susceptible to a host of problems including hypothermia and respiratory distress. 27 Childbirth and Obstetrical Emergencies

44 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Active Labor and Abnormal Delivery –Premature Birth Emergency Medical Care: –Dry the baby thoroughly to avoid heat loss. –Gently suction the mouth and nose to keep the airway clear of fluid. –Administer blow-by oxygen. –Support ventilation as needed. –Prevent contamination since the premature baby is very susceptible to infection. –Wrap the baby securely to keep it warm. 27 Childbirth and Obstetrical Emergencies

45 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Care of the Healthy Newborn –Protecting the newborn against heat loss is critical! Heat loss can deplete the newborn of vital energy needed for survival Assure that the newborn is completely dried and covered –Also assure that the airway is clear of all secretion or birth fluids. Perform additional suctioning as needed. 27 Childbirth and Obstetrical Emergencies

46 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Care of the Healthy Newborn –Perform the APGAR score 1 and 5 minutes after birth: A - Appearance P - Pulse G - Grimace A - Activity R - Respirations 27 Childbirth and Obstetrical Emergencies

47 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Care of the Healthy Newborn –APGAR Score: Appearance The skin of a newborn should be pink. Assess the newborn’s skin color and score as follows: –Entire body blue or pale - 0 points –Blue hands and feet - 1 point –Entire body pink - 2 points 27 Childbirth and Obstetrical Emergencies

48 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Care of the Healthy Newborn –APGAR Score: Pulse The pulse of a newborn should be greater than 100 beats per minute. Assess the newborn’s brachial pulse or use a stethoscope and score as follows: –Pulse absent - 0 points –Pulse less than point –Pulse greater than points 27 Childbirth and Obstetrical Emergencies

49 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Care of the Healthy Newborn –APGAR Score: Activity A newborn should exhibit active flexion and extension of the extremities. Assess the newborn’s activity and score as follows: –No extremity movement - 0 points –Minimal activity - 1 point –Strong activity - 2 points 27 Childbirth and Obstetrical Emergencies

50 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Care of the Healthy Newborn –APGAR Score: Respirations A newborn should breathe between 30 and 60 times a minute or exhibit a strong cry. Assess the newborn’s breathing and score as follows: –No respiratory effort - 0 points –Slow (<30/minute), irregular, or weak cry - 1 point –Normal respirations or strong cry - 2 points 27 Childbirth and Obstetrical Emergencies

51 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment and Care of the Healthy Newborn –APGAR Score At the conclusion of the APGAR score, add the numbers together and consider the following: –7-10 points - The newborn should be active and vigorous. Provide routine care. –4-6 points - The newborn is moderately depressed. Provide stimulation and oxygen. –0-3 points - The newborn is severely depressed and requires extensive resuscitation. 27 Childbirth and Obstetrical Emergencies

52 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Emergency Care of the Depressed Newborn –A minority of newborns will require some form of resuscitation aside from drying, warming, positioning, and suctioning. Additional resuscitation measures include: Oxygen administration Ventilation with the bag mask CPR 27 Childbirth and Obstetrical Emergencies

53 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren 27 Childbirth and Obstetrical Emergencies

54 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Emergency Care of the Depressed Newborn –Oxygen administration Administer blow-by oxygen if the newborn displays: –Cyanosis of the skin –Spontaneous and adequate breathing –Heart rate above 100 beats per minute 27 Childbirth and Obstetrical Emergencies

55 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Emergency Care of the Depressed Newborn –Ventilation with the Bag Mask Provide ventilations with the bag mask at a rate of 30 to 60 breaths per minute if: –The newborn’s breathing is slow or otherwise inadequate. –The newborn’s heart rate is less than 100 beats per minute. –The newborn’s trunk remains cyanotic despite the administration of blow-by oxygen. Reassess the infant’s color, respiratory effort, and heart rate after 30 seconds of ventilation. 27 Childbirth and Obstetrical Emergencies

56 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Emergency Care of the Depressed Newborn –Cardiopulmonary Resuscitation Provide CPR if: –The newborn’s heart rate is less than 60 beats per minute. Reassess the infant’s color, respiratory effort, and heart rate after 30 seconds of CPR and treat according to findings. 27 Childbirth and Obstetrical Emergencies

57 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren General Information –Gynecological emergencies are those that apply to the female reproductive system and typically present with: Abdominal pain Vaginal bleeding Fever and chills (infection) Sexual assault or rape 27 Gynecological Emergencies

58 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Assessment –Assess the patient as you would any other person with similar complaints. –Consider the following guidelines: Maintain a high regard for privacy and question the female in a discreet manner. If performing a rapid trauma assessment, cover the patient to protect her privacy. Never examine the genitalia of a sexual assault or rape victim unless there is profuse or life threatening hemorrhage. Preserve all evidence associated with a sexual assault or rape. Handle the patient’s clothing as little as possible. Follow local protocols for crime scene protection. 27 Gynecological Emergencies

59 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Treatment –Treat the patient as you would any other person with similar complaints. Ensure an adequate airway, breathing, and circulation. Look for and treat shock (hypoperfusion) if present. Place a sanitary napkin over the vaginal opening if hemorrhage is present. Never pack the vagina to control bleeding. Provide additional care based on the patient’s complaint(s) or assessment findings. Transport. 27 Gynecological Emergencies

60 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Placenta Previa –Placenta previa occurs when the placenta is abnormally implanted at the bottom of the uterus over the cervix. When the fetus changes position or the cervix dilates in preparation for birth, the placenta tears resulting in painless vaginal bleeding. –Placenta previa is a major cause of third trimester bleeding (1 in 250 pregnancies). 27 Enrichment

61 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Placenta Previa –The hallmark sign of placenta previa is painless vaginal bleeding during the third trimester. 27 Enrichment

62 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Placenta Previa –Predisposing factors for placenta previa include: Greater than 2 deliveries Rapid succession of pregnancies Greater than 35 years of age Previous placenta previa History of early vaginal bleeding during pregnancy Bleeding after intercourse during third trimester 27 Enrichment

63 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Placenta Previa –Emergency Care Assess and care for the female as you would any other predelivery patient. Actively examine for shock (hypoperfusion). Placenta previa can cause harm to both the mother and baby and requires hospital evaluation. 27 Enrichment

64 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Abruptio Placenta –Abruptio placenta is the abnormal separation of the placenta from the uterine wall prior to birth and jeopardizes both mother and baby by: Providing inadequate gas exchange (oxygen, carbon dioxide, and waste removal) between mother and fetus Severe maternal blood loss resulting in hypovolemic shock 27 Enrichment

65 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Abruptio Placenta –Signs and symptoms of abruptio placenta include: Vaginal bleeding associated with pain Abdominal pain due to muscle spasm of the uterus Pain to the mid to lower back Presence of uterine contractions (usually) Tender abdomen on palpation Vaginal bleeding (varies) –The amount of active bleeding does not necessarily correlate to the actual blood loss due to blood trapping. 27 Enrichment

66 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Abruptio Placenta –Predisposing factors for abruptio placenta include: Hypertension Use of cocaine or other vasoconstrictive drugs Preeclampsia Several births Previous abruption Smoking Short umbilical cord Premature rupture of the amniotic sac Diabetes mellitus 27 Enrichment

67 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Abruptio placenta –Emergency Care Assess and care for the female as you would any other predelivery patient. Actively examine for shock (hypoperfusion). Provide oxygen and rapid transport. 27 Enrichment

68 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Preeclampsia and Eclampsia –Preeclampsia is a condition characterized by high blood pressure, swelling in the extremities, headaches, and visual disturbances –Eclampsia involves more severe cases of eclampsia with the addition of seizure activity Seizure can cause premature labor or abruptio placenta and prove life threatening to the fetus 27 Enrichment

69 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Preeclampsia and Eclampsia –Signs and symptoms of preeclampsia and eclampsia include: Altered mental status Hypertension Abdominal pain Blurred vision or other visual disturbances Swelling of the extremities and/or face Decreased urine output Persistent vomiting Seizures (specific to eclampsia) 27 Enrichment

70 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Preeclampsia and Eclampsia –Predisposing factors for preeclampsia and eclampsia include: History of hypertension, diabetes, kidney disease, liver disease, or heart disease No previous pregnancies History of poor nutrition 27 Enrichment

71 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Preeclampsia and Eclampsia –Emergency Care Assess and care for the female as you would any other predelivery patient. Treat the seizing female like any other seizure patient. Provide oxygen and quiet transport if a life threatening condition like seizure activity is not present. 27 Enrichment

72 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Ruptured Uterus –As the uterus enlarges throughout pregnancy, the uterine wall becomes extremely thin and is prone to spontaneous or traumatic rupture. The fetus can be released into the abdominal cavity. Blood loss can be severe: –Maternal mortality is between 5 and 20% –Fetal mortality is 50% Uterine rupture requires emergency surgery. 27 Enrichment

73 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Ruptured Uterus –Signs and symptoms of ruptured uterus include: Tearing or shearing sensation in the abdomen Constant and severe abdominal pain Nausea and vomiting Shock (hypoperfusion) Vaginal bleeding ranging from minor to severe Cessation of noticeable contractions Ability to palpate fetus in the abdominal cavity 27 Enrichment

74 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Ruptured Uterus –Predisposing factors for ruptured uterus include: History of previous uterine rupture Abdominal trauma Large fetus History of birthing more than two children Prolonged and difficult labor Previous caesarean section or abdominal surgery 27 Enrichment

75 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Ruptured Uterus –Emergency Care Assess and care for the female as you would any other predelivery patient. Treat shock (hypoperfusion) if present. Provide oxygen and rapid transport. 27 Enrichment

76 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Ectopic Pregnancy –An ectopic pregnancy occurs when the fertilized egg implants in an area other than the uterus. Fallopian tube (90%) Abdominal cavity (6%) Outside wall of the uterus Ovary –The growing embryo and placenta will eventually rupture the tissue causing life threatening hemorrhage. 27 Enrichment

77 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Ectopic Pregnancy –Rupture typically occurs during the first semester between 2 and 12 weeks. –Ectopic pregnancy occurs in 1 in 200 pregnancies. –Rupture ectopic pregnancy is the leading cause of maternal death during pregnancy. 27 Enrichment

78 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Ectopic Pregnancy –Signs and symptoms of an ectopic pregnancy include: Sudden, sharp abdominal pain to one side of the abdomen Vaginal bleeding (varies in intensity) Lower abdominal pain Tender, bloated abdomen Palpable mass in the abdomen Weakness or dizziness when standing or sitting Decreased BP and increased pulse rate Signs of shock (hypoperfusion) Urge to defecate 27 Enrichment

79 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Ectopic Pregnancy –Predisposing factors for an ectopic pregnancy include: Previous ectopic pregnancy Pelvic inflammatory disease Adhesions from surgery Tubal ligation 27 Enrichment

80 CHAPTER Copyright 2004 Prentice Hall Publishing A division of Pearson Inc. Prehospital Emergency Care 7e Mistovich/Hafen/Karren Ectopic Pregnancy –Emergency Care Assess and care for the female as you would any other predelivery patient. Treat shock (hypoperfusion)if present. Provide oxygen and rapid transport. 27 Enrichment


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