1. Childbirth and Gynecologic Emergencies
Chapter 22
Childbirth and Gynecologic Emergencies

2. Childbirth and Gynecologic Emergencies of Pregnancy (1 of 2)
Birth canal: Vagina and lower part of uterus
Cervix: Small opening at lower end of uterus
Placenta: Mother and fetus exchange nourishment and waste through this organ
Umbilical cord: Extension of placenta through which fetus receives nourishment
Amniotic sac: Bag of fluid that cushions fetus

3. Childbirth and Gynecologic Emergencies of Pregnancy (2 of 2)
Crowning: Fetus’s head presses against vaginal opening
Bloody show: Mucus and blood discharged as labor begins
Labor: Process of childbirth
Miscarriage: Delivery of fetus before it can live independent of mother

4. Predelivery Emergencies
Miscarriage
Usually during first 3 months
Most occur because fetus was not developing properly
Emotionally upsetting
Have a woman help the victim.

5. Recognizing Miscarriage
Cramping pain in lower abdomen
Aching lower back
Vaginal bleeding
Passage of tissue from vagina

6. Care for Miscarriage Reassure the woman.
Help into comfortable position with legs bent.
Have woman place sanitary pad over outside of vagina.
Transport tissue from vagina to hospital with woman.
Transport to medical care.
Call if bleeding is heavy or signs of shock.

7. Vaginal Bleeding During Late Pregnancy
Last 3 months
Usually an emergency
Find out amount of bleeding
Have a woman help the victim if possible.

8. Recognizing Vaginal Bleeding During Late Pregnancy
Signs of shock could result from heavy bleeding.

9. Care for Vaginal Bleeding During Late Pregnancy
Place woman on left side.
Have woman place sanitary pad over outside of vagina.
Call

10. Vaginal Bleeding Caused by Injury
Difficult to determine source of bleeding
Can be difficult to care for due to:
Modesty
Pain

11. Recognizing Vaginal Bleeding Caused by Injury
Injuries of external female genitalia
Severe pain
Blood in vaginal area
Massive internal vaginal bleeding

12. Care for Injury-Related Vaginal Bleeding
Direct pressure over bulky dressing or sanitary pad
Apply ice.
Do not place dressings into vagina.
Place victim on left side.
Seek medical care.

13. Non-Injury-Related Vaginal Bleeding
Most likely to be menstrual
Can indicate more serious conditions:
Miscarriage
Childbirth
Infection

14. Recognizing Non-Injury-Related Vaginal Bleeding
Abdominal cramps

15. Care for Non-Injury-Related Vaginal Bleeding
Reassure woman.
Help into comfortable position with legs bent.
Have woman place sanitary pad over outside of vagina.
Seek medical care.

16. Delivery Unplanned time or place = emergency
Can be stressful for first aider
Can be a happy event

17. Imminent Delivery (1 of 3)
Consider transport if woman is not straining or crowning and this is first pregnancy.
If transport is possible, place woman on left side.
Prevents possible drop in blood pressure.

18. Imminent Delivery (2 of 3)
If straining or crowning, prepare to assist delivery.
Call EMS.
Find private, clean area.
Wear gloves, more protection if possible.
Do not touch vaginal area except during delivery.
Do not let mother use toilet.
Do not hold mother’s legs together.

19. Imminent Delivery (3 of 3)
If head is not presenting, delivery will be complicated.
Tell mother not to push.
Attempt to calm and reassure.
Call

20. Stages of Labor (1 of 4) Three-stage process: Uterine contractions
Delivery of baby
Delivery of placenta

21. Stages of Labor (2 of 4) First stage
Contractions last several hours, aching in back/cramps in abdomen
Contractions grow shorter, increase in intensity
Amniotic sac breaks
If amniotic sac breaks prematurely or not during labor, seek medical care.

22. Stages of Labor (3 of 4) Second stage 30 minutes to 2 hours
Neck of cervix fully opens
Baby is born
Baby’s head normally comes out first

23. Stages of Labor (4 of 4) Third stage 15 minutes or more
Placenta is expelled

24. Recognizing Impending Delivery (1 of 2)
Has woman had a baby before?
How frequent are the contractions?
Has amniotic sac ruptured?
Does mother feel like she must move her bowels?

25. Recognizing Impending Delivery (2 of 2)
If yes, examine for crowning:
Bulging at vaginal opening
Part of baby is visible
Explain what you are doing
Protect woman’s privacy
Use blanket to shield from others

26. Delivery Procedures Supplies: Clean sheets, towels, blankets
Plastic bag or towel
Clean, unused medical exam gloves
Sanitary pads
Newspapers, plastic, cloth sheet
Rubber bulb syringe
Sterile gauze pads
Strips of gauze, new or clean shoelaces

27. Care During Delivery (1 of 6)
Take infection-control precautions.
Have mother lie on back with knees drawn up, legs spread apart, or other safe position.
Have woman take short, quick breaths during contractions.
Have woman take deep breaths between contractions.
Place absorbent, clean materials under mother’s buttocks.

28. Care During Delivery (2 of 6)
Elevate mother’s buttocks with blankets or pillow.
When baby’s head appears, gently place your palm on top of the head.
Have woman stop pushing.
Do not push on fontanels.
If amniotic sac does not break, tear it with your fingers and push away from baby’s head and mouth.

29. Care During Delivery (3 of 6)
If umbilical cord is wrapped around neck, gently slip over baby’s shoulder.
Or, alleviate pressure on cord
Support head.
Suction baby’s mouth and nostrils.
Support body with both hands as baby emerges.
Do not pull on baby or touch armpits.

30. Care During Delivery (4 of 6)
Keep baby level with vagina.
Wipe blood and mucus from baby’s mouth and nose.
Dry the infant.
Rub baby’s back, flick soles of feet.
If baby does not breathe in 30 seconds, begin CPR.
Wrap baby in warm blanket, place on side.
Maintain at level of vagina.

31. Care During Delivery (5 of 6)
When umbilical cord stops pulsating, tie with gauze.
Do not cut cord unless in remote location.
If so, tie cord 4 inches away from baby.
Make second tie 2 inches from first tie.
Cut between ties.
Watch for delivery of placenta.
Do not pull umbilical cord.

32. Care During Delivery (6 of 6)
Wrap placenta in towel with 3/4 of umbilical cord.
Place towel in plastic bag, keep bag at level of infant.
Take placenta to hospital.
Place sterile pad over vaginal opening.
Lower mother’s legs, help her hold them together.
Gently massage woman’s abdomen just below navel.

33. Delivery Aftercare Monitor mother’s breathing and pulse.
Replace blood-soaked sheets, blankets.
Massage uterus if blood loss continues.
Place palm on mother’s lower abdomen.
Massage
Mother may breast feed after delivery of placenta.
This helps control bleeding.

34. Initial Care of the Newborn (1 of 2)
Pulse should be more than 100 beats/min.
Respiratory rate should be more than 40 breaths/min.
Baby is often crying.
Position, dry baby, keep warm, stimulate to breathe
Repeat suctioning.

35. Initial Care of the Newborn (2 of 2)
CPR if does not breathe in 30 seconds.
Ensure that airway is open.
Give one rescue breath every 3 seconds.
Reassess after 1 minute.

36. Abnormal Deliveries Most births are normal, natural.
Complications can arise.
Stay calm, deliberate, gentle.
Call

37. Prolapsed Cord
Umbilical cord comes through the birth canal before the head.
Cord is squeezed between baby’s head and mother’s body.
Oxygen to baby could be stopped.
Baby in danger of suffocation

38. Recognizing Prolapsed Cord
Umbilical cord is seen before baby’s head.

39. Care for Prolapsed Cord
Raise mother’s buttocks.
Insert gloved fingers into vagina on either side of cord.
Push baby away from cord.
Do not push cord into vagina.
Call

40. Breech Birth Presentation
Baby’s buttocks emerge before the head
Most common type of abnormal delivery
Place mother in kneeling, head-down position.
Seek medical care.
Suffocation can occur.

41. Recognizing Breech Birth Presentation
Baby’s buttocks come out first.

42. Care for Breech Birth Presentation
Place one hand in vagina, position palm toward baby’s face.
Form a “V” with fingers on either side of baby’s nose.
Push vaginal wall away from baby’s face until head is delivered.
Call
Have woman continue to push

43. Limb Presentation
Arm, leg, or foot of the infant protrudes from birth canal
Foot more commonly presents when infant is in breech presentation

44. Recognizing Limb Presentation
Arm, leg, or foot appears first.

45. Care for Limb Presentation
Place mother in head-down position with pelvis elevated.
Do not pull on baby or push limb back in.
Call

46. Meconium Baby’s first feces, in amniotic fluid
Associated with fetal distress during labor, greater risk of infant death
Danger if baby breathes into lungs

47. Recognizing Meconium Greenish or brownish-yellow amniotic fluid Tarry
Almost odorless

48. Care for Baby in Danger of Inhaling Meconium
Keep infant in moderate head-down position.
Suction mouth and nostrils.
Try not to stimulate infant to breathe before suctioning.
Keep baby’s airway open.
Call

49. Premature Birth Baby weighing less than 5.5 lb or born before 7 months
Need special care
Smaller, less developed
Cardiovascular and respiratory systems often immature

50. Recognizing Premature Birth
Difficult without scale to weigh
Smaller and thinner than full-term infant
Head proportionately large compared to body
Cheesy, white coating on skin is minimal or absent

51. Care for Premature Babies
Keep baby warm; increased risk of hypothermia
Keep mouth and nose clear of mucus.
Monitor breathing.
Perform CPR if necessary.

52. Gynecologic Emergencies
Reproductive-system problems that occur in nonpregnant females

53. Sexual Assault and Rape
Rape is fastest growing violent crime in US.
Most often victim is a woman.
1 in 3 American women sexually assaulted at some point.
Men can also be raped.
Rape
Attempted or actual sexual intercourse against victim’s will
Physical and psychological injury
Calm, sympathetic care is essential.

54. Recognizing Sexual Assault and Rape (1 of 2)
Focus on providing care, not obtaining evidence.
Preserve evidence.
Question about injuries only, not crime.
Use SAMPLE survey.

55. Recognizing Sexual Assault and Rape (2 of 2)
Signs:
Headaches
Sleeplessness, nightmares
Nausea, muscle spasms
Confusion
Depression
Anxiety, jumpiness

56. Care for Sexual Assault and Rape (1 of 2)
Don’t ask a lot of questions.
Don’t blame survivor.
Be supportive.
Remind that he/she is safe.
Determine immediate care needed.
Try to have woman present to care for female victim.
Do not expose genitalia unless extreme care is needed.

57. Care for Sexual Assault and Rape (2 of 2)
Try to preserve evidence.
Encourage victim not to change clothes, wash, urinate, defecate, douche.
Do not leave victim alone.
Protect privacy.
Provide crisis center information.
Get survivor to medical care.
Encourage survivor to get medical care if he/she refuses.