Presentation on theme: "Childbirth and Gynecologic Emergencies"— Presentation transcript:
1Childbirth and Gynecologic Emergencies Chapter 22Childbirth and Gynecologic Emergencies
2Childbirth and Gynecologic Emergencies of Pregnancy (1 of 2) Birth canal: Vagina and lower part of uterusCervix: Small opening at lower end of uterusPlacenta: Mother and fetus exchange nourishment and waste through this organUmbilical cord: Extension of placenta through which fetus receives nourishmentAmniotic sac: Bag of fluid that cushions fetus
3Childbirth and Gynecologic Emergencies of Pregnancy (2 of 2) Crowning: Fetus’s head presses against vaginal openingBloody show: Mucus and blood discharged as labor beginsLabor: Process of childbirthMiscarriage: Delivery of fetus before it can live independent of mother
4Predelivery Emergencies MiscarriageUsually during first 3 monthsMost occur because fetus was not developing properlyEmotionally upsettingHave a woman help the victim.
5Recognizing Miscarriage Cramping pain in lower abdomenAching lower backVaginal bleedingPassage of tissue from vagina
6Care 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.
7Vaginal Bleeding During Late Pregnancy Last 3 monthsUsually an emergencyFind out amount of bleedingHave a woman help the victim if possible.
8Recognizing Vaginal Bleeding During Late Pregnancy Signs of shock could result from heavy bleeding.
9Care for Vaginal Bleeding During Late Pregnancy Place woman on left side.Have woman place sanitary pad over outside of vagina.Call
10Vaginal Bleeding Caused by Injury Difficult to determine source of bleedingCan be difficult to care for due to:ModestyPain
11Recognizing Vaginal Bleeding Caused by Injury Injuries of external female genitaliaSevere painBlood in vaginal areaMassive internal vaginal bleeding
12Care for Injury-Related Vaginal Bleeding Direct pressure over bulky dressing or sanitary padApply ice.Do not place dressings into vagina.Place victim on left side.Seek medical care.
13Non-Injury-Related Vaginal Bleeding Most likely to be menstrualCan indicate more serious conditions:MiscarriageChildbirthInfection
15Care 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.
16Delivery Unplanned time or place = emergency Can be stressful for first aiderCan be a happy event
17Imminent 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.
18Imminent 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.
19Imminent Delivery (3 of 3) If head is not presenting, delivery will be complicated.Tell mother not to push.Attempt to calm and reassure.Call
20Stages of Labor (1 of 4) Three-stage process: Uterine contractions Delivery of babyDelivery of placenta
21Stages of Labor (2 of 4) First stage Contractions last several hours, aching in back/cramps in abdomenContractions grow shorter, increase in intensityAmniotic sac breaksIf amniotic sac breaks prematurely or not during labor, seek medical care.
22Stages of Labor (3 of 4) Second stage 30 minutes to 2 hours Neck of cervix fully opensBaby is bornBaby’s head normally comes out first
23Stages of Labor (4 of 4) Third stage 15 minutes or more Placenta is expelled
24Recognizing 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?
25Recognizing Impending Delivery (2 of 2) If yes, examine for crowning:Bulging at vaginal openingPart of baby is visibleExplain what you are doingProtect woman’s privacyUse blanket to shield from others
26Delivery Procedures Supplies: Clean sheets, towels, blankets Plastic bag or towelClean, unused medical exam glovesSanitary padsNewspapers, plastic, cloth sheetRubber bulb syringeSterile gauze padsStrips of gauze, new or clean shoelaces
27Care 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.
28Care 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.
29Care During Delivery (3 of 6) If umbilical cord is wrapped around neck, gently slip over baby’s shoulder.Or, alleviate pressure on cordSupport head.Suction baby’s mouth and nostrils.Support body with both hands as baby emerges.Do not pull on baby or touch armpits.
30Care 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.
31Care 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.
32Care 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.
33Delivery 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.MassageMother may breast feed after delivery of placenta.This helps control bleeding.
34Initial 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 breatheRepeat suctioning.
35Initial 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.
36Abnormal Deliveries Most births are normal, natural. Complications can arise.Stay calm, deliberate, gentle.Call
37Prolapsed CordUmbilical 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
38Recognizing Prolapsed Cord Umbilical cord is seen before baby’s head.
39Care 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
40Breech Birth Presentation Baby’s buttocks emerge before the headMost common type of abnormal deliveryPlace mother in kneeling, head-down position.Seek medical care.Suffocation can occur.
41Recognizing Breech Birth Presentation Baby’s buttocks come out first.
42Care 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.CallHave woman continue to push
43Limb PresentationArm, leg, or foot of the infant protrudes from birth canalFoot more commonly presents when infant is in breech presentation
44Recognizing Limb Presentation Arm, leg, or foot appears first.
45Care for Limb Presentation Place mother in head-down position with pelvis elevated.Do not pull on baby or push limb back in.Call
46Meconium Baby’s first feces, in amniotic fluid Associated with fetal distress during labor, greater risk of infant deathDanger if baby breathes into lungs
47Recognizing Meconium Greenish or brownish-yellow amniotic fluid Tarry Almost odorless
48Care 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
49Premature Birth Baby weighing less than 5.5 lb or born before 7 months Need special careSmaller, less developedCardiovascular and respiratory systems often immature
50Recognizing Premature Birth Difficult without scale to weighSmaller and thinner than full-term infantHead proportionately large compared to bodyCheesy, white coating on skin is minimal or absent
51Care for Premature Babies Keep baby warm; increased risk of hypothermiaKeep mouth and nose clear of mucus.Monitor breathing.Perform CPR if necessary.
52Gynecologic Emergencies Reproductive-system problems that occur in nonpregnant females
53Sexual 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.RapeAttempted or actual sexual intercourse against victim’s willPhysical and psychological injuryCalm, sympathetic care is essential.
54Recognizing 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.
55Recognizing Sexual Assault and Rape (2 of 2) Signs:HeadachesSleeplessness, nightmaresNausea, muscle spasmsConfusionDepressionAnxiety, jumpiness
56Care 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.
57Care 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.