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Chapter 31 Obstetrics and Neonatal Care 1. Introduction Most infants are delivered in a _______________________. Occasionally, the birth process moves.

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Presentation on theme: "Chapter 31 Obstetrics and Neonatal Care 1. Introduction Most infants are delivered in a _______________________. Occasionally, the birth process moves."— Presentation transcript:

1 Chapter 31 Obstetrics and Neonatal Care 1

2 Introduction Most infants are delivered in a _______________________. Occasionally, the birth process moves faster than the mother expects. You must then decide whether to: – Stay on the scene and deliver the infant – _______________________ the patient to the hospital 2

3 Female Anatomy (1 of 2) _______________________ : developing unborn baby. Uterus: organ that fetus grows in. _______________________ : organ through which fetus exchanges nourishment and waste products. Birth Canal: vagina and lower part of uterus _______________________ Cord: cord through which fetus receives nourishment. 3

4 Female Anatomy (2 of 2) Amniotic Sac: sac that surrounds fetus. _______________________ : Lowest part of uterus. Vagina: lowest part of birth canal. _______________________ : skin between vagina and anus. 4

5 Female Reproductive System 5

6 The Uterus A muscular organ where the fetus grows for approximately 9 months (40 weeks). Responsible for _______________________ during labor Helps to push the infant through the birth canal The birth canal is made up of the vagina and the lower third, or neck, of the uterus, called the _______________________. 6

7 Placenta (1 of 2) Attaches to the _______________________ lining of the wall of the uterus and connects to the fetus by the umbilical cord. The placental barrier consists of two _______________________ of cells. 7

8 Placenta (2 of 2) After delivery, the placenta, or _______________________, separates from the uterus and delivers. Anything _______________________ by a pregnant woman also affects the fetus including nutrients, oxygen, waste, carbon dioxide, toxins 8

9 Umbilical Cord The umbilical cord is the _______________________ of the fetus. The umbilical _______________________ carries oxygenated blood from the woman to the fetus. The umbilical _______________________ carry deoxygenated blood from the fetus to the woman. 9

10 Amniotic Sac Contains about 500 to 1,000 mL of amniotic fluid Fluid helps _______________________ and protect the fetus. Fluid is released in a _______________________ when the sac ruptures, usually at the beginning of labor. 10

11 Terms (1 of 4) _______________________ : bulging of vagina caused by baby’s head Bloody Show: mucous and blood that comes out of the vagina as labor begins. _______________________ : muscles of uterus open the birth canal and push the baby’s head down through it. 11

12 Terms (2 of 4) _______________________ Part: the part of the baby that comes out first, usually the head. _______________________ : a miscarriage. Live Birth Certificate: a certificate that live birth has occurred. _______________________ Death Certificate: a certificate for a stillborn baby. 12

13 Terms (3 of 4) _______________________ : Number of pregnancies a woman has had _______________________ : Number of live births Example: Para 1 gravida 2 means patient has had one live birth and is now in her second pregnancy Example: Para 1 gravida 3 means patient has lost one pregnancy in the past 13

14 Terms (4 of 4) _______________________ : 1 st pregnancy Multigravida: more than one pregnancy Primapara: patient has had one previous live birth _______________________ : more than one previous live birth 14

15 Crowning 15

16 Three Stages of Labor First stage: _______________________ of the cervix – Begins with onset of contractions to full cervix dilation Second stage: Delivery of the _______________________ – Full cervical dilation to the expulsion of the infant Third stage: Delivery of the _______________________ – Delivery of the infant to delivery of the placenta 16

17 Pre-Delivery Emergencies 17

18 Pre-Eclampsia Pregnancy-induced _______________________ Can develop after the _______________________ week of gestation Signs and symptoms include headache, seeing of spots, _______________________ in the hands and feet, anxiety, and high blood pressure. 18

19 Eclampsia Characterized by _______________________ that occur as a result of hypertension. To treat eclampsia: Lie the patient on her side, preferably the left. Maintain an airway. Provide supplemental oxygen. If vomiting occurs, _______________________ the airway. Provide rapid _______________________ and call for ALS. 19

20 Supine Hypotensive Syndrome Caused by compression of the descending _______________________ and the inferior vena cava by the pregnant uterus when the patient lies supine _______________________ results. 20

21 Hemorrhage Vaginal bleeding that occurs _______________________ labor begins If present in early pregnancy, it may be a _______________________ abortion or ectopic pregnancy. 21

22 Ectopic Pregnancy (1 of 3) Occurs when an egg is implanted some place other than the _______________________ ; normally a _______________________ tube 22

23 Ectopic Pregnancy (2 of 3) Missed periods, other S/S of early _______________________ Vaginal bleeding __________-__________ weeks after LMP Abdominal pain, may refer to shoulder Signs of _______________________ History of PID, tubal ligation, or previous ectopic pregnancy 23

24 Ectopic Pregnancy (3 of 3) Should be considered for any woman of _______________________ age with unilateral lower abdominal pain and missed _______________________ period Abdominal pain or unexplained hypovolemic shock in a woman of child bearing age = ectopic pregnancy until proven otherwise. 24

25 Placenta Problems (1 of 2) Placenta _______________________ Premature separation of the _______________________ Minimal external bleeding Rock _______________________ uterus S/S of hypovolemic shock 25

26 Placenta Problems (2 of 2) Placenta _______________________ Development of placenta over the cervix _______________________ bright red bleeding _______________________ uterus S/S of hypovolemic shock 26

27 Gestational Diabetes Develops _______________________ during pregnancy. Normally corrects itself following _______________________ of the infant Treat as regular patient with diabetes. 27

28 Trauma and Pregnancy (1 of 3) With a trauma call involving a pregnant patient, you have two patients: the woman and the unborn fetus Any trauma to the woman has a direct effect on the _______________________. Transport on _______________________ side if possible. Slightly elevate left side of board if immobilized 28

29 Trauma and Pregnancy (2 of 3) Pregnant women have an increased amount of overall total blood volume and a ____________% increase in heart rate. May have a significant amount of blood loss before you will see signs of _______________________ Uterus is vulnerable to penetrating trauma and blunt injuries. 29

30 Trauma and Pregnancy (3 of 3) When a pregnant woman is involved in a motor vehicle crash, severe _______________________ may occur from injuries to the pregnant uterus. _______________________ is one of the leading causes of abruptio placenta. Significant vaginal bleeding is common with severe abdominal pain. 30

31 Field Delivery of a Baby 31

32 When to Consider Field Delivery Delivery can be expected within a _______________________ minutes A natural disaster or other catastrophe makes it impossible to reach a hospital No _______________________ is available 32

33 Is Delivery Imminent? Ask: (1 of 3) How long have you been pregnant? When are you _______________________ ? Is this your _______________________ baby? Are you having contractions? – How _______________________ apart? – How long do they last? 33

34 Is Delivery Imminent? Ask: (2 of 3) Do you feel as though you will have a _______________________ movement? Have you had spotting or bleeding? Has your _______________________ broken? Were any of your previous children delivered by _______________________ section? 34

35 Is Delivery Imminent? Ask: (3 of 3) Have you had _______________________ in a previous pregnancy? Do you use drugs, drink alcohol, or take any medications? Is there a chance of _______________________ birth? Does your doctor expect _______________________ ? 35

36 Transporting a Pregnant Patient If delivery is not imminent, _______________________ on left side if in last two trimesters of pregnancy. If the patient was subject to spinal injury, stabilize and _______________________ backboard with towel roll on right side. 36

37 Preparing for Delivery (1 of 2) Use proper BSI precautions. Be _______________________ and reassuring while protecting the mother’s modesty. Contact medical control for a decision to deliver on scene or transport. Prepare _______________________ kit. 37

38 Preparing for Delivery (2 of 2) Push away or remove mother’s clothing while preserving modesty. Place the mother in a semi- _______________________ position. Pad under and around the mother’s _______________________. 38

39 Positioning for Delivery 39

40 Precautions Look, don’t _______________________. Do not allow mother to go to the restroom. Do not hold or bind mother’s _______________________ together. Gather all equipment needed. One EMT should remain with patient at all times. Use caution when _______________________ the patient. 40

41 Delivering the Infant (1 of 3) Support the _______________________ as it emerges. _______________________ infant’s airway 41

42 Delivering the Infant (2 of 3) Once the head emerges, the _______________________ will be visible. Support the head and upper body as the shoulders deliver. Handle the infant _______________________ but gently as the body delivers. 42

43 Delivering the Infant (3 of 3) Clamp the cord and cut it. – Place 2 clamps and cut between clamps – Do not cut too _______________________ to infant _______________________ airway again 43

44 Complications with Normal Vaginal Delivery Unruptured amniotic sac – _______________________ the sac and push it away from the baby. Umbilical cord around the neck – Gently slip the cord over the infant’s head. – It may have to be _______________________. 44

45 Cord Around Neck 45

46 Postdelivery Care Immediately wrap the infant in a towel with the head _______________________ than the body. Suction the mouth and nose again. Clamp and cut the cord. Record _______________________ of birth. Ensure the infant is pink and breathing well. Record Apgar Score at __________ minute and ___________ minutes. 46

47 APGAR Scoring ________________ _______ Pulse ________________ _______ Activity ________________ _______ 47

48 APGAR Score Recorded at 1 minute after delivery and 5 minutes after _______________________ 48

49 Delivery of Placenta (1 of 2) Placenta is attached to the end of the umbilical cord. Gently _______________________ the uterus will speed the delivery of the placenta. 49

50 Delivery of Placenta (2 of 2) It should deliver within __________minutes. Do not _______________________ on cord Once the placenta delivers, wrap it and take to the _______________________ so it can be examined. If the mother continues to bleed, transport promptly to the hospital. 50

51 Post Delivery Emergencies More than 30 minutes elapse, and the placenta has not delivered There is more than __________mL of bleeding before delivery of the placenta. There is significant bleeding after the delivery of the placenta. Problems with the _______________________ 51

52 Neonatal Resuscitation 52

53 Neonatal Care Newborn should begin _______________________ spontaneously within 15 to 30 seconds after birth. Heart rate should be __________beats/min or higher Suction Airway Lay baby on _______________________ with head lower than body 53

54 Neonatal Stimulation If the infant is non responsive: – Gently tap or flick the soles of the _______________________ or rub the back. – Begin resuscitation efforts. Many infants require some form of stimulation, including: – Positioning the airway, _______________________, warming, suctioning, or tactile stimulation 54

55 Neonatal Resuscitation If neonate is not breathing after stimulation: Apply gentle artificial _______________________. Continue resuscitation until breathing starts, then give oxygen. Begin CPR if no pulse after _______________________ minute. 55

56 Giving Chest Compressions to a Neonate (1 of 2) Find the proper position – Just below the _______________________ line – Middle third of the sternum Wrap your hands around the body, with your thumbs resting at that position. (2 hands _______________________ technique) Press your thumbs gently against the sternum, compressing _______________________ depth of chest. 56

57 Giving Chest Compressions to an Infant (2 of 2) Ventilate with a BVM device after every _______________________ compression. _______________________ compressions per minute Coordinate chest compressions with ventilations at a ratio of 3:1. Continue CPR during transport. 57

58 Additional Concerns Any newborn that requires more than routine resuscitation requires transport to a hospital with a neonatal _______________________ care unit. About 12% of deliveries are complicated by the presence of _______________________. – Continue vigorous suctioning of the infant after delivery. 58

59 Delivery Complications 59

60 Breech Delivery Presenting part is the _______________________ or legs. Breech delivery is usually slow, giving you time to get to the hospital. Support the infant as it comes out. If head does not quickly deliver, make a “V” with your gloved fingers then place them in the _______________________ to prevent it from compressing infant’s airway. 60

61 Breech Delivery 61

62 Limb Presentation This is a very rare occurrence. Cannot be delivered in the _______________________ This is a true _______________________ that requires immediate transport. Give oxygen and transport rapidly 62

63 Prolapsed Cord (1 of 2) _______________________ is presenting part Head will compress the cord cutting off blood and oxygen to the fetus Treatment is to relieve _______________________ on the cord 63

64 Prolapsed Cord (2 of 2) Place the pregnant woman on a backboard in _______________________ or knee- chest position Place fingers into the mother’s vagina and push the cord away from the infant’s _______________________. Transport immediately. 64

65 Spina Bifida Developmental defect in which a portion of the spinal cord or meninges may _______________________ outside of the vertebrae Cover area with moist, sterile compresses to prevent _______________________. Maintain body temperature by holding baby against an adult for _______________________. 65

66 Spontaneous Abortion (Miscarriage) Delivery of the fetus or placenta before the __________th week Infection and bleeding are the most important complications. Treat the mother for _______________________. Transport to the hospital. Bring tissue that has passed through the _______________________ to the hospital. 66

67 Twins Twins are usually smaller than single infants. After 10 minutes after the first birth, contractions will begin again, and the birth process will repeat itself. Delivery procedures are the same as that for _______________________ infants. There may be one or two _______________________ to deliver. 67

68 Substance Abuse (1 of 2) Effects of addiction on the fetus include: – _______________________ – Low birth weight – Severe _______________________ distress – Death Fetal alcohol _______________________ describes the condition of infants born to mothers who have abused alcohol. 68

69 Substance Abuse (2 of 2) Pay special attention to your safety. Wear _______________________ protection, a face mask, and gloves at all times. Look for clues that you are dealing with an addicted mother. The newborn will probably need immediate _______________________. Contact ALS backup for respiratory _______________________ 69

70 Premature Infant (1 of 2) The usual gestation period is 9 calendar months, or __________weeks. A normal, single infant will weigh about 7 lb at birth. Any infant who delivers before _________ months (36 weeks) or weighs less than __________lb at birth is considered premature. 70

71 Premature Infant (1 of 2) A premature infant is smaller and _______________________, and the head is pro-portionately larger. There will be less body _______________________. 71

72 Care of Premature Infant (1 of 2) Premature infants require special care to survive. Often require _______________________ efforts, which should be performed unless it is physically impossible With such care, infants as small as __________lb have survived and developed normally. 72

73 Care of Premature Infant (2 of 2) Keep the infant _______________________. Keep the mouth and nose clear of _______________________. Give oxygen. Do not _______________________ the infant. Notify the hospital. 73

74 Postterm Pregnancy (1 of 2) Pregnancies lasting longer than ___________weeks Infants can be larger, sometimes weighing ___________ lb or more. Can lead to problems with the mother and infant: 74

75 Problems With Postterm Pregnancy A more difficult labor and delivery Increased chance of injury to the _______________________ Increased chance of cesarean section Woman is at risk for _______________________ tears and infection. Infants have increased risks of _______________________ aspirations, infection, and being stillborn. Infants may not have developed _______________________. 75

76 Fetal Demise An infant that has died in the uterus before labor This is a very _______________________ situation for family and providers. Labor process is normal The infant may be born with skin blisters, skin _______________________, and dark discoloration. Do not attempt to _______________________ an obviously dead infant. 76

77 Delivery Without Sterile Supplies You should always have goggles and sterile gloves with you. Use _______________________ sheets and towels. Do not cut or clamp umbilical _______________________. Keep placenta and infant at same _______________________. 77

78 Pulmonary Embolism Postpartum patients are at an increased risk of a _______________________ embolism. Results from a _______________________ that travels through the bloodstream and becomes lodged in the pulmonary circulation The obstruction will block blood flow to the lungs and is potentially life threatening Characterized by sudden onset of _______________________ and possible chest pain 78


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