2IntroductionMost 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
3Female 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.
4Female 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.
6The UterusA muscular organ where the fetus grows for approximately 9 months (40 weeks).Responsible for _______________________ during laborHelps to push the infant through the birth canalThe birth canal is made up of the vagina and the lower third, or neck, of the uterus, called the _______________________ .
7Placenta (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.
8Placenta (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
9Umbilical CordThe 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.
10Amniotic SacContains about 500 to 1,000 mL of amniotic fluidFluid helps _______________________ and protect the fetus.Fluid is released in a _______________________ when the sac ruptures, usually at the beginning of labor.
11Terms (1 of 4)_______________________ : bulging of vagina caused by baby’s headBloody 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.
12Terms (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.
13Terms (3 of 4)_______________________ : Number of pregnancies a woman has had_______________________ : Number of live birthsExample: Para 1 gravida 2 means patient has had one live birth and is now in her second pregnancyExample: Para 1 gravida 3 means patient has lost one pregnancy in the past
14Terms (4 of 4)_______________________ : 1st pregnancyMultigravida: more than one pregnancyPrimapara: patient has had one previous live birth_______________________ : more than one previous live birth
16Three Stages of LaborFirst stage: _______________________ of the cervixBegins with onset of contractions to full cervix dilationSecond stage: Delivery of the _______________________Full cervical dilation to the expulsion of the infantThird stage: Delivery of the _______________________Delivery of the infant to delivery of the placenta
18Pre-EclampsiaPregnancy-induced _______________________Can develop after the _______________________ week of gestationSigns and symptoms include headache, seeing of spots, _______________________ in the hands and feet, anxiety, and high blood pressure.
19EclampsiaCharacterized 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.
20Supine Hypotensive Syndrome Caused by compression of the descending _______________________ and the inferior vena cava by the pregnant uterus when the patient lies supine_______________________ results.
21HemorrhageVaginal bleeding that occurs _______________________ labor beginsIf present in early pregnancy, it may be a _______________________ abortion or ectopic pregnancy.
22Ectopic Pregnancy (1 of 3) Occurs when an egg is implanted some place other than the _______________________ ; normally a _______________________ tube
23Ectopic Pregnancy (2 of 3) Missed periods, other S/S of early _______________________Vaginal bleeding __________-__________ weeks after LMPAbdominal pain, may refer to shoulderSigns of _______________________History of PID, tubal ligation, or previous ectopic pregnancy
24Ectopic Pregnancy (3 of 3) Should be considered for any woman of _______________________ age with unilateral lower abdominal pain and missed _______________________ periodAbdominal pain or unexplained hypovolemic shock in a woman of child bearing age = ectopic pregnancy until proven otherwise.
25Placenta Problems (1 of 2) Premature separation of the _______________________Minimal external bleedingRock _______________________ uterusS/S of hypovolemic shock
26Placenta Problems (2 of 2) Development of placenta over the cervix_______________________ bright red bleeding_______________________ uterusS/S of hypovolemic shock
27Gestational DiabetesDevelops _______________________ during pregnancy.Normally corrects itself following _______________________ of the infantTreat as regular patient with diabetes.
28Trauma and Pregnancy (1 of 3) With a trauma call involving a pregnant patient, you have two patients: the woman and the unborn fetusAny trauma to the woman has a direct effect on the _______________________ .Transport on _______________________ side if possible. Slightly elevate left side of board if immobilized
29Trauma 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.
30Trauma 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.
32When to Consider Field Delivery Delivery can be expected within a _______________________ minutesA natural disaster or other catastrophe makes it impossible to reach a hospitalNo _______________________ is available
33Is 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?
34Is 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?
35Is 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 _______________________ ?
36Transporting 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.
37Preparing 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.
38Preparing 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 _______________________ .
40PrecautionsLook, 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.
41Delivering the Infant (1 of 3) Support the _______________________ as it emerges._______________________ infant’s airway
42Delivering 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.
43Delivering the Infant (3 of 3) Clamp the cord and cut it.Place 2 clamps and cut between clampsDo not cut too _______________________ to infant_______________________ airway again
44Complications with Normal Vaginal Delivery Unruptured amniotic sac_______________________ the sac and push it away from the baby.Umbilical cord around the neckGently slip the cord over the infant’s head.It may have to be _______________________ .
46Postdelivery CareImmediately 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.
48APGAR ScoreRecorded at 1 minute after delivery and 5 minutes after _______________________
49Delivery 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.
50Delivery of Placenta (2 of 2) It should deliver within __________minutes.Do not _______________________ on cordOnce 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.
51Post Delivery Emergencies More than 30 minutes elapse, and the placenta has not deliveredThere is more than __________mL of bleeding before delivery of the placenta.There is significant bleeding after the delivery of the placenta.Problems with the _______________________
53Neonatal CareNewborn should begin _______________________ spontaneously within 15 to 30 seconds after birth.Heart rate should be __________beats/min or higherSuction AirwayLay baby on _______________________ with head lower than body
54Neonatal StimulationIf 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
55Neonatal 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.
56Giving Chest Compressions to a Neonate (1 of 2) Find the proper positionJust below the _______________________ lineMiddle third of the sternumWrap 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.
57Giving Chest Compressions to an Infant (2 of 2) Ventilate with a BVM device after every _______________________ compression._______________________ compressions per minuteCoordinate chest compressions with ventilations at a ratio of 3:1.Continue CPR during transport.
58Additional ConcernsAny 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.
60Breech DeliveryPresenting 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.
62Limb PresentationThis is a very rare occurrence.Cannot be delivered in the _______________________This is a true _______________________ that requires immediate transport.Give oxygen and transport rapidly
63Prolapsed Cord (1 of 2)_______________________ is presenting partHead will compress the cord cutting off blood and oxygen to the fetusTreatment is to relieve _______________________ on the cord
64Prolapsed Cord (2 of 2)Place the pregnant woman on a backboard in _______________________ or knee-chest positionPlace fingers into the mother’s vagina and push the cord away from the infant’s _______________________ .Transport immediately.
65Spina BifidaDevelopmental defect in which a portion of the spinal cord or meninges may _______________________ outside of the vertebraeCover area with moist, sterile compresses to prevent _______________________ .Maintain body temperature by holding baby against an adult for _______________________ .
66Spontaneous Abortion (Miscarriage) Delivery of the fetus or placenta before the __________th weekInfection 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.
67TwinsTwins 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.
68Substance Abuse (1 of 2)Effects of addiction on the fetus include:_______________________Low birth weightSevere _______________________ distressDeathFetal alcohol _______________________ describes the condition of infants born to mothers who have abused alcohol.
69Substance 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 _______________________
70Premature 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.
71Premature Infant (1 of 2)A premature infant is smaller and _______________________ , and the head is pro-portionately larger.There will be less body _______________________ .
72Care of Premature Infant (1 of 2) Premature infants require special care to survive.Often require _______________________ efforts, which should be performed unless it is physically impossibleWith such care, infants as small as __________lb have survived and developed normally.
73Care 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.
74Postterm Pregnancy (1 of 2) Pregnancies lasting longer than ___________weeksInfants can be larger, sometimes weighing ___________ lb or more.Can lead to problems with the mother and infant:
75Problems With Postterm Pregnancy A more difficult labor and deliveryIncreased chance of injury to the _______________________Increased chance of cesarean sectionWoman is at risk for _______________________ tears and infection.Infants have increased risks of _______________________ aspirations, infection, and being stillborn.Infants may not have developed _______________________ .
76Fetal DemiseAn infant that has died in the uterus before laborThis is a very _______________________ situation for family and providers.Labor process is normalThe infant may be born with skin blisters, skin _______________________ , and dark discoloration.Do not attempt to _______________________ an obviously dead infant.
77Delivery 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 _______________________ .
78Pulmonary EmbolismPostpartum patients are at an increased risk of a _______________________ embolism.Results from a _______________________ that travels through the bloodstream and becomes lodged in the pulmonary circulationThe obstruction will block blood flow to the lungs and is potentially life threateningCharacterized by sudden onset of _______________________ and possible chest pain