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Obstetrics and Gynecological Emergencies Chapter 17.

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Presentation on theme: "Obstetrics and Gynecological Emergencies Chapter 17."— Presentation transcript:

1 Obstetrics and Gynecological Emergencies Chapter 17

2 Topic Overview Reproductive Anatomy Normal Delivery Care/Resuscitation of Newborn Abnormal deliveries Predelivery emergencies Gynecologic emergencies

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4 Anatomy

5 Childbirth Terms & Definitions –Crowning When the presenting part of the baby first bulges from the vaginal opening –Cephalic presentation - Head first –Breech presentation Limb Frank

6 LABOR First Stage Begins with regular contractions, then thinning and gradual dilation of the cervix and ends when the cervix if fully dilated Second Stage Begins when the baby’s head enters the birth canal until the baby is born Third Stage Following the birth of the baby until the placenta is delivered

7 Your Role Materials Needed –Need OB kit (if available) –Gloves –Towels and drapes –4 x 4s –Bulb syringe –Umbilical tape or clamps –Scissors or scalpel for cutting the cord

8 Childbirth –A baby blanket –Several sanitary napkins –Plastic bag –Standard BSI precautions

9 Childbirth Delivery Kit

10 Normal Delivery Transport Decision (911 Call) –Based on evaluation –Number of prior births –Distance to hospital or birthing center –Complications expected Delivery Precautions –Use of BSI –Keep mother out of bathroom –Do not hold mother’s knees together

11 Childbirth Evaluating the Mother –Patient name, age –Which pregnancy? –Gravida, Para and AB –How long in labor –Ask the patient if she feels the need to move her bowels –Check for Crowning** –Time uterine contractions

12 Childbirth –Vital signs if time allows –Remember if this first baby and crowing or urge to push is not present then transport can be effect –DO NOT LET MOTHER GO TO THE BATHROOM

13 Childbirth Preparing for Delivery –Control the scene –BSI –Position the patient –Remove clothing that can obstruct view of delivery –Create a sterile field –Position OB kit or available materials

14 Childbirth The Delivery

15 Crowning of Infant’s Head

16 Delivery of Head - Prevent Explosive Delivery

17 Delivery of the Head

18 Delivery Procedures If amniotic sac has not broken, puncture sac and pull away from baby's face. Determine if umbilical cord is around baby’s neck. If so, clamp and cut cord.

19 Suction mouth, then nose Aid in birth of upper shoulder

20 Support the trunk Support the legs

21 Childbirth Delivery Procedures –Wipe blood, mucus from nose and mouth –Suction –Warmth is critical! –Wrap baby in warm towel, head lower than trunk –Keep infant level with vagina until cord is cut

22 Clamp or tie cord; then cut Evaluate baby

23 Observe for delivery of placenta When placneta delivers, place in a plastic bag for transport to hospital

24 Childbirth –After Delivery Procedures Control vaginal bleeding after delivery –DO PLACE ANYTHING IN THE VAGINA –Place a sanitary napkin over the vaginal opening –Have mother lower her legs **Massage the fundus **Nursing the baby can help the uterus contract and return to normal –Record time of delivery

25 Childbirth Vaginal Bleeding –A loss of 55 cc is well tolerated. –Treat for shock

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27 Care of Newborn Position, dry, wipe, wrap Repeat clearing airway (suction) Cover the head

28 Normal Assessment Findings Newborn AppearancePulseGrimaceActivity Respiratory effort ========== APGARAPGAR Color: No central cyanosis Greater than 100/min. Vigorous & crying Good extremity motion Normal, crying

29 Childbirth

30 Resuscitation of the Newborn

31 Inverted Pyramid of Neonatal Resuscitation

32 Breathing Effort ‡ If shallow, slow, or absent: Provide artificial ventilations, Provide artificial ventilations, 40-60/minute /minute. Reassess after 30 seconds. Reassess after 30 seconds. Continue as necessary. Continue as necessary.

33 Heart Rate ‡ If less than 100/minute: Provide artificial ventilations, 40-60/minute. Provide artificial ventilations, 40-60/minute. Reassess after 30 seconds. Reassess after 30 seconds. If no improvement, continue ventilations. If no improvement, continue ventilations. (Continued)

34 Heart Rate ‡ If less than 60-80/minute and not responding to ventilation: Start chest compressions. Start chest compressions. (Continued)

35 Heart Rate If at any time the heart rate is less than 60, begin ventilations and compressions immediately.

36 Color If central (trunk) cyanosis is present with adequate breathing and heart rate, administer blow-by oxygen.

37 Childbirth Complications / Abnormal Deliveries

38 Complications Supine Hypotensive Syndrome –The weight of the baby, placenta and amniotic fluid can compress the vena cava –Care Place mother on lateral left side

39 Complications Breach Birth –Baby’s buttocks or lower extremities presenting Greater risk of trauma, prolapsed cord –Care Never pull on the babies legs High flow oxygen Place mother in head-down position with hips elevated

40 Complications –If body delivers support the body and prevent an explosive delivery of the head –If necessary to create an airway, place two fingers of gloved hand into vagina making a “V” with your fingers to create an airway. Hope position until EMS arrives or baby delivers

41 Complications Prolapsed Umbilical Cord –Mother in head down and buttocks up (kneeling with buttocks up) –High flow oxygen –Check cord for a pulse –Wrap the cord in a towel to keep warm –Insert gloved fingers in the vaginal and pressure gently on the babies head or buttocks to take pressure off the cord

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44 Complications Limb Presentation –High flow oxygen –Do Not pull on the baby

45 Complications Multiple Births –Delivery procedures the same for each birth Prepare for multiple resuscitations –Clamp the cord of the first baby –2 nd baby may be born before or after the placenta –Care for first infant –Maintain body temperature of the infants

46 Complications Premature Birth –Keep baby WARM –Keep airway clear –Provide ventilation (BVM) and chest compressions as needed –Watch the umbilical cord for bleeding –Oxygen using blow by method –Avoid contamination, Do Not breath into the face of the baby

47 Complications Pre-birth bleeding –If you have any pre-birth bleeding place a pad at the opening of the vagina –Save any tissue which is passed Meconium –Green or brown amniotic fluid indicates presence of fecal matter –Suggests fetal distress during labor

48 Complications Pre-Eclampsia –High blood pressure and swelling of the extremities –The pregnant female needs to be monitored closely Eclampsia –Seizures during pregnancy –Seizures are a dire emergency –Mother should be transported by EMS –Administer high-flow oxygen

49 Complications Fetal tissue goes to hospital –Provide emotional support for mother

50 Complications Miscarriage (Spontaneous Abortion) –Complete patient assessment –treatment based on assessment –911 (Save all tissue expelled) –Vital Signs –Treat for shock –Place a napkin over the vaginal opening –Replace all blood soaked pads and keep –Emotional support for the patient

51 Obstetrics and Gynecological Emergencies Trauma In Pregnancy- Patient Assessment –Pulse will be beats higher –A pregnant female has 30-35% more blood so signs of shock will be delayed –Ask patient about any blows to the back, pelvis or abdomen –Ask if the patient is bleeding or has any discharge (water has broken)

52 Obstetrics and Gynecological Emergencies Treatment for Pregnant Trauma Patient –High flow oxygen –Be ready to suction due due to nausea and possible vomiting –Activate EMS –Provide emotional support

53 Gynecological Emergencies

54 Vaginal Bleeding Can be potentially life-threatening –Follow BSI precautions –Assure airway –Assess and treat for shock –Provide oxygen –Activate EMS if bleeding is severe

55 Gynecological Emergencies Trauma to the External Genitalia –Scene size up and look at the mechanism of injury –During initial assessment look for signs of shock –Treat like any soft-tissue injury Control bleeding with direct pressure Never pack vagina –If signs of shock high flow O 2

56 Gynecological Emergencies Sexual Assault –Treat scene as a crime scene –Complete patient assessment and care Take care not to destroy evidence on the scene Activate EMS –Provide comfort for the patient –Non-judgemental attitude –Psychological care required

57 Gynecological Emergencies Sexual Assault –Preserve potential evidence –Discourage patient from bathing, voiding

58 Review Questions Describe the anatomy of the reproductive system List the items you will need in a childbirth kit What factors will determine whether 911 should transport or deliver at scene

59 Review Questions Describe the normal delivery process Describe the APGAR scoring system Describe the following, and the care for each: –Limb presentation –Prolapsed cord –Breech presentation –Meconium


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