1. Obstetrics and Gynecology
CHAPTER 24 1 1

2. Obstetrics:
The care of women during pregnancy, childbirth and the period up to 42 days after expulsion of all pregnancy contents.
Gynecology is the study of diseases of women’s reproductive organs. 1 2

3. Birth is a natural process, and the EMT’s role is to assist in the delivery.1 3

4. Reproductive Anatomy and Physiology1 4

5. The Female Reproductive System
Fallopian tube
Ovary
Uterus
Cervix
Vagina 1 5

6. Birth canal: Consists of the lower part of the uterus and the vagina.
This is the pathway the fetus travels during birth. 1 6

7. A woman’s vital signs change during pregnancy.
Heart rate may increase
Blood pressure may decrease 1 7

8. Perineum: The area of skin between the vagina and the anus.
May often tear as a result of the pressure exerted by the fetus during childbirth. 1 8

9. Placenta:
The fetal and maternal organ through which the fetus absorbs oxygen and nutrients and excretes wastes; it is attached to the fetus via the umbilical cord. 1 9

10. Anatomic Structures of Pregnancy
Placenta
Umbilical cord
Uterus
Cervix
Amniotic sac
Vagina 1 10

11. Amniotic sac:
The membrane forming a closed, fluid-filled sac around a developing fetus.
Generally ruptures prior to childbirth, and may be described by the patient as “my water broke.” 1 11

12. Fetus at 49 Days 1 13

13. Fetus at 4 Months 1 14

14. Labor 1 15

15. Stages of Labor First Stage: Contraction & dilation Second Stage:
Baby moves through birth canal & is born
Third Stage:
Placenta delivered 1 16

16. Bloody show:
The expulsion of the mucous plug as the cervix dilates, which sometimes produces a small amount of bleeding.
Often occurs at the beginning of labor. 1 17

17. Crowning occurs when the head is forced against the vaginal opening.10 18

18. If crowning occurs, birth is imminent, and the EMT should be prepared for immediate delivery!1 19

19. Contents of the Childbirth Kit1 20

20. Contents of the OB Kit Surgical scissors or scalpel - to cut the cord
Hemostats or cord clamps - to clamp the cord
Umbilical tape or sterilized cord - to tie the cord
Bulb syringe - to suction infant’s mouth & nose
Towels - to dry infant 1 21

21. Contents of the OB Kit continued
Gauze sponges - to wipe infant’s mouth and nose
Sterile gloves - to wear during delivery
Baby blanket - to warm infant
Sanitary napkins - for mother after delivery
Plastic bag - to transport placenta to hospital 1 22

22. Obstetrical Kit 1 23

23. Predelivery Emergencies
Miscarriage 1 24

24. Abortion:
The medical term for any delivery or removal of a human fetus before it can live on its own.
Often referred to as a miscarriage when it occurs spontaneously. 1 25

25. Emergency Care for Miscarriage
Treat patient based on signs and symptoms
Shock may be present
Administer O2 via nonrebreather mask at a rate of 15 L/minute
Apply external vaginal pads or sanitary napkins
Estimate blood loss by number of napkins used
Bring any fetal tissue to hospital
Provide emotional support 1 26

26. Ectopic pregnancy:
An abnormal pregnancy in which the fetal tissue implants outside the uterus.
Can be fatal if undetected, due to massive blood loss. 1 27

27. Seizure during Pregnancy1 28

28. Care for Seizures during Pregnancy
Treat patient based on signs and symptoms
Administer O2 via nonrebreather mask at a rate of 15 L/minute
Keep patient calm and quiet
Transport patient on left side
Rapid transport without siren 1 29

29. Placing the patient on her left side reduces pressure on the circulatory system.10 30

30. Vaginal Bleeding Late in Pregnancy1 31

31. Conditions Causing Vaginal Bleeding
Miscarriage, abortion
Abruptio placentae
Placenta previa
Uterine rupture 1 32

32. Vaginal Bleeding Late in Pregnancy
Treat patient based on signs and symptoms
Administer O2 via nonrebreather mask at a rate of 15 L/minute
Place a sanitary napkin over the vaginal opening
Transport patient on left side
Be prepared to treat for shock if signs and symptoms warrant 1 33

33. Trauma 1 34

34. Traumatic injuries to a pregnant woman are treated the same as injuries to other patients - with a few exceptions... 1 35

35. Trauma in Pregnancy
Transport patient on left side (utilize backboard tilted to the left)
Administer O2 via nonrebreather mask at a rate of 15 L/minute
Expect vomiting and be prepared to suction
Be prepared to treat for shock
Rapid transport
Consider calling for ALS interface 1 36

36. If immobilized, tilt the board using a blanket or padding.10 37

37. Caesarean section:
A surgical delivery in which the muscles of the abdomen are cut and the baby is delivered through the opening.
Sometimes done by a physician in the event of the traumatic death of the mother, in an attempt to save the baby. 1 38