1. Obstetrics and Gynecological Emergencies
Chapter 17
Obstetrics and Gynecological Emergencies

2. Objectives (1 of 3)
Identify the following structures: uterus, vagina, fetus, placenta, umbilical cord, amniotic sac, perineum.
Identify and explain the use of the contents of an obstetrics kit.
Identify predelivery emergencies.
State indicators of imminent delivery.

3. Objectives (2 of 3)
Differentiate the emergency medical care provided to a patient with predelivery emergencies from a normal delivery.
Establish the relationship between body substance isolation and childbirth.
State the steps to assist in the delivery.

4. Objectives (3 of 3) Describe how and when to cut the umbilical cord.
Discuss the emergency medical care of a patient with a gynecological emergency.

5. Female Reproductive System

6. Three Stages of Labor First stage Dilation of the cervix Second stage
Expulsion of the infant
Third stage
Delivery of the placenta

7. Predelivery Emergencies
Preeclampsia (hypertension)
Headache, vision disturbance, edema, anxiety
Eclampsia
Convulsions resulting from hypertension
Supine hypotensive syndrome
Low blood pressure from lying supine

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

9. Ectopic Pregnancy Pregnancy outside of the uterus
Occurs once in every 200 pregnancies.
Consider with a missed menstrual cycle and sudden, severe abdominal pain.
History of PID, tubal ligation, or previous ectopic pregnancy

10. Placenta Problems Placenta abruptio
Premature separation of the placenta
Placenta previa
Development of placenta over the cervix

11. Trauma and Bleeding
Any vaginal bleeding with pregnancy is a serious sign.
Save all blood-soaked pads and any passed tissue.
Do not insert pads into the vagina.
Transport promptly with woman on her left side.
Signs of shock can be delayed, but the fetus may be in trouble.

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

13. Crowning

14. Preparing for Delivery
Use proper BSI precautions.
Be calm and reassuring while protecting the mother’s modesty.
Contact medical control for a decision to deliver on scene or transport.
Prepare OB kit.

15. Positioning for Delivery

16. Delivering the Infant (1 of 2)
Support the head as it emerges, suction the mouth than nose.
Check for nuchal cord, cut if necessary.
Once the head emerges, the shoulders will be visible.

17. Delivering the Infant (2 of 2)
Support the head and upper body as the shoulders deliver.
Handle the infant firmly but gently as the body delivers.
Clamp the cord and cut it.

18. Complications with Normal Vaginal Delivery
Unruptured amniotic sac
Puncture the sac and push it away from the baby.
Umbilical cord around the neck (nuchal cord)
Gently slip the cord over the infant’s head.
Cut cord if necessary.

19. Postdelivery Care
Immediately wrap the infant in a towel with the head lower than the body.
Suction the mouth and nose again.
Clamp and cut the cord if not done already.
Ensure the infant is pink and breathing well.

20. Delivery of the Placenta
Placenta is attached to the end of the umbilical cord.
It should deliver within 30 minutes.
Once the placenta delivers, wrap it and take it to the hospital so it can be examined.
If the mother continues to bleed, transport promptly to the hospital.

21. APGAR Scoring (0 to 10) A Appearance P Pulse G Grimace A Activity
R Respirations
Scored at 1 and 5 minutes after birth

22. Neonatal Resuscitation

23. Giving Chest Compressions to an Infant (1 of 2)
Find the proper position
Just below the nipple line
Middle third of the sternum
Wrap your hands around the body, with your thumbs resting at that position.
Press your thumbs gently against the sternum, compressing ½” to ¾” deep.

24. Giving Chest Compressions to an Infant (2 of 2)
Ventilate with a BVM device after every third compression.
90 compressions to 30 ventilations per minute
Continue CPR while awaiting transport.

25. Breech Delivery Presenting part is the buttocks.
Breech delivery is usually slow, giving you time to arrange for transport to the hospital.
Support the infant as it comes out.
Make a “V” with your gloved fingers then place them in the vagina to prevent it from compressing infant’s airway.

26. Rare Presentations Limb presentation This is a very rare occurrence.
This is a true emergency that requires immediate transport.
Prolapsed cord
Arrange for immediate transport.
Place fingers into the mother’s vagina and push the cord away from the infant’s face.

27. Excessive Bleeding
Bleeding always occurs with delivery but should not exceed 500 mL.
Massage the mother’s uterus to slow bleeding.
Treat for shock.
Place pad over vaginal opening.
Arrange for immediate transport to hospital.

28. Spontaneous Abortion (Miscarriage)
Delivery of the fetus or placenta before the 20th week
Infection and bleeding are the most important complications.
Treat the mother for shock.
Arrange for immediate transport.
Bring tissue that has passed through the vagina to the hospital.

29. Twins Twins are usually smaller than single infants.
Delivery procedures are the same as that for single infants.
There may be one or two placentas to deliver.

30. Premature Infants and Procedures
Delivery before 8 months or weight less than 5 lb at birth.
Keep the infant warm.
Keep the mouth and nose clear of mucus.
Give oxygen.
Do not infect the infant.
Notify EMS.

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

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

33. Gynecologic Emergencies
Soft-tissue injuries can be painful and bleed profusely.
Treat as other soft-tissue injuries, and never insert dressing into the vagina.
Have a second rescuer present, preferably female, when treating such emergencies.

34. Stresses and Pregnancy
More women are now active well into the third trimester of pregnancy.
Environmental conditions can increase risks to mother and fetus.
Altitude
Diving
Temperature and humidity