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Obstetrics and Genecological Emergencies. Anatomy and Physiology of childbirth Pregnancy and delivery Fetus developing baby Uterus where fetus grows during.

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Presentation on theme: "Obstetrics and Genecological Emergencies. Anatomy and Physiology of childbirth Pregnancy and delivery Fetus developing baby Uterus where fetus grows during."— Presentation transcript:

1 Obstetrics and Genecological Emergencies

2 Anatomy and Physiology of childbirth Pregnancy and delivery Fetus developing baby Uterus where fetus grows during pregnancy Cervix neck of the uterus

3 Vagina birth canal Placenta *attaches to wall of uterus *an exchange area between mom and fetus of oxygen and nutrients *expelled at birth

4 The fetus has its own circulatory system blood from the fetus is sent through the umbilical cord to the placenta The umbilical cord is 1 wide and 22 long at birth; expelled at birth Amniotic sac encloses the fetus

5 Nine months of pregnancy are divided into 3 trimesters The first pregnancy trimester is the stage of pregnancy from conception to 12 weeks. The second pregnancy trimester starts from the 13th week to the 28th week. the baby grows rapidly and shows movements

6 The Third Trimester is the last trimester from the 28th week till the birth of the baby. Changes to a womans body Increased blood volume Increased cardiac output volume of blood being pumped by the heart in one minute

7 Increased cardiac rate Blood pressure slightly decreased Slowed digestion Crowning presenting part of the baby first bulges from the vaginal opening Cephalic presentation head first Breech buttocks or feet deliver first

8 Labor entire process of delivery Three stages First stage regular contractions and dilation of cervix stage ends with full dilation

9 Second stage when the baby enters the birth canal Third stage after baby is born and lasts until placenta and umbilical cord is delivered Meconium staining *fluid that is green or brownish yellow *indicates fetal distress during labor

10 Bloody show *watery, bloody discharge of mucus associated with first stages of labor *part of discharge is s mucous plug that was in the cervix

11 Labor pains Time or duration start of one contraction to relaxation of uterus Interval or frequency time of the start of one contraction to the beginning of the next

12 Normal childbirth OB kit Supplies when OB kit not available Clean sheets and towels for draping Heavy flat twine or new shoe laces Towel or plastic bag to wrap placenta Clean, unused rubber gloves and eyewear

13 Normal delivery Evaluating the mother Name, age, expected due date First pregnancy? How long and how often contractions Water broke? Bloody show?

14 Time length and frequency of contactions Feel the uterus contracting VS if abnormal alert hospital Transport decision Provide emotional support

15 Supine hypotension syndrome Third trimester Weight of the baby, uterus, placenta, and amniotic fluid can compress the inferior vena cava when supine Dizziness and drop in blood pressure blood is shunted Transport in left lateral recumbent position

16 Prepare mother for delivery Ensure privacy BSI Place on bed, floor, or on cot Elevate buttocks and draw up knees Remove any clothing or underclothing that obstructs view of the vaginal opening

17 Use sterile sheets or towels to cover Position someone at the head provide support, monitor, alert for vomiting Position OB kit for easy access Delivering the baby Have constant view of vaginal opening Be prepared that there is going to be some discomfort

18 Talk to the mother Encourage her to relax between contractions Encourage to breathe deeply through the mouth do not allow to hyperventilate Assure that when water breaks that is normal

19 Position gloved hand at the vaginal opening upon crowning Place one hand below the head as it delivers spread fingers evenly to avoid soft spot Do not pull on the baby

20 If amniotic sac has not broken by time babys head is delivered, puncture membrane Examine for meconium staining suction

21 Once head delivers, check if umbilical cord is wrapped around the neck *gently loosen cord if necessary and bring over shoulder and head *if cord cant be loosened or slipped over shoulder, clamp and cut When entire head is delivered check the airway *wipe mouth and nose with sterile gauze *suction with bulb syringe

22 Help deliver the shoulders *gently guide the head downwards *if second shoulder is slow to deliver, guide head upwards Support the head throughout the entire process

23 Newborns are slippery *grasp the lower extremities to assure good hold *never pick up by the feet Lay baby on side with head slightly lower than body Suction once again Keep level at level of vagina until umbilical cord stops pulsating

24 Wrap the baby in warm, dry blanket Note the exact time of birth Assessing the newborn Apgar score reassess after 5 minutes

25 Care Place on sterile sheet as close to vagina as possible so infants blood doesnt transfuse back into the placenta Do not place on mothers ABD until cord has been clamped

26 Resuscitation of the newborn Provide warmth and clear airway suction Keep the baby on its side Establish breathing heart rate color

27 If heart rate is < 100 artificial ventilations at 40 to 60 If heart rate is < 60 CPR {3:1} 120 compressions/minute If cyanotic with adequate respirations and pulse rate, give oxygen

28 Cutting the umbilical cord Keep warm cover the head; keep ambulance warm Use sterile clamps or umbilical tape Apply 10 from baby; 7 (4 finger) from distal clamp Cut the cord between clamp Place placenta end of cord on the drape over the mothers legs

29 When moving the baby take care to not cause trauma to the cord Caring for the mother Delivering the placenta Third stage of labor Usually expels within a few minutes but can take 30 minutes or longer Save and transport Label with name of mother and time expelled

30 Transport if the placenta doesnt deliver within 20 minutes after delivery Hemorrhage 500cc of blood loss is normal Hemorrhage control Place sanitary napkin or vagina, never pack Lower legs and keep together

31 Elevate feet Massage uterus to help it contract Mother can nurse If perineum is torn, treat as a wound Comforting mom Communicate Frequent VS Keep mother and baby warm

32 CHILDBIRTH COMPLICATIONS Breech presentation buttocks or both legs first Complications rate high Immediate transport Never attempt to deliver by pulling on the legs O2

33 Place mother in head down position with pelvis elevated If the body delivers support it and prevent and explosive delivery of the head Insert gloved index and middle finger inside vagina and forma V around the nose

34 After delivery care is the same as for a cephalic delivery Prolapsed cord Umbilical cord presents first Position mother with head down and buttocks raised with a blanket or pillow, using gravity to lessen the pressure on birth canal

35 O2 Check cord for pulses Wrap with towel; must be kept warm Insert several fingers of a gloved hand inside the vagina and push up on the babys head or buttocks to keep pressure off cord- - - continue until releived by a physician

36 Keeping mother, child and EMT as a unit, rapid transport VS Limb presentation Arm, single leg or arm and leg present Often a prolapsed cord as well Rapid transport head-down, pelvis elevated

37 Do not attempt to pull on the limb or place into vagina Do not insert hand/fingers into the vagina other than to manage a prolapsed cord Multiple birth Deliver in same manner of single birth requires 2x the supplies and help

38 When delivered identify the infants in order of birth If it is unknown there are multiple babies Large before delivery Remains large after the first delivers Contractions continue after delivery of first Second baby may be breech within minutes of the first

39 Placenta delivered normally Care Clamp or tie cord after birth of first and before birth of second Second baby may be born before or after delivery of the placenta Babies, umbilical cords, placenta, mother are all cared for as with a single birth

40 Babies will probably be smaller than with a single birth important to keep warm Premature birth < 5.5# Born before 37 th week of pregnancy Keep warm Place cap on head Airway management; suction with bulb syringe

41 If heart rate is < 100 artificial ventilations at 40 to 60 If heart rate is < 60 CPR {3:1} 120 compressions/minute If cyanotic with adequate respirations and pulse rate, give oxygen

42 Watch the umbilical cord for bleeding O2 Avoid contamination Transport in warm ambulance Call ahead

43 Meconium staining *fluid that is green or brownish yellow *indicates fetal distress during labor Reduce risk of apiration do not stmulate until suctioned Airway management

44 If heart rate is < 100 artificial ventilations at 40 to 60 If heart rate is < 60 CPR {3:1} 120 compressions/minute If cyanotic with adequate respirations and pulse rate, give oxygen

45 Rapid transport Emergencies in pregnancy Excessive prebirth hemorrhage Miscarriage Placenta previa

46 Placenta Previa *placenta is formed low in uterus and close to or over the cervical opening *will not allow for a normal delivery Abruptio Placentae *placenta separates from the uterine wall Either of above may occur in 3 rd trimester Both are life threatening

47 Assessment Usually profuse bleeding from the vagina May or may not complain of ABD pain Initial assessment; look for signs of shock Baseline VS Care Shock; O2 Rapid Transport

48 Place sanitary napkin over vaginal opening and note the time; never pack Save all soaked material as well as any tissue that is passed

49 Ectopic pregnancy An ectopic pregnancy is a complication of pregnancy in which the fertilized ovum is developed in any tissue other than the uterine wall. Most ectopic pregnancies occur in the Fallopian tube (so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. The fetus produces enzymes that allow it to implant in varied types of tissues, and thus an embryo implanted elsewhere than the uterus can cause great tissue damage in its efforts to reach a sufficient supply of blood. An ectopic pregnancy is a medical emergency, and, if not treated properly, can lead to the death of the woman.complication of pregnancyfertilizedovumuterineFallopian tubecervixovaries abdomen

50 Assessment Any woman of childbearing age with abdominal pain has an ectopic pregnancy until proven otherwise May have s/s of shock due to internal bleeding Acute abdominal pain Often with vaginal bleeding

51 Care Rapid transport Position for shock 02 NPO

52 Seizures in pregnancy Sometimes called eclampsia Preeclampsia; swelling of the extremities Assessment Elevated blood pressure Excessive weight gain Gross swelling of face, hands, ankles, feet headache

53 Care Ensure and maintain airway O2 Transport on left side Handle gently Keep warm but dont overheat Have suction ready Have OB kit ready

54 Miscarriage and abortion Abortion Spontaneous abortion Miscarriage Induced abortion

55 Assessment Cramping abdominal pains Bleeding {moderate to severe} Dicharge of tissue and blood from vagina Care Baseline VS Treat for s/s of shock O2

56 Place sanitary napkins over vaginal opening Rapid transport Replace and save all soaked pads Save all expelled tissue Provide emotional support

57 Trauma in pregnancy Most common is MVA Uterus is frequently injured Sudden blunt trauma in later months may cause uterine rupture or premature separation; massive bleeding and shock Treat as for any other trauma pt.

58 Assessment Pulse 10 to 15 bpm faster than non- pregnant female Increased blood volume Ascertain if there were any blows to ABD, pelvis, or back Ascertain if water has broke

59 Care Examine unconscious for ABD injuries consider MOI Cardiac arrest management Airway management O2 Suction Rapid transport left lateral recumbent VS Provide emotional support

60 Stillbirths Baby who dies in the womb Do not lie to mother Allow her to see the baby if she wishes Obvious death blisters foul odor skin or tissue deterioration and discoloration softened head

61 Obviously dead sometime before birth no resuscitation Born in pulmonary or cardiac arrest resuscitative measures Baby is alive but pulmonary or cardiac arrest seems imminent resuscitative measures

62 Accidental death of a pregnant woman Aggressive resuscitation efforts should be taken Reposition hands 1 to 2 higher Efforts will be ceased in the E.R.

63 Gynecological Emergencies Vaginal bleeding Potentially life threatening especially if accompanied with ABD pain Hypovelemic shock Care Standard precautions Airway Treat for shock transort

64 Trauma to external genitalia MOI Assess for severe blood loss and shock and treat accordingly Care Control bleeding O2 Maintain a professional attitude Respect patients privacy

65 Sexual Assault Scene safety may need to stage Treat both medically and psychologically Airway Take care not to disturb any potential evidence Examine genitalia only if there is sign of trauma Do not allow to bathe, void or clean wounds Reporting requirements

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