Obstetrics and Gynecological Emergencies You are having a WHAT!?!? BABY

Obstetrics and Gynecological Emergencies Terms & Definitions Crowning When the presenting part of the baby first bulges from the vaginal opening Cephalic presentation - Head first Breech presentation Limb Frank

LABOR First Stage Second Stage Third 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

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

Obstetrics and Gynecological Emergencies A baby blanket Several sanitary napkins Plastic bag Standard BSI precautions

Obstetrics and Gynecological Emergencies 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

Obstetrics and Gynecological Emergencies 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

Obstetrics and Gynecological Emergencies Preparing for Delivery Control the scene BSI Position the patient Remove clothing that can obstruct view of delivery Position OB kit or available materials

Obstetrics and Gynecological Emergencies The Delivery

Obstetrics and Gynecological Emergencies

Obstetrics and Gynecological Emergencies Controlling vaginal bleeding after delivery DO PLACE ANYTHING IN THE VAGINA Have mother lower her legs Massage the fundus Nursing the baby can help the uterus contract and return to normal

Obstetrics and Gynecological Emergencies Complications of the Delivery

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

Obstetrics and Gynecological Emergencies Breach Birth Never pull on the babies legs High flow oxygen 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

Obstetrics and Gynecological Emergencies 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

Obstetrics and Gynecological Emergencies Limb Presentation High flow oxygen Do Not pull on the baby

Obstetrics and Gynecological Emergencies Multiple Births Clamp the cord of the first baby 2nd baby may be born before or after the placenta Care for first infant Maintain body temperature of the infants

Obstetrics and Gynecological Emergencies Premature Birth Keep baby WARM Keep airway clear Provide ventilation 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

Obstetrics and Gynecological Emergencies 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

Obstetrics and Gynecological Emergencies Pre-Eclampsia High blood pressure and swelling of the extremities The pregnant female needs to be monitored closely Eclampsia Seizures that occur during pregnancy Seizures are a dire emergency, the mother should be transported by EMS

Obstetrics and Gynecological Emergencies Vital Signs Treat for shock Place a napkin over the vaginal opening Transport CODE 3 Replace all blood soaked pads and keep Save all tissue expelled Emotional support for the patient

Obstetrics and Gynecological Emergencies Trauma In Pregnancy- Patient Assessment Pulse will be 10-15 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)

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

Obstetrics and Gynecological Emergencies GYN EMERGENCIES

Obstetrics and Gynecological Emergencies 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

Obstetrics and 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 Control bleeding with direct pressure If signs of shock high flow O2

Obstetrics and Gynecological Emergencies Sexual Assault Treat scene as a crime scene Perform ABC’s Take care not to destroy evidence on the scene Activate EMS Provide comfort for the patient Discourage the patient from bathing, voiding, or cleansing any wounds