1. OBSTETRICS AND GYNECOLOGY

2. Lesson Objective: Indicate procedures for emergency (pre -hospital) childbirth.

3. OVERVIEW Anatomy Review Beginning of Labor Predelivery Emergencies
Preparing for Delivery
Delivering the Baby

4. OVERVIEW cont. Postdelivery Care Resuscitation of the Newborn
Abnormal Deliveries & Complications
Gynecologic Emergencies

5. Anatomy Review Fetus Uterus Placenta Umbilical Cord Amniotic Sac
Cervix

6. The Stages of Labor
1st Stage - 1st contraction until cervix is fully dilated.
2nd Stage - full dilation until birth.
3rd Stage - birth of baby, until delivery of placenta

7. Signs of Labor Beginning of regular contractions Bloody show
Rupture of the amniotic sac (water breaks)

8. Predelivery Emergencies
Miscarriage
Seizures
Vaginal Bleeding
Trauma

9. Miscarriage Delivery of fetus & placenta before 20 weeks
Danger - bleeding & infection

10. Treatment Initial assessment History & physical exam
Ask if she is pregnant
Ask date of last cycle

11. Treatment
Apply external vaginal pads
Collect tissues
Transport

12. Seizures
Eclampsia - related to high blood pressure

13. Treatment Initial assessment HX & vitals Transport on left side
Monitor airway & give O2
Transport

14. Vaginal Bleeding Early pregnancy - may be normal
Later stages of pregnancy
Placenta abruptio - placenta separates prematurely
Placenta previa - placenta develops over & covers the mouth of the uterus

15. Placenta abruptio - placenta separates prematurely
Placenta previa - placenta develops over & covers the mouth of the uterus

16. Treatment BSI Initial assessment History and physical exam
Ask patient if she has any pain.

17. Treatment Transport on left side Sterile pad or sanitary napkin
Save any tissue
Transport

18. Trauma
Severe bleeding
Injury to fetus

19. Treatment Initial assessment O2 Place on left side
Control external bleeding
Transport

20. Preparing for Delivery
Assessing the need for emergency delivery
First decision - whether or not you have time to transport?

21. Decision based on three factors:
Is the delivery imminent
Hospital cannot be reached due to a natural disaster, weather, or traffic conditions
No transportation is available

22. Equipment Surgical scissors-1 pair Hemostats or cord clamps-3
Umbilical tape/sterile cord
Small rubber bulb syringe
Towels-5

23. Equipment 1 dozen 2” x 10” gauze sponges Rubber gloves Baby blanket-1
Sanitary napkins
Plastic bag

24. Delivering The Baby Position and support Flat, sturdy surface
Lie with knees drawn up and spread apart
Elevate buttocks with blankets

25. Position and support Create sterile field One towel under buttocks
One between her legs
One across her abdomen
Partner at head
Reassure/comfort
Assist airway

26. Delivering the Head Place fingers on bony part of skull
If amniotic sac does not break, or has not broken:
Use clamp to puncture
Push away from nose and mouth

27. Delivering the Head Umbilical cord around neck? Slip over shoulder
Clamp and cut it

28. Delivering the Body Support head and body Grasp feet
Support with both hands
Baby will be slippery
Do not squeeze neck or chest

30. Post Delivery Care Initial care of baby Set baby down
Same level or lower than birth canal
On side with head slightly lower than body
Continue to aspirate

31. Initial care of the baby
Wrap in blanket
Warm prior if possible
Leave only face expose
If not breathing, perform CPR

32. Cutting the Umbilical cord
Clamp with two clamps
Four fingers width from the baby
Two to six inches apart
Cut between clamps

33. Apgar score
1 and 5 minutes
Healthy baby will score 10
Five areas

34. APGAR Appearance - pink shortly after birth
Pulse- greater than 100/min
Grimace - crying, or withdrawing in response to stimuli
Activity - resistance or muscle tone when attempts are made to straighten legs
Respirations - regular and rapid

35. Delivery of Placenta Normal Delivery
Within a few minutes of baby’s birth
Usually less than 250 ml blood loss
Record delivery time
Take to hospital

36. Delivery of Placenta Provide prompt transport
If not delivered within 30 minutes
250ml of bleeding occurs before delivery of placenta
Significant bleeding occurs after delivery of placenta
Do not pull cord!

38. Click for Video

39. Resuscitation of Newborn
Assessing the baby
Respirations
Pulse
Artificial Ventilation
Use BVM
breaths per minute

40. Resuscitation of Newborn
Chest compressions
Heart rate is < 60 bpm, or between bpm and not rising
Both thumbs on middle third of the sternum or one thumb over the other

41. Prolapsed umbilical cord
Abnormal Deliveries
Prolapsed umbilical cord
Cord comes out before baby
Do not replace!
Danger: Decreased O2 to the baby

42. Treatment Place mother with legs and buttocks elevated
Exert gentle counter pressure with gloved hand
Wrap moistened sterile towel around cord
Oxygen
Keep warm
Transport

43. Breech Delivery Presenting part - buttocks or feet Treatment
Position and drape mother
Allow buttocks and feet to deliver
Support legs and trunk

44. Treatment Head usually delivers on its own
If not within 3 minutes of buttocks and trunk, do not pull!
Cup hand over baby’s face/mouth and transport
Head delivers- procedures the same

45. Limb Presentation Presenting part single arm, leg, or foot
Cannot successfully deliver in the field

46. Treatment Give mother O2 Place mother on back, head lower than pelvis
Cover with sterile towel
Transport

47. Multiple Births 1st baby is small Abdomen still large
Contractions about 10 minutes after first baby

48. Treatment Cut cord on first baby Follow normal delivery procedures
May be considered premature

49. Premature Infants
Premature - born before 8th month or weighing less than 5 1/2 lbs.
Judge weight
Thinner, smaller, redder than full term
Head larger

50. 5 important steps in management
Keep warm
90-95 degrees F
Keep mouth, nose, and throat clear
Make sure cord not bleeding
Apply additional clamps or ties
Slightest bleeding serious

51. 5 important steps in management
Increase O2 in enviroment
Make tent over head
Aim O2 at top of tent
Do not administer directly
Avoid infection
Use sterile equipment
Avoid unnecessary handling

52. Gynecologic Emergencies
Trauma to external genetalia
Treat as other bleeding and soft tissue injuries O2
Never pack vagina
Transport

53. Alleged Sexual Assault and Rape
Patient may refuse assistance

54. Treatment BSI Airway Nonjudgmental attitude during SAMPLE
Crime scene protection

55. Treatment Examine genitalia only if profuse bleeding
Use same sex providers if possible
Discourage bathing, voiding, or cleaning wounds

56. The End