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

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. Obstetrics and Gynecological Emergencies
The Delivery

10. Obstetrics and Gynecological Emergencies

11. 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

12. Obstetrics and Gynecological Emergencies
Complications of the Delivery

13. 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

14. 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

15. 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

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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Obstetrics and Gynecological Emergencies
Trauma In Pregnancy- Patient Assessment
Pulse will be 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)

23. 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

24. Obstetrics and Gynecological Emergencies
GYN EMERGENCIES

25. 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

26. 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

27. 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