Obstetrics and gynecology
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OBSTETRICS AND GYNECOLOGY. Lesson Objective: Indicate procedures for emergency (pre -hospital) childbirth. OVERVIEW. Anatomy Review Beginning of Labor Predelivery Emergencies Preparing for Delivery Delivering the Baby. OVERVIEW cont. Postdelivery Care Resuscitation of the Newborn

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Lesson objective indicate procedures for emergency pre hospital childbirth l.jpg

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

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  • Anatomy Review

  • Beginning of Labor

  • Predelivery Emergencies

  • Preparing for Delivery

  • Delivering the Baby

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  • Postdelivery Care

  • Resuscitation of the Newborn

  • Abnormal Deliveries & Complications

  • Gynecologic Emergencies

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Anatomy Review

  • Fetus

  • Uterus

  • Placenta

  • Umbilical Cord

  • Amniotic Sac

  • Cervix

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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

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Signs of Labor

  • Beginning of regular contractions

  • Bloody show

  • Rupture of the amniotic sac (water breaks)

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Predelivery Emergencies

  • Miscarriage

  • Seizures

  • Vaginal Bleeding

  • Trauma

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  • Delivery of fetus & placenta before 20 weeks

  • Danger - bleeding & infection

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  • Initial assessment

  • History & physical exam

    • Ask if she is pregnant

    • Ask date of last cycle

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  • Apply external vaginal pads

  • Collect tissues

  • Transport

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  • Eclampsia - related to high blood pressure

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  • Initial assessment

  • HX & vitals

  • Transport on left side

  • Monitor airway & give O2

  • Transport

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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

Vaginal Bleeding

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  • Placenta abruptio - placenta separates prematurely

  • Placenta previa - placenta develops over & covers the mouth of the uterus

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  • BSI

  • Initial assessment

  • History and physical exam

    • Ask patient if she has any pain.

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  • Transport on left side

  • Sterile pad or sanitary napkin

  • Save any tissue

  • Transport

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  • Severe bleeding

  • Injury to fetus

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  • Initial assessment

  • O2

  • Place on left side

  • Control external bleeding

  • Transport

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Preparing for Delivery

Assessing the need for emergency delivery

  • First decision - whether or not you have time to transport?

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  • 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

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  • Surgical scissors-1 pair

  • Hemostats or cord clamps-3

  • Umbilical tape/sterile cord

  • Small rubber bulb syringe

  • Towels-5

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  • 1 dozen 2” x 10” gauze sponges

  • Rubber gloves

  • Baby blanket-1

  • Sanitary napkins

  • Plastic bag

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Delivering The Baby

Position and support

  • Flat, sturdy surface

  • Lie with knees drawn up and spread apart

  • Elevate buttocks with blankets

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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

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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

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Delivering the Head

  • Umbilical cord around neck?

    • Slip over shoulder

    • Clamp and cut it

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Delivering the Body

  • Support head and body

  • Grasp feet

  • Support with both hands

    • Baby will be slippery

    • Do not squeeze neck or chest

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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

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Initial care of the baby

  • Wrap in blanket

    • Warm prior if possible

    • Leave only face expose

  • If not breathing, perform CPR

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Cutting the Umbilical cord

  • Clamp with two clamps

    • Four fingers width from the baby

    • Two to six inches apart

  • Cut between clamps

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Apgar score

  • 1 and 5 minutes

  • Healthy baby will score 10

  • Five areas

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  • 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

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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

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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!

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Resuscitation of Newborn

  • Assessing the baby

    • Respirations

    • Pulse

  • Artificial Ventilation

    • Use BVM

    • 40- 60 breaths per minute

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Resuscitation of Newborn

  • Chest compressions

    • Heart rate is < 60 bpm, or between 60- 80 bpm and not rising

    • Both thumbs on middle third of the sternum or one thumb over the other

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Abnormal Deliveries

Prolapsed umbilical cord

  • Cord comes out before baby

  • Do not replace!

  • Danger: Decreased O2 to the baby

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  • Place mother with legs and buttocks elevated

  • Exert gentle counter pressure with gloved hand

  • Wrap moistened sterile towel around cord

  • Oxygen

  • Keep warm

  • Transport

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Breech Delivery

  • Presenting part - buttocks or feet

  • Treatment

    • Position and drape mother

    • Allow buttocks and feet to deliver

    • Support legs and trunk

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  • 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

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Limb Presentation

  • Presenting part single arm, leg, or foot

  • Cannot successfully deliver in the field

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  • Give mother O2

  • Place mother on back, head lower than pelvis

  • Cover with sterile towel

  • Transport

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Multiple Births

  • 1st baby is small

  • Abdomen still large

  • Contractions about 10 minutes after first baby

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  • Cut cord on first baby

  • Follow normal delivery procedures

  • May be considered premature

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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

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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

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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

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Gynecologic Emergencies

Trauma to external genetalia

  • Treat as other bleeding and soft tissue injuries

  • O2

  • Never pack vagina

  • Transport

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Alleged Sexual Assault and Rape

Patient may refuse assistance

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  • BSI

  • Airway

  • Nonjudgmental attitude during SAMPLE

  • Crime scene protection

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  • Examine genitalia only if profuse bleeding

  • Use same sex providers if possible

  • Discourage bathing, voiding, or cleaning wounds