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Reproductive system. emergency childbirth & obstetrical problems. Anatomy. Look up in text. Ch 4 and 20. Definitions. birth canal perineum placenta umbilical cord amniotic sac. ovum embryo fetus uterus (cervix, body, fundus). Definitions. trimester full term crowning

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reproductive system

Reproductive system

emergency childbirth & obstetrical problems

anatomy
Anatomy

Look up in text.

Ch 4 and 20

definitions
Definitions
  • birth canal
  • perineum
  • placenta
  • umbilical cord
  • amniotic sac
  • ovum
  • embryo
  • fetus
  • uterus (cervix, body, fundus)
definitions4
Definitions
  • trimester
  • full term
  • crowning
  • fertilization - where occurs?
predelivery emergencies
Predelivery Emergencies
  • Pregnancy Induced Hypertension (PIH)
    • Preeclampsia (aka. Toxemia)
  • Eclampsia
  • Supine hypotensive syndrome
    • Low blood pressure from lying supine
preeclampsia toxemia
Preeclampsia (toxemia)
  • 2 & 3 trimester of pregnancy
  • headache
  • hypertension
  • edema & sudden weight gain
  • visual problems
  • anxiety
eclampsia
Eclampsia
  • symptoms of preeclampsia +
  • seizures
  • coma
treatment
Treatment
  • high flow O2
  • quiet, code 2 transport (unless seizing or coma)
  • left lateral position
hemorrhage
Hemorrhage
  • Vaginal bleeding
  • If present in early pregnancy,

-spontaneous abortion

-ectopic pregnancy

  • Later in pregnancy
    • Placenta problems
spontaneous abortion miscarriage
Spontaneous Abortion (Miscarriage)
  • Before the 20th week
  • Infection and bleeding - complications
  • Treat for shock
  • Transport
  • Bring any tissue (POC) that has passed
ectopic pregnancy
Ectopic Pregnancy
  • Pregnancy outside of the uterus
  • Any woman of childbearing age with abdominal pain and missed period
  • History of PID, tubal ligation, or previous ectopic pregnancy
placenta problems
Placenta abruptio

Premature separation of the placenta

Placenta previa

Development of placenta over the cervix

Placenta Problems
placenta previa and placenta abruptio tx
Placenta Previa andPlacenta Abruptio TX

high flow o2

rapid transport

left lateral position

focused history
Focused History
  • “What baby is this for you”?
  • PARA - GRAVIDA - ABORTIONS
  • Contractions?
  • How long ago did labor start?
  • Due date
  • Prenatal care & problems?
  • Prior births & problems?
  • Urge to push?
  • Has water broken?
labor
Labor
  • ouch
labor duration
Labor duration
  • primipara - first time for mom
    • Usually 18-24 hours!
  • Multipara - mom with more than 1 live births
    • Usually 7 to 10 hrs
when to consider field delivery
When to Consider Field Delivery
  • Delivery is imminent
  • It is impossible to reach a hospital
  • No transportation is available
signs of imminent delivery
Signs of imminent delivery
  • Crowning
  • Urge to bear down or go to the bathroom
  • “it’s coming”
  • contractions of increased frequency & intensity
three stages of labor
Three Stages of Labor
  • 1st stage
    • Onset of labor to full dilation of the cervix
  • 2nd stage
    • Full dilation to delivery of infant
  • 3rd stage
    • Delivery of infant to delivery of placenta
preparing for delivery
Preparing for Delivery
  • Use proper BSI precautions
  • Be calm and reassuring
  • Protect mother’s modesty
  • Contact medical control
    • deliver on scene
    • transport
  • Position mother for delivery
  • Prepare OB kit.
delivering the infant
Delivering the Infant
  • Support the head as it emerges.
  • Suction mouth then nose
  • Support the head and upper body as the shoulders deliver.
  • Handle the infant firmly but gently as the body delivers.
post delivery care
Post delivery Care
  • Immediately wrap the infant in a towel with the head lower than the body.
  • Suction the mouth and nose again.
  • Clamp and cut the cord.
  • Ensure the infant is pink and breathing well.
  • APGAR
apgar scoring
APGAR Scoring

A Appearance

P Pulse

G Grimace

A Activity

R Respirations

delivery of placenta
Delivery of Placenta
  • Takes 15-30 mins
  • When placenta delivers, wrap it and take it with you
  • Massage fundus
  • If the mother continues to bleed, transport promptly
childbirth video

Childbirth Video

lights, camera, action!

complications with normal vaginal delivery
Complications with Normal Vaginal Delivery
  • Unruptured amniotic sac
  • Umbilical cord around the neck
  • Meconium staining
breech delivery
Breech Delivery
  • Presenting part is the buttocks or legs.
  • Breech delivery is usually slow
  • Support the infant as it comes out.
  • Insert your gloved fingers into the vagina and make a “V” to protect airway
rare presentations
Rare Presentations
  • Limb presentation
    • very rare
    • requires immediate transport.
  • Prolapsed cord
    • Transport immediately.
    • Place fingers into the mother’s vagina and push the head away from the cord.
twins
Twins
  • Usually smaller
  • Delivery procedures are same
  • There may be one or two placentas
delivering an infant of an addicted mother
Delivering an Infant of an Addicted Mother
  • Ensure proper BSI precautions
  • Deliver as normal
  • Watch for severe respiratory depression and low birth weight
  • May require immediate care
premature infants
Premature Infants

Delivery before 8 months or weight less than 5 lb at birth.

  • Keep warm
  • Keep mouth and nose clear of mucus
  • Give low flow oxygen
  • Do not infect the infant
  • Notify the hospital
giving chest compressions to an infant
Giving Chest Compressions to an Infant
  • Wrap your hands around the body, with your thumbs resting at proper position
    • Just below the nipple line
    • Middle third of the sternum
  • Give gentle compressions ½” to ¾” deep
  • 3 compressions to 1 ventilation
  • 30 ventilations & 90 compressions/minute
delivery without sterile ob kit
Delivery Without Sterile OB kit
  • You should always have goggles and sterile gloves with you.
  • Use clean sheets and towels.
  • Do not cut or clamp umbilical cord.
  • Keep placenta and infant at same level.
fetal demise
Fetal Demise

An infant that has died in the uterus before labor

  • Very emotional situation
  • Infant may be born with skin blisters, skin sloughing, and dark discoloration.
  • Do not attempt to resuscitate an obviously dead infant.
additional notes
Additional notes:
  • during pregnancy blood volume almost doubles
  • resting pulse rate is faster in pregnant patients
  • during trauma mother’s body will attempt to save itself
sexual assault
Sexual Assault
  • Do not examine genitalia unless there is obvious bleeding.
  • Document carefully and preserve evidence
  • The patient should not wash the area, defecate, eat, or drink until examined.
  • Treat other injuries accordingly
  • Offer to call the local rape crisis center.
the end

The end

For now anyways..