obstetrics and gynecology l.
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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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Presentation Transcript
overview
OVERVIEW
  • Anatomy Review
  • Beginning of Labor
  • Predelivery Emergencies
  • Preparing for Delivery
  • Delivering the Baby
overview cont
OVERVIEW cont.
  • Postdelivery Care
  • Resuscitation of the Newborn
  • Abnormal Deliveries & Complications
  • Gynecologic Emergencies
anatomy review
Anatomy Review
  • Fetus
  • Uterus
  • Placenta
  • Umbilical Cord
  • Amniotic Sac
  • Cervix
the stages of labor
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
signs of labor
Signs of Labor
  • Beginning of regular contractions
  • Bloody show
  • Rupture of the amniotic sac (water breaks)
predelivery emergencies
Predelivery Emergencies
  • Miscarriage
  • Seizures
  • Vaginal Bleeding
  • Trauma
miscarriage
Miscarriage
  • Delivery of fetus & placenta before 20 weeks
  • Danger - bleeding & infection
treatment
Treatment
  • Initial assessment
  • History & physical exam
    • Ask if she is pregnant
    • Ask date of last cycle
treatment11
Treatment
  • Apply external vaginal pads
  • Collect tissues
  • Transport
seizures
Seizures
  • Eclampsia - related to high blood pressure
treatment13
Treatment
  • Initial assessment
  • HX & vitals
  • Transport on left side
  • Monitor airway & give O2
  • Transport
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

Vaginal Bleeding
slide15
Placenta abruptio - placenta separates prematurely
  • Placenta previa - placenta develops over & covers the mouth of the uterus
treatment16
Treatment
  • BSI
  • Initial assessment
  • History and physical exam
    • Ask patient if she has any pain.
treatment17
Treatment
  • Transport on left side
  • Sterile pad or sanitary napkin
  • Save any tissue
  • Transport
trauma
Trauma
  • Severe bleeding
  • Injury to fetus
treatment19
Treatment
  • Initial assessment
  • O2
  • Place on left side
  • Control external bleeding
  • Transport
preparing for delivery
Preparing for Delivery

Assessing the need for emergency delivery

  • First decision - whether or not you have time to transport?
slide21
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
equipment
Equipment
  • Surgical scissors-1 pair
  • Hemostats or cord clamps-3
  • Umbilical tape/sterile cord
  • Small rubber bulb syringe
  • Towels-5
equipment23
Equipment
  • 1 dozen 2” x 10” gauze sponges
  • Rubber gloves
  • Baby blanket-1
  • Sanitary napkins
  • Plastic bag
delivering the baby
Delivering The Baby

Position and support

  • Flat, sturdy surface
  • Lie with knees drawn up and spread apart
  • Elevate buttocks with blankets
position and support
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
delivering the head
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
delivering the head27
Delivering the Head
  • Umbilical cord around neck?
    • Slip over shoulder
    • Clamp and cut it
delivering the body
Delivering the Body
  • Support head and body
  • Grasp feet
  • Support with both hands
    • Baby will be slippery
    • Do not squeeze neck or chest
post delivery care
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
initial care of the baby
Initial care of the baby
  • Wrap in blanket
    • Warm prior if possible
    • Leave only face expose
  • If not breathing, perform CPR
cutting the umbilical cord
Cutting the Umbilical cord
  • Clamp with two clamps
    • Four fingers width from the baby
    • Two to six inches apart
  • Cut between clamps
apgar score
Apgar score
  • 1 and 5 minutes
  • Healthy baby will score 10
  • Five areas
apgar
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
delivery of placenta
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
delivery of placenta36
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!
resuscitation of newborn
Resuscitation of Newborn
  • Assessing the baby
    • Respirations
    • Pulse
  • Artificial Ventilation
    • Use BVM
    • 40- 60 breaths per minute
resuscitation of newborn40
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
abnormal deliveries
Abnormal Deliveries

Prolapsed umbilical cord

  • Cord comes out before baby
  • Do not replace!
  • Danger: Decreased O2 to the baby
treatment42
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
breech delivery
Breech Delivery
  • Presenting part - buttocks or feet
  • Treatment
    • Position and drape mother
    • Allow buttocks and feet to deliver
    • Support legs and trunk
treatment44
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
limb presentation
Limb Presentation
  • Presenting part single arm, leg, or foot
  • Cannot successfully deliver in the field
treatment46
Treatment
  • Give mother O2
  • Place mother on back, head lower than pelvis
  • Cover with sterile towel
  • Transport
multiple births
Multiple Births
  • 1st baby is small
  • Abdomen still large
  • Contractions about 10 minutes after first baby
treatment48
Treatment
  • Cut cord on first baby
  • Follow normal delivery procedures
  • May be considered premature
premature infants
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
5 important steps in management
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
5 important steps in management51
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
gynecologic emergencies
Gynecologic Emergencies

Trauma to external genetalia

  • Treat as other bleeding and soft tissue injuries
  • O2
  • Never pack vagina
  • Transport
alleged sexual assault and rape
Alleged Sexual Assault and Rape

Patient may refuse assistance

treatment54
Treatment
  • BSI
  • Airway
  • Nonjudgmental attitude during SAMPLE
  • Crime scene protection
treatment55
Treatment
  • Examine genitalia only if profuse bleeding
  • Use same sex providers if possible
  • Discourage bathing, voiding, or cleaning wounds