Chapter 37 Emergency Childbirth
Jan 03, 2016
Chapter 37Emergency Childbirth
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Overview
Anatomy Review Normal Childbirth Emergency Childbirth Special Delivery Scenarios Post-Delivery Care
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Anatomy Review
During pregnancy, the uterus enlarges The fetus obtains all nutrients from
the placenta The umbilical cord connects the fetus to
the placenta; both are enclosed in the amniotic sac
Effacement and cervical dilation begin as the pregnancy comes to an end
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Normal Childbirth
Stage 1 of labor– Fetal head moves into pelvis– Cervix thins and dilates– Uterus begins to contract– Can take from a few to up to 30 hours– The amniotic sac ruptures
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Normal Childbirth
Stage 2 of labor– Forceful uterine contractions– Increasing vaginal pressure– The head becomes visible– Mother begins to push– Fetus exhibits the cardinal movements of labor– The newborn is delivered– Usually 30 to 60 minutes
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Normal Childbirth
Stage 3 of labor– Uterus decreases in size– The placenta separates from the uterus and is
expelled – Generally within 30 minutes of delivery
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Stop and Review
What are the normal anatomical changes that occur during pregnancy?
Describe the three stages of labor.
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The Process of Birth
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Emergency Childbirth
History– What is the due date?– Have there been any complications with the
pregnancy?– Note the color of the amniotic fluid– When did contractions begin and how far apart are
they?– Note the number of pregnancies and the number
of live children
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Emergency Childbirth
Assessment– Initial assessment and vital signs– Look for signs of crowning or abnormalities– Maintain privacy and perform assessment in the
presence of another EMT– Only repeat examination if patient’s condition
changes
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Emergency Childbirth
Preparation for delivery– Don appropriate PPE– Prepare supplies– Contact medical control– Two EMTs should facilitate
delivery: one to tend to the mother and one to tend to the newborn
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Emergency Childbirth
Normal delivery– Since field delivery is rare, EMTs may want to
review these steps frequently – Most deliveries are completed without
complications
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Special Delivery Scenarios
Prolapsed umbilical cord– A cord lodged between the birth canal and the
fetus’ head– Can be life threatening– The cord is visible on examination of the vaginal
opening– Place mother on 100% oxygen and place in head
down, buttocks raised position– Push the fetus away from cord
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Special Delivery Scenarios
Breech presentation– Fetus may present buttocks first or limbs first– Increases fetus’ risk of injury– Place mother on 100% oxygen and position head
down with pelvis elevated– Immediately transport to nearest facility– Call medical control
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Special Delivery Scenarios
Meconium– Aspiration can be harmful to the fetus– Can result in infection and injury to the lung tissue– The thicker it is, the more dangerous to the fetus– Suction the nose and mouth to remove the
meconium– Transport immediately and call for ALS backup
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Special Delivery Scenarios
Multiple gestation – Delivery of two or more newborns– Usually premature– Second is often in breech presentation– Transport immediately
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Special Delivery Scenarios
Premature delivery– Early delivery of the newborn– Underdeveloped pulmonary system– Prone to injury and requires extensive
resuscitation– Transport as soon as possible and alert the
hospital you are en route
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Post-Delivery Care
Mother– Monitor for bleeding– Stimulate contraction of the uterus via massage– If bleeding is excessive, treat for shock
Newborn– Initial assessment and resuscitation if required
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Stop and Review
What are the signs of a pending delivery? Why is the predelivery history important? Describe the assessment and management
of the following:– Prolapsed umbilical cord– Breech presentation– Multiple births– Meconium