Home OBSTETRICS AND GYNECOLOGY Home Lesson Objective: Lesson Objective: Indicate procedures for emergency (pre -hospital) childbirth.

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OBSTETRICS AND GYNECOLOGY

OBSTETRICS AND GYNECOLOGY

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Lesson Objective:Lesson Objective:

Indicate procedures for emergency (pre -hospital) childbirth.

Lesson Objective:Lesson Objective:

Indicate procedures for emergency (pre -hospital) childbirth.

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OVERVIEWOVERVIEW

Anatomy ReviewAnatomy Review Beginning of LaborBeginning of Labor Predelivery EmergenciesPredelivery Emergencies Preparing for DeliveryPreparing for Delivery Delivering the BabyDelivering the Baby

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OVERVIEW cont.OVERVIEW cont.

Postdelivery CarePostdelivery Care Resuscitation of the NewbornResuscitation of the Newborn Abnormal Deliveries & ComplicationsAbnormal Deliveries & Complications Gynecologic EmergenciesGynecologic Emergencies

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FetusFetus UterusUterus PlacentaPlacenta Umbilical CordUmbilical Cord Amniotic SacAmniotic Sac CervixCervix

Anatomy ReviewAnatomy Review

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The Stages of Labor The Stages of Labor

1st Stage - 1st contraction until cervix is fully 1st Stage - 1st contraction until cervix is fully dilated.dilated.

2nd Stage - full dilation until birth.2nd Stage - full dilation until birth. 3rd Stage - birth of baby, until delivery of placenta3rd Stage - birth of baby, until delivery of placenta

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Signs of LaborSigns of Labor

Beginning of regular contractionsBeginning of regular contractions Bloody showBloody show Rupture of the amniotic sac (water Rupture of the amniotic sac (water

breaks)breaks)

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Predelivery EmergenciesPredelivery Emergencies

MiscarriageMiscarriage SeizuresSeizures Vaginal BleedingVaginal Bleeding TraumaTrauma

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Miscarriage Miscarriage

Delivery of fetus & placenta before 20 Delivery of fetus & placenta before 20 weeksweeks

Danger - bleeding & infectionDanger - bleeding & infection

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Treatment Treatment

Initial assessment Initial assessment History & physical examHistory & physical exam

Ask if she is pregnant Ask if she is pregnant Ask date of last cycleAsk date of last cycle

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TreatmentTreatment

Apply external vaginal padsApply external vaginal pads Collect tissuesCollect tissues TransportTransport

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Seizures Seizures Seizures Seizures

EclampsiaEclampsia - related to high blood - related to high blood pressure pressure

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TreatmentTreatment

Initial assessmentInitial assessment HX & vitalsHX & vitals Transport on left sideTransport on left side Monitor airway & give OMonitor airway & give O22

TransportTransport

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Vaginal BleedingVaginal BleedingVaginal BleedingVaginal Bleeding

Early pregnancy - may be normalEarly pregnancy - may be normal Later stages of pregnancyLater stages of pregnancy

Placenta abruptio Placenta abruptio - placenta - placenta separates prematurely separates prematurely

Placenta previa Placenta previa - placenta develops - placenta develops over & covers the mouth of the over & covers the mouth of the uterusuterus

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Placenta abruptio Placenta abruptio - - placenta separates placenta separates prematurelyprematurely

Placenta previa Placenta previa - - placenta develops placenta develops over & covers the over & covers the mouth of the mouth of the uterusuterus

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TreatmentTreatmentTreatmentTreatment

BSIBSI Initial assessmentInitial assessment History and physical examHistory and physical exam

Ask patient if she has any pain.Ask patient if she has any pain.

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TreatmentTreatmentTreatmentTreatment

Transport on left sideTransport on left side Sterile pad or sanitary napkinSterile pad or sanitary napkin Save any tissueSave any tissue TransportTransport

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TraumaTraumaTraumaTrauma

Severe bleedingSevere bleeding Injury to fetus Injury to fetus

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TreatmentTreatmentTreatmentTreatment

Initial assessmentInitial assessment OO22

Place on left sidePlace on left side Control external bleedingControl external bleeding TransportTransport

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Preparing for DeliveryPreparing for DeliveryPreparing for DeliveryPreparing for Delivery

Assessing the need for emergency Assessing the need for emergency deliverydelivery

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

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Decision based on three factors:Decision based on three factors:

Is the delivery imminentIs the delivery imminent Hospital cannot be reached due to Hospital cannot be reached due to

a natural disaster, weather, or a natural disaster, weather, or traffic conditionstraffic conditions

No transportation is availableNo transportation is available

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EquipmentEquipment

Surgical scissors-1 pairSurgical scissors-1 pair Hemostats or cord clamps-3Hemostats or cord clamps-3 Umbilical tape/sterile cordUmbilical tape/sterile cord Small rubber bulb syringeSmall rubber bulb syringe Towels-5Towels-5

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EquipmentEquipment

1 dozen 2” x 10” gauze sponges1 dozen 2” x 10” gauze sponges Rubber glovesRubber gloves Baby blanket-1Baby blanket-1 Sanitary napkinsSanitary napkins Plastic bagPlastic bag

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Delivering The BabyDelivering The Baby

Position and supportPosition and support Flat, sturdy surfaceFlat, sturdy surface Lie with knees drawn up and Lie with knees drawn up and

spread apartspread apart Elevate buttocks with blanketsElevate buttocks with blankets

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Position and supportPosition and supportPosition and supportPosition and support

Create sterile fieldCreate sterile field One towel under buttocksOne towel under buttocks One between her legsOne between her legs One across her abdomenOne across her abdomen

Partner at headPartner at head Reassure/comfortReassure/comfort Assist airway Assist airway

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Delivering the HeadDelivering the Head Place fingers on bony part of skullPlace fingers on bony part of skull If amniotic sac does not break, or has not If amniotic sac does not break, or has not

broken:broken: Use clamp to punctureUse clamp to puncture Push away from nose and mouthPush away from nose and mouth

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Delivering the HeadDelivering the Head

Umbilical cord around neck?Umbilical cord around neck? Slip over shoulderSlip over shoulder Clamp and cut itClamp and cut it

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Delivering the BodyDelivering the Body

Support head and Support head and bodybody

Grasp feetGrasp feet Support with both Support with both

handshands Baby will be Baby will be

slipperyslippery Do not squeeze Do not squeeze

neck or chestneck or chest

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Post Delivery CarePost Delivery Care

Initial care of babyInitial care of baby Set baby downSet baby down Same level or lower than birth canalSame level or lower than birth canal On side with head slightly lower than On side with head slightly lower than

bodybody Continue to aspirateContinue to aspirate

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Initial care of the babyInitial care of the baby

Wrap in blanketWrap in blanket Warm prior if possibleWarm prior if possible Leave only face exposeLeave only face expose

If not breathing, perform CPRIf not breathing, perform CPR

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Cutting the Umbilical cordCutting the Umbilical cord

Clamp with two clampsClamp with two clamps Four fingers width from the babyFour fingers width from the baby Two to six inches apartTwo to six inches apart

Cut between clampsCut between clamps

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Apgar scoreApgar score

1 and 5 minutes1 and 5 minutes Healthy baby will score 10Healthy baby will score 10 Five areasFive areas

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APGARAPGAR AAppearanceppearance - pink shortly after birth - pink shortly after birth PPulseulse- greater than 100/min- greater than 100/min GGrimacerimace - crying, or withdrawing in - crying, or withdrawing in

response to stimuliresponse to stimuli AActivityctivity - resistance or muscle tone - resistance or muscle tone

when attempts are made to straighten when attempts are made to straighten legslegs

RRespirationsespirations - regular and rapid - regular and rapid

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Delivery of PlacentaDelivery of Placenta

Normal DeliveryNormal Delivery Within a few Within a few

minutes of baby’s minutes of baby’s birthbirth

Usually less than Usually less than 250 ml blood loss250 ml blood loss

Record delivery Record delivery timetime

Take to hospitalTake to hospital

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Delivery of Placenta Delivery of Placenta Provide prompt transportProvide prompt transport

If not delivered within 30 minutesIf not delivered within 30 minutes 250ml of bleeding occurs before 250ml of bleeding occurs before

delivery of placentadelivery of placenta Significant bleeding occurs after Significant bleeding occurs after

delivery of placentadelivery of placenta Do not pull cord!Do not pull cord!

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Click for Video

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Resuscitation of NewbornResuscitation of Newborn Assessing the babyAssessing the baby

RespirationsRespirations PulsePulse

Artificial VentilationArtificial Ventilation Use BVMUse BVM 40- 60 breaths per minute40- 60 breaths per minute

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Resuscitation of NewbornResuscitation of Newborn

Chest compressionsChest compressions Heart rate is < 60 bpm, or between Heart rate is < 60 bpm, or between

60- 80 bpm and not rising60- 80 bpm and not rising Both thumbs on middle third of the Both thumbs on middle third of the

sternum or one thumb over the sternum or one thumb over the otherother

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Abnormal DeliveriesAbnormal Deliveries

Prolapsed Prolapsed umbilical cordumbilical cord

Cord comes out Cord comes out before babybefore baby

Do not replace!Do not replace! Danger: Decreased Danger: Decreased

OO22 to the baby to the baby

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TreatmentTreatment Place mother with legs and buttocks Place mother with legs and buttocks

elevatedelevated Exert gentle counter pressure with gloved Exert gentle counter pressure with gloved

handhand Wrap moistened sterile towel around cordWrap moistened sterile towel around cord OxygenOxygen Keep warmKeep warm TransportTransport

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Breech DeliveryBreech Delivery

Presenting part Presenting part - - buttocks or feetbuttocks or feet

TreatmentTreatment Position and Position and

drape motherdrape mother Allow buttocks Allow buttocks

and feet to deliverand feet to deliver Support legs and Support legs and

trunktrunk

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TreatmentTreatment

Head usually delivers on its ownHead usually delivers on its own If not within 3 minutes of buttocks If not within 3 minutes of buttocks

and trunk, do not pull!and trunk, do not pull! Cup hand over baby’s face/mouth Cup hand over baby’s face/mouth

and transportand transport Head delivers- procedures the Head delivers- procedures the

samesame

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Limb PresentationLimb Presentation

Presenting part single arm, leg, or Presenting part single arm, leg, or footfoot

Cannot successfully deliver in the Cannot successfully deliver in the fieldfield

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TreatmentTreatment

Give mother OGive mother O22

Place mother on back, head lower Place mother on back, head lower than pelvisthan pelvis

Cover with sterile towelCover with sterile towel TransportTransport

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Multiple BirthsMultiple Births

1st baby is small1st baby is small Abdomen still largeAbdomen still large Contractions about 10 minutes after Contractions about 10 minutes after

first babyfirst baby

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TreatmentTreatment

Cut cord on first babyCut cord on first baby Follow normal delivery proceduresFollow normal delivery procedures May be considered prematureMay be considered premature

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Premature InfantsPremature Infants

Premature Premature - born before 8th month or - born before 8th month or weighing less than 5 1/2 lbs.weighing less than 5 1/2 lbs. Judge weightJudge weight Thinner, smaller, redder than full Thinner, smaller, redder than full

termterm Head largerHead larger

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5 important steps in management5 important steps in management5 important steps in management5 important steps in management

Keep warmKeep warm 90-95 degrees F90-95 degrees F

Keep mouth, nose, and throat clear Keep mouth, nose, and throat clear Make sure cord not bleedingMake sure cord not bleeding

Apply additional clamps or tiesApply additional clamps or ties Slightest bleeding seriousSlightest bleeding serious

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5 important steps in management5 important steps in management5 important steps in management5 important steps in management

Increase OIncrease O22 in enviroment in enviroment Make tent over headMake tent over head Aim OAim O22 at top of tent at top of tent Do not administer directlyDo not administer directly

Avoid infectionAvoid infection Use sterile equipmentUse sterile equipment Avoid unnecessary handlingAvoid unnecessary handling

Increase OIncrease O22 in enviroment in enviroment Make tent over headMake tent over head Aim OAim O22 at top of tent at top of tent Do not administer directlyDo not administer directly

Avoid infectionAvoid infection Use sterile equipmentUse sterile equipment Avoid unnecessary handlingAvoid unnecessary handling

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Gynecologic EmergenciesGynecologic Emergencies

Trauma to external genetaliaTrauma to external genetalia Treat as other bleeding and soft Treat as other bleeding and soft

tissue injuriestissue injuries OO22

Never pack vaginaNever pack vagina TransportTransport

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Alleged Sexual Assault and RapeAlleged Sexual Assault and Rape

Patient may refuse assistancePatient may refuse assistance

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TreatmentTreatment

BSIBSI AirwayAirway Nonjudgmental attitude during Nonjudgmental attitude during

SAMPLESAMPLE Crime scene protectionCrime scene protection

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TreatmentTreatment

Examine genitalia only if profuse Examine genitalia only if profuse bleedingbleeding

Use same sex providers if possibleUse same sex providers if possible Discourage bathing, voiding, or Discourage bathing, voiding, or

cleaning woundscleaning wounds

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The EndThe End