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OBSTETRICS AND GYNECOLOGY

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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OBSTETRICS AND GYNECOLOGY

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  1. OBSTETRICS AND GYNECOLOGY

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

  3. OVERVIEW • Anatomy Review • Beginning of Labor • Predelivery Emergencies • Preparing for Delivery • Delivering the Baby

  4. OVERVIEW cont. • Postdelivery Care • Resuscitation of the Newborn • Abnormal Deliveries & Complications • Gynecologic Emergencies

  5. Anatomy Review • Fetus • Uterus • Placenta • Umbilical Cord • Amniotic Sac • Cervix

  6. 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

  7. Signs of Labor • Beginning of regular contractions • Bloody show • Rupture of the amniotic sac (water breaks)

  8. Predelivery Emergencies • Miscarriage • Seizures • Vaginal Bleeding • Trauma

  9. Miscarriage • Delivery of fetus & placenta before 20 weeks • Danger - bleeding & infection

  10. Treatment • Initial assessment • History & physical exam • Ask if she is pregnant • Ask date of last cycle

  11. Treatment • Apply external vaginal pads • Collect tissues • Transport

  12. Seizures • Eclampsia - related to high blood pressure

  13. Treatment • Initial assessment • HX & vitals • Transport on left side • Monitor airway & give O2 • Transport

  14. 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

  15. Placenta abruptio - placenta separates prematurely • Placenta previa - placenta develops over & covers the mouth of the uterus

  16. Treatment • BSI • Initial assessment • History and physical exam • Ask patient if she has any pain.

  17. Treatment • Transport on left side • Sterile pad or sanitary napkin • Save any tissue • Transport

  18. Trauma • Severe bleeding • Injury to fetus

  19. Treatment • Initial assessment • O2 • Place on left side • Control external bleeding • Transport

  20. Preparing for Delivery Assessing the need for emergency delivery • First decision - whether or not you have time to transport?

  21. 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

  22. Equipment • Surgical scissors-1 pair • Hemostats or cord clamps-3 • Umbilical tape/sterile cord • Small rubber bulb syringe • Towels-5

  23. Equipment • 1 dozen 2” x 10” gauze sponges • Rubber gloves • Baby blanket-1 • Sanitary napkins • Plastic bag

  24. Delivering The Baby Position and support • Flat, sturdy surface • Lie with knees drawn up and spread apart • Elevate buttocks with blankets

  25. 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

  26. 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

  27. Delivering the Head • Umbilical cord around neck? • Slip over shoulder • Clamp and cut it

  28. Delivering the Body • Support head and body • Grasp feet • Support with both hands • Baby will be slippery • Do not squeeze neck or chest

  29. 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

  30. Initial care of the baby • Wrap in blanket • Warm prior if possible • Leave only face expose • If not breathing, perform CPR

  31. Cutting the Umbilical cord • Clamp with two clamps • Four fingers width from the baby • Two to six inches apart • Cut between clamps

  32. Apgar score • 1 and 5 minutes • Healthy baby will score 10 • Five areas

  33. 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

  34. 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

  35. 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!

  36. Click for Video

  37. Resuscitation of Newborn • Assessing the baby • Respirations • Pulse • Artificial Ventilation • Use BVM • 40- 60 breaths per minute

  38. 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

  39. Abnormal Deliveries Prolapsed umbilical cord • Cord comes out before baby • Do not replace! • Danger: Decreased O2 to the baby

  40. 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

  41. Breech Delivery • Presenting part - buttocks or feet • Treatment • Position and drape mother • Allow buttocks and feet to deliver • Support legs and trunk

  42. 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

  43. Limb Presentation • Presenting part single arm, leg, or foot • Cannot successfully deliver in the field

  44. Treatment • Give mother O2 • Place mother on back, head lower than pelvis • Cover with sterile towel • Transport

  45. Multiple Births • 1st baby is small • Abdomen still large • Contractions about 10 minutes after first baby

  46. Treatment • Cut cord on first baby • Follow normal delivery procedures • May be considered premature

  47. 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

  48. 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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