Chapter 17 Obstetrics and Gynecological Emergencies.

Chapter 17

Obstetrics and Gynecological Emergencies

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Chapter 17: Obstetrics and Gynecological Emergencies

• Identify the following structures: uterus, vagina, fetus, placenta, umbilical cord, amniotic sac, perineum.

• Identify and explain the use of the contents of an obstetrics kit.

• Identify predelivery emergencies.

• State indicators of imminent delivery.

Objectives (1 of 3)

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• Differentiate the emergency medical care provided to a patient with predelivery emergencies from a normal delivery.

• Establish the relationship between body substance isolation and childbirth.

• State the steps to assist in the delivery.

Objectives (2 of 3)

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• Describe how and when to cut the umbilical cord.

• Discuss the emergency medical care of a patient with a gynecological emergency.

Objectives (3 of 3)

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Female Reproductive System

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Three Stages of Labor

• First stage

– Dilation of the cervix

• Second stage

– Expulsion of the infant

• Third stage

– Delivery of the placenta

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Predelivery Emergencies• Preeclampsia (hypertension)

– Headache, vision disturbance, edema, anxiety

• Eclampsia

– Convulsions resulting from hypertension

• Supine hypotensive syndrome

– Low blood pressure from lying supine

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Hemorrhage

• Vaginal bleeding that occurs before labor begins

• If present in early pregnancy, it may be a spontaneous abortion or ectopic pregnancy.

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Ectopic Pregnancy

• Pregnancy outside of the uterus

• Occurs once in every 200 pregnancies.

• Consider with a missed menstrual cycle and sudden, severe abdominal pain.

• History of PID, tubal ligation, or previous ectopic pregnancy

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Placenta Problems• Placenta abruptio

– Premature separation of the placenta

• Placenta previa– Development of

placenta over the cervix

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Trauma and Bleeding• Any vaginal bleeding with pregnancy is a serious

sign.

• Save all blood-soaked pads and any passed tissue.

• Do not insert pads into the vagina.

• Transport promptly with woman on her left side.

• Signs of shock can be delayed, but the fetus may be in trouble.

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When to Consider Field Delivery

• Delivery can be expected within a few minutes

• A natural disaster or other catastrophe makes it impossible to reach a hospital

• No transportation is available

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Crowning

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Preparing for Delivery

• Use proper BSI precautions.

• Be calm and reassuring while protecting the mother’s modesty.

• Contact medical control for a decision to deliver on scene or transport.

• Prepare OB kit.

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Positioning for Delivery

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Delivering the Infant (1 of 2)

• Support the head as it emerges, suction the mouth than nose.

• Check for nuchal cord, cut if necessary.

• Once the head emerges, the shoulders will be visible.

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Delivering the Infant (2 of 2)

• Support the head and upper body as the shoulders deliver.

• Handle the infant firmly but gently as the body delivers.

• Clamp the cord and cut it.

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Complications with Normal Vaginal Delivery

• Unruptured amniotic sac

– Puncture the sac and push it away from the baby.

• Umbilical cord around the neck (nuchal cord)

– Gently slip the cord over the infant’s head.

– Cut cord if necessary.

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Postdelivery 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 if not done already.

• Ensure the infant is pink and breathing well.

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Delivery of the Placenta

• Placenta is attached to the end of the umbilical cord.

• It should deliver within 30 minutes.• Once the placenta delivers, wrap it and

take it to the hospital so it can be examined.

• If the mother continues to bleed, transport promptly to the hospital.

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APGAR Scoring(0 to 10)

A Appearance

P Pulse

G Grimace

A Activity

R Respirations

• Scored at 1 and 5 minutes after birth

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Neonatal Resuscitation

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Giving Chest Compressions to an Infant (1 of 2)

• Find the proper position

– Just below the nipple line

– Middle third of the sternum

• Wrap your hands around the body, with your thumbs resting at that position.

• Press your thumbs gently against the sternum, compressing ½” to ¾” deep.

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Giving Chest Compressions to an Infant (2 of 2)

• Ventilate with a BVM device after every third compression.

• 90 compressions to 30 ventilations per minute

• Continue CPR while awaiting transport.

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Breech Delivery• Presenting part is the buttocks.

• Breech delivery is usually slow, giving you time to arrange for transport to the hospital.

• Support the infant as it comes out.

• Make a “V” with your gloved fingers then place them in the vagina to prevent it from compressing infant’s airway.

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Rare Presentations• Limb presentation

– This is a very rare occurrence.– This is a true emergency that requires

immediate transport.• Prolapsed cord

– Arrange for immediate transport.– Place fingers into the mother’s vagina and

push the cord away from the infant’s face.

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Excessive Bleeding

• Bleeding always occurs with delivery but should not exceed 500 mL.

• Massage the mother’s uterus to slow bleeding.

• Treat for shock.

• Place pad over vaginal opening.

• Arrange for immediate transport to hospital.

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Spontaneous Abortion (Miscarriage)

• Delivery of the fetus or placenta before the 20th week

• Infection and bleeding are the most important complications.

• Treat the mother for shock.• Arrange for immediate transport.• Bring tissue that has passed through the

vagina to the hospital.

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Twins

• Twins are usually smaller than single infants.

• Delivery procedures are the same as that for single infants.

• There may be one or two placentas to deliver.

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Premature Infants and Procedures

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

– Keep the infant warm.

– Keep the mouth and nose clear of mucus.

– Give oxygen.

– Do not infect the infant.

– Notify EMS.

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Fetal Demise• An infant that has died in the uterus before

labor

• This is a very emotional situation for family and providers.

• The infant may be born with skin blisters, skin sloughing, and dark discoloration.

• Do not attempt to resuscitate an obviously dead infant.

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Delivery Without Sterile Supplies

• 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.

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Gynecologic Emergencies

• Soft-tissue injuries can be painful and bleed profusely.

• Treat as other soft-tissue injuries, and never insert dressing into the vagina.

• Have a second rescuer present, preferably female, when treating such emergencies.

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Stresses and Pregnancy• More women are now active well into the

third trimester of pregnancy.

• Environmental conditions can increase risks to mother and fetus.

– Altitude

– Diving

– Temperature and humidity

Chapter 17 Obstetrics and Gynecological Emergencies.

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