Obstetrics/Gynecology. Female Reproductive System.
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Transcript of Obstetrics/Gynecology. Female Reproductive System.
Obstetrics/Gynecology
Female Reproductive System
Anatomy/Physiology Terminology Uterus
Organ in which the fetus grows, located in the mother’s lower abdomen.
Birth CanalVagina and lower part of the uterus
CervixLower part of the uterus that opens during labor to
allow baby to pass into the birth canal Vagina
Lower part of the birth canal Ovaries
Produce ova (eggs) for conception
PerineumArea of skin and muscle between a women’s vagina
and anus
Female Reproductive CycleFemale Reproductive Cycle Menstruation
Stimulated by estrogen and progesterone Ovaries release ovum Uterus walls thicken Fallopian tubes move egg (peristalsis) Uterine walls expelled (bleeding 3–5 days)
Fertilization Sperm reaches ovum Ovum becomes embryo Embryo implants in uterus Fetal stage begins
Anatomy/Physiology Terminology
FetusDeveloping unborn baby
Placenta (afterbirth)Disk-like organ through which baby exchanges waste
products and nourishment during pregnancy Amniotic Sac (bag of waters)
Sac that completely encases baby inside the uterus. Amniotic fluid should be clear.
Fetal Development Umbilical Cord
Rope-like structure, 20” long that acts as a “pipeline” between baby and placenta
Contains 2 arteries and 1 vein
Labor Contraction of uterine muscles which push the baby into the birth canal
Presenting Part Part of the baby which comes through the birth canal first
270 Days Length of average pregnancy – about 40 weeks
Labor and Delivery Dilation
Stretching or opening
EffacementThinning of the
cervix to allow passage of the fetus into the birth canal
CrowningThe appearance of the baby’s head at the
vaginal opening
Labor and Delivery Primigravida
Woman who is pregnant for the first time Multigravida
Woman who has been pregnant more than once Primipara
Woman who has delivered one viable (over 20 weeks) infant Multipara
Woman who has delivered more than one viable infant
Labor and Delivery
LighteningSensation of the fetus moving from high in the
abdomen to low in the birth canal. Braxton Hicks
Irregular pre-labor contractions of the uterus.
Three Stages of Labor First Stage
The time from the first uterine contraction until the cervix is fully dilated (open). Amniotic sac breaks. The time between contractions is measured from the end of one contraction until the beginning of the next.
Second StageFull dilation (10 centimeters) of the cervix to birth of
the baby, decision to transport or not
Third StageBirth of the baby to delivery of placenta. Wait 20
minutes before transport, save all tissues, record mother’s name and time of birth
Cephalic birthHead comes through the birth canal first“normal” birth. This accounts for most of deliveries
that an EMT will assist withFontanelles “soft spot” – facilitate the birth
Evaluation of Mother History
When was your last normal menstrual period (LNMP)?Abdominal pain? (location/quality)Vaginal bleeding/discharge? Is there a possibility you might be pregnant?
Missed period?Nausea/vomitingIncreased urinary frequencyBreast enlargementVaginal discharge
3 Signs of Eminent Delivery
Water BrokeBloody show
Mucus plug
Bowel movement Crowning
History If pregnant:
Para = # of live birthsGravida = # of pregnancies-3 /+ 7 to estimate due dateSubtract 3 from the month of the LNMPAdd 7 to the date of the LNMPLNMP - 12/9/98Due date - 9/16/99
Normal Delivery1. Place mom on firm surface. Leave at least 12”
from the end of the bed (room to lay baby after delivery)
2. Place clean sheet, blanket or newspaper under mother’s buttock
Normal Delivery3. Drape mom if materials are present
4. When the baby’s head appears, place fingers gently around the head and exert SLIGHT pressure to prevent explosive delivery
Normal Delivery5. Check for the umbilical cord around the neck
after the head appears.
6. Slip cord over baby’s head if wound around neck. If it cannot be slid off the neck, clamp the cord and immediately cut the cord.
7. Continue to support the head but do not pull
8. Be prepared to use a bulb syringe to suction the infant. Suction the mouth first, then the nose.
Normal Delivery9. Place the other hand under baby’s body as it is
born
10. To stimulate the baby to breath you should gently rub its back or tap the soles of its feet.
VernixWhite, cheese-like film that covers the baby to separate it
from the amniotic fluid. May be present at birth
11. When providing oxygen to a newborn, the EMT should deliver the oxygen into the top of an aluminum foil tent placed over the baby’s head
12. If necessary, lower baby’s head to facilitate delivery of upper shoulders and guide head upward to deliver lower shoulder
13. Place the baby at or below the level of the mother’s vagina. Hold baby in head down position to facilitate drainage of blood and mucous
14. Clamp the cord 10” from baby and then 7” away from the baby. When the umbilical cord stops throbbing, cut the cord between the two clamps. If bleeding from the umbilical cord continues, apply another clamp as close to the original one as possible.
Normal Delivery15. Keep the baby warm. Preventing heat loss is a major
concern.
16. Observe mom for delivery of the placenta. Do not wait for delivery of afterbirth to transport. It can take more than 30 minutes to deliver.
17. If there is excessive bleeding following normal delivery you should:
Massage the uterus Place the woman in the shock position Give oxygen
Normal Delivery18. When delivered wrap placenta in newspaper or
place in a container and take to the hospital with patient so the hospital staff can determine if it has been completely expelled.
19. Transport. If possible the newborn should be transported in an approved safety seat.
Infant Assessment
A – appearance (color) P – pulse (heart rate) G – grimace (muscle tone) A – activity (response to flicking soles of feet) R – respiratory effort
An new born’s normal heart rate = 120-160
Infant Assessment If you cannot detect a brachial pulse in a non-
breathing newborn, you should clamp and cut the cord and then begin CPR.
Rate of pulmonary resuscitation in a newborn is 1 breath every 3 seconds.
Ratio of compressions to breaths is 3 to 1 CPR is performed by wrapping your hands around
the chest and placing your thumbs upon the sternum.
Abnormal Deliveries1. Breech Buttocks or both feet of the baby come through the birth
canal first
Abnormal DeliveriesWith Breech Births:
1. Allow butt/trunk delivery, provide support for body, arms, legs.
2. Head will deliver on own accord. If it does not do so within 3 minutes, form a “V” with your fingers (index and middle) on each side of infants nose and maintain airway
3. DO NOT allow EXPLOSIVE delivery
4. DO NOT pull the baby out
Abnormal Deliveries2. Prolapsed Umbilical Cord When the umbilical cord presents first This is dangerous because it may compress the
cord cutting off circulation1. Elevate hips – shock position
2. Administer oxygen
3. Wrap cord in sterile, moist dressing (or towel)
4. Transport ASAP
Abnormal Deliveries2. Prolapsed Umbilical Cord (cont.)
5. MAINTAIN GENTLE PRESSURE ON BABY’S HEAD, BUT DO NOT PUSH CORD BACK IN
6. Form “V” with fingers (index & middle) on each side of the umbilical cord and gently press to take pressure off the cord.
Abnormal Deliveries3. Limb Presentation
1. Transport ASAP!!!! True Emergency
2. Only a doctor can deliver or treat this
Complications of Pregnancy and During
Delivery
Ectopic PregnancyAny pregnancy occurring
outside the uterus Placenta Previa
Implantation of placenta over cervical opening
Will not allow for normal delivery.
Cause of excessive pre-birth bleeding
Gestational Diabetes Eclampsia (toxemia of pregnancy)
Abnormal body reaction to pregnancy, resulting in convulsions, possible coma
Supine hypotensive syndromeThis occurs when the mother lies flat on her back and
the uterus, fetus, and placenta compress the inferior vena cava.
Deoxygenated blood to the heart is impaired and the blood pressure drops.
Place mother on her left side and treat for shock Abrupito Placenta
Condition in which the placenta separates from the uterine wall; a cause of pre-birth bleeding
Ruptured uterus Tearing sensation in the abdomen caused by previous cesarean
section, weakened uterine wall, baby too large for pelvis extended labor.
Severe pain, nausea, shock symptoms, minimal bleeding
Multiple births If the mothers abdomen remains unusually large after delivery,
you should prepare for multiple births
Meconium A baby’s first bowel movement. Stains amniotic fluid greenish
or brownish-yellow in color Can be toxic to baby if breathed into the lungs Sign of fetal or maternal distress
Complications
1. Cord around the neck – nuchal cord
2. Unbroken amniotic sac
3. Hypo/Hypertension
4. Pre-delivery bleeding
5. Drug dependency
6. 5 blood soaked pads after delivery is an EMERGENCY
Pre-Delivery Emergencies Excessive Pre-birth bleeding
Treat for shockDo Not hold legs together – place sanitary napkin on
vaginal opening and transport ASAPReplace pads as necessary, save pads for blood loss,
save the tissues Pre-Eclampsia (Toxemia) “poisoning of the blood”
– swelling of face, hands, feet, high blood pressure, convulsions
Pre-Delivery Emergencies
Ectopic pregnancy Pregnancy outside the uterus. Life threatening and very
painful.May cause a woman to have:
Acute abdominal painRapid/weak pulseSlight vaginal bleedingGo into shock
Pre-Delivery Emergencies
Miscarriage (Spontaneous Abortion) and AbortionStopping the pregnancy either by natural means or by
medical means, before the 28th week.Treat for shock, transport, and save all tissues