Transcript Childbirth

Obstetrics and Gynecological
Emergencies
Chapter 17
Topic Overview
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Reproductive Anatomy
Normal Delivery
Care/Resuscitation of Newborn
Abnormal deliveries
Predelivery emergencies
Gynecologic emergencies
Anatomy
Childbirth
• Terms & Definitions
– Crowning
• When the presenting part of the baby first
bulges from the vaginal opening
– Cephalic presentation - Head first
– Breech presentation
• Limb
• Frank
LABOR
• First Stage
• Begins with regular contractions, then thinning and
gradual dilation of the cervix and ends when the
cervix if fully dilated
• Second Stage
• Begins when the baby’s head enters the birth canal
until the baby is born
• Third Stage
• Following the birth of the baby until the placenta is
delivered
Your Role
• Materials Needed
– Need OB kit (if available)
– Gloves
– Towels and drapes
– 4 x 4s
– Bulb syringe
– Umbilical tape or clamps
– Scissors or scalpel for cutting the cord
Childbirth
– A baby blanket
– Several sanitary napkins
– Plastic bag
– Standard BSI precautions
Childbirth Delivery Kit
Normal Delivery
• Transport Decision (911 Call)
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Based on evaluation
Number of prior births
Distance to hospital or birthing center
Complications expected
• Delivery Precautions
– Use of BSI
– Keep mother out of bathroom
– Do not hold mother’s knees together
Childbirth
• Evaluating the Mother
– Patient name, age
– Which pregnancy?
– Gravida, Para and AB
– How long in labor
– Ask the patient if she feels the need to move
her bowels
– Check for Crowning**
– Time uterine contractions
Childbirth
– Vital signs if time allows
– Remember if this first baby and crowing or
urge to push is not present then transport can
be effect
– DO NOT LET MOTHER GO TO THE
BATHROOM
Childbirth
• Preparing for Delivery
– Control the scene
– BSI
– Position the patient
– Remove clothing that
can obstruct view of
delivery
– Create a sterile field
– Position OB kit or
available materials
Childbirth
The Delivery
Crowning of Infant’s Head
Delivery of Head - Prevent
Explosive Delivery
Delivery of the Head
Delivery Procedures
• If amniotic sac has not broken,
puncture sac and pull away
from baby's face.
• Determine if umbilical cord is
around baby’s neck. If so,
clamp and cut cord.
• Suction mouth, then
nose
• Aid in birth of upper
shoulder
• Support the trunk
• Support the legs
Childbirth
• Delivery Procedures
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Wipe blood, mucus from nose and mouth
Suction
Warmth is critical!
Wrap baby in warm towel, head lower than
trunk
– Keep infant level with vagina until cord is cut
• Clamp or tie cord;
then cut
• Evaluate baby
• Observe for
delivery of
placenta
• When placneta
delivers, place in a
plastic bag for
transport to hospital
Childbirth
– After Delivery Procedures
• Control vaginal bleeding after delivery
– DO PLACE ANYTHING IN THE VAGINA
– Place a sanitary napkin over the vaginal opening
– Have mother lower her legs
• **Massage the fundus
• **Nursing the baby can help the uterus contract and
return to normal
– Record time of delivery
Childbirth
• Vaginal Bleeding
– A loss of 55 cc is well tolerated.
– Treat for shock
Care of Newborn
• Position, dry, wipe, wrap
• Repeat clearing airway (suction)
• Cover the head
Normal Assessment
Findings Newborn
A=
P=
G=
A=
R=
Appearance
Pulse
Grimace
Activity
Respiratory
effort
Color: No central cyanosis
Greater than 100/min.
Vigorous & crying
Good extremity motion
Normal, crying
Childbirth
Sign
0
Appearance Blue/Pale
(Skin Color)
Pulse Rate Absent
1
Body Pink Completely
Extremities pink
Blue
Below 100 Above 100
Grimace
No
Grimaces
Response
Activity
Limp
Respiratory Absent
2
Cries
Some
Active
flexion of
motion
extremities
Slow and
Strong Cry
irregular
Total Score
Resuscitation
of the Newborn
Inverted Pyramid of Neonatal Resuscitation
Drying. Warming. Positioning.
Suction. Tactile Stimulation.
Oxygen
Bag-Mask Ventilation
Chest
Compressions
Intubation
Medications
Breathing Effort
 If shallow, slow, or absent:
• Provide artificial ventilations,
40-60/minute.
• Reassess after 30 seconds.
• Continue as necessary.
Heart Rate
 If less than 100/minute:
• Provide artificial ventilations,
40-60/minute.
• Reassess after 30 seconds.
• If no improvement, continue
ventilations.
(Continued)
Heart Rate
 If less than 60-80/minute and
not responding to ventilation:
• Start chest compressions.
(Continued)
Heart Rate
If at any time the heart rate is less
than 60, begin ventilations and
compressions immediately.
Color
If central (trunk) cyanosis is
present with adequate breathing
and heart rate, administer
blow-by oxygen.
Childbirth
Complications / Abnormal
Deliveries
Complications
• Supine Hypotensive Syndrome
– The weight of the baby, placenta and
amniotic fluid can compress the vena cava
– Care
• Place mother on lateral left side
Complications
• Breach Birth
– Baby’s buttocks or lower extremities
presenting
• Greater risk of trauma, prolapsed cord
– Care
• Never pull on the babies legs
• High flow oxygen
• Place mother in head-down position with hips
elevated
Complications
– If body delivers support the body and
prevent an explosive delivery of the head
– If necessary to create an airway, place two
fingers of gloved hand into vagina making
a “V” with your fingers to create an airway.
Hope position until EMS arrives or baby
delivers
Complications
• Prolapsed Umbilical Cord
– Mother in head down and buttocks up
(kneeling with buttocks up)
– High flow oxygen
– Check cord for a pulse
– Wrap the cord in a towel to keep warm
– Insert gloved fingers in the vaginal and
pressure gently on the babies head or
buttocks to take pressure off the cord
Complications
• Limb Presentation
– High flow oxygen
– Do Not pull on the baby
Complications
• Multiple Births
– Delivery procedures the same for each
birth
• Prepare for multiple resuscitations
– Clamp the cord of the first baby
– 2nd baby may be born before or after the
placenta
– Care for first infant
– Maintain body temperature of the infants
Complications
• Premature Birth
– Keep baby WARM
– Keep airway clear
– Provide ventilation (BVM) and
chest compressions as needed
– Watch the umbilical cord for
bleeding
– Oxygen using blow by method
– Avoid contamination, Do Not
breath into the face of the baby
Complications
• Pre-birth bleeding
– If you have any pre-birth bleeding place a
pad at the opening of the vagina
– Save any tissue which is passed
• Meconium
– Green or brown amniotic fluid indicates
presence of fecal matter
– Suggests fetal distress during labor
Complications
• Pre-Eclampsia
– High blood pressure and swelling of the
extremities
– The pregnant female needs to be
monitored closely
• Eclampsia
– Seizures during pregnancy
– Seizures are a dire emergency
– Mother should be transported by EMS
– Administer high-flow oxygen
Complications
• Fetal tissue goes to hospital
– Provide emotional support for mother
Complications
• Miscarriage (Spontaneous Abortion)
– Complete patient assessment
– treatment based on assessment
– 911 (Save all tissue expelled)
– Vital Signs
– Treat for shock
– Place a napkin over the vaginal opening
– Replace all blood soaked pads and keep
– Emotional support for the patient
Obstetrics and Gynecological
Emergencies
Trauma In Pregnancy- Patient Assessment
– Pulse will be 10-15 beats higher
– A pregnant female has 30-35% more blood
so signs of shock will be delayed
– Ask patient about any blows to the back,
pelvis or abdomen
– Ask if the patient is bleeding or has any
discharge (water has broken)
Obstetrics and Gynecological
Emergencies
Treatment for Pregnant Trauma Patient
– High flow oxygen
– Be ready to suction due due to nausea and
possible vomiting
– Activate EMS
– Provide emotional support
Gynecological Emergencies
Gynecological Emergencies
Vaginal Bleeding
Can be potentially life-threatening
– Follow BSI precautions
– Assure airway
– Assess and treat for shock
– Provide oxygen
– Activate EMS if bleeding is severe
Gynecological Emergencies
Trauma to the External Genitalia
– Scene size up and look at the mechanism
of injury
– During initial assessment look for signs of
shock
– Treat like any soft-tissue injury
• Control bleeding with direct pressure
• Never pack vagina
– If signs of shock high flow O2
Gynecological Emergencies
Sexual Assault
– Treat scene as a crime scene
– Complete patient assessment and care
• Take care not to destroy evidence on the scene
• Activate EMS
– Provide comfort for the patient
– Non-judgemental attitude
– Psychological care required
Gynecological Emergencies
Sexual Assault
– Preserve potential evidence
– Discourage patient from bathing, voiding
Review Questions
• Describe the anatomy of the reproductive
system
• List the items you will need in a childbirth
kit
• What factors will determine whether 911
should transport or deliver at scene
Review Questions
• Describe the normal delivery process
• Describe the APGAR scoring system
• Describe the following, and the care for
each:
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Limb presentation
Prolapsed cord
Breech presentation
Meconium