Chapter 25 Obstetrics PDF

Slide 0 Slide 1 Slide 2 Chapter 25 Obstetrics and Gynecology Slide 3 Overview  Reproductive Anatomy and Physiology  Labor  Contents of the Childbirth Kit  Predelivery Emergencies  Miscarriage  Seizure During Pregnancy  Vaginal Bleeding Late...

Slide 0 Slide 1 Slide 2 Chapter 25 Obstetrics and Gynecology Slide 3 Overview  Reproductive Anatomy and Physiology  Labor  Contents of the Childbirth Kit  Predelivery Emergencies  Miscarriage  Seizure During Pregnancy  Vaginal Bleeding Late in Pregnancy  Trauma Slide 4 Overview  Normal Delivery  Predelivery Considerations  Precautions  Delivery Procedure  Initial Care of the Newborn  Abnormal Deliveries and Complications  Prolapsed Cord  Breech Presentation  Limb Presentation  Multiple Births  Passage of Meconium  Premature Birth Slide 5 overview  Most deliveries – normal in hospital.  Not all the babies born in any medical facility.  birth is a natural process that usually requires no medical intervention.  In EMT career he may have such kind of emergency that the woman is going to deliver and he is the only person to help. Slide 6 Reproductive Anatomy and Physiology Slide 7 Reproductive Anatomy and Physiology  Uterus  Organ in which a fetus grows  Responsible for labor and expulsion of infant Slide 8 uterus Slide 9 cervix  Neck of uterus containing a mucus plug, it dilates to allow the fetus to pass through it. Slide 10 cervix Slide 11 Birth canal Vagina and lower part of the uterus Slide 12 Vagina  Lower part of the birth canal Slide 13 vagina Slide 14 perineum  Skin between vagina and anus.  Often tears as a result of pressure exerted by the fetus during child birth. Slide 15 Reproductive Anatomy and Physiology Slide 16 Reproductive Anatomy and Physiology  Fetus  Developing unborn baby  Umbilical cord  Cord that is an extension of the placenta through which fetus receives nourishment while in the uterus. Slide 17 placenta Fetal organ through which fetus exchanges nourishment and waste products during pregnancy Slide 18 Amniotic sac ( bag of water) Sac that surrounds the fetus inside the uterus. Contains 1- 2 liter fluid. Ruptures before child birth often described by the patient “my water is broken”. Slide 19 Reproductive Anatomy and Physiology  Fetus at 4 months Slide 20 Labor Slide 21 Labor  The process by which babies are born.  Generally devided into three stages Slide 22 Labor  The three stages of labor Slide 23 First stage  From Regular contraction of the uterus to the fetus enters into the birth canal.  Cervix dilate. (Approximately 10cm dilate) Slide 24 First stage  Mucus and blood may pass through the vagina known as bloody show. Slide 25 Second stage  Starts when fetus enters into birth canal and ends when the baby is born. Slide 26 Second stage  Presenting part  The part of the infant/fetus that comes first—usually the head Slide 27 Second stage  Crowning  Bulging-out of the vagina, which is opening as the fetus’ head or presenting part presses against it  Delivery is imminent if crowning is present Slide 28 Third stage of labor  After delivery of the baby to the delivery of placenta. Slide 29 Third stage  Pain- mother feel pain with each contraction in uterus. And pain goes away as uterus relax.  Father, friend, husband or an EMT must be present to help her breathe regularly during the contractions. So that she didn’t feel a lot of pain.  The time for delivery varies in different woman. Slide 30 Contents of a Childbirth Delivery Kit  Surgical scissors  Hemostats or cord clamps  Umbilical tape or sterilized cord  Bulb syringe  Towels  Gauze sponges (2)  Sterile gloves  One baby blanket  Sanitary napkins  Plastic bag Slide 31 Predelivery Emergencies Slide 32 Predelivery Emergencies  Miscarriage (spontaneous abortion)  Emergency medical care  Size-up  Initial assessment  History and physical exam  Assess baseline vitals  Treatment based on signs and symptoms  Apply external vaginal pads  Bring fetal tissues to hospital  Support mother Slide 33 Predelivery Emergencies  Seizure during pregnancy  Emergency medical care  Size-up  Initial assessment  History and physical exam  Assess baseline vitals  Treatment based on signs and symptoms  Transport on left side Slide 34 preclempsia Slide 35 Predelivery Emergencies  Vaginal bleeding late in pregnancy  Late-pregnancy vaginal bleeding, with or without pain  Emergency medical care  Size-up  Initial assessment  History and physical exam  Assess baseline vitals  Treatment based on signs and symptoms  Apply external vaginal pads  Transport Slide 36 Abruptio placenta  Vaginal bleeding with a lot of pain.  Concealed bleeding.  Look for signs of shock. Slide 37 Placenta previa  Pain less vaginal bleeding.  Loss of blood with each contraction of uterus.  Requires cesarean section.  Transport the patient immediately.  Look for the signs of shock. Slide 38 Predelivery Emergencies  Transporting pregnant patients on their left side will reduce the pressure the fetus places on the circulatory system Slide 39 Predelivery Emergencies  Trauma  Emergency medical care  Size-up  Initial assessment  History and physical exam  Assess baseline vitals  Treatment based on signs and symptoms  Transport on left side Slide 40 Normal Delivery  Predelivery considerations  It is best to transport an expectant mother, unless delivery is expected within a few minutes Slide 41 Normal Delivery  Focused history to determine if delivery is imminent  Are you pregnant?  How long have you been pregnant?  What is the due date of delivery?  Are there contractions or pain?  Any bleeding or discharge?  Is crowning occurring with contractions?  What is the frequency and duration of contractions?  Does the patient feel as if she needs to have a bowel movement with increasing pressure in the vaginal area?  Does she feel the need to push?  Rock-hard abdomen? Slide 42 Rectum and baby Slide 43 Normal Delivery  Precautions  Use body substance isolation  Do not touch vaginal areas except during delivery and when your partner is present  Do not let the mother go to bathroom  Do not hold the mother’s legs together  Recognize your own limitations and transport even if delivery must occur during transport Slide 44 Normal Delivery  If delivery is imminent with crowning, contact medical direction for decision to commit to delivery on site. If delivery does not occur within 10 minutes, contact medical direction for permission to transport Slide 45  Normal Delivery  Delivery procedure  Apply gloves, mask, gown, eye protection for infection control precautions  Have mother lie with knees drawn up and spread apart Slide 46 Normal Delivery  Elevate buttocks with blankets or pillow  Create sterile field around vaginal opening with sterile towels or paper barriers Slide 47  Normal Delivery  When the infant’s head appears during crowning, place fingers on bony part of skull (not fontanelle or face) and exert very gentle pressure to prevent explosive delivery and support perineum.  Use caution to avoid fontanelle Slide 48 Normal Delivery  If the amniotic sac does not break or has not broken, use a clamp to puncture the sac and push it away from the infant’s head and mouth as they appear Slide 49 Normal Delivery  As the infant’s head is being born, determine if the umbilical cord is around the infant’s neck; slip over the shoulder or clamp, cut and unwrap Slide 50 Normal Delivery  After the infant’s head is born, support the head, suction the mouth two or three times, and suction the nostrils  Use caution to avoid contact with the back of the mouth Slide 51 Normal Delivery  As the torso and full body are born, support the infant with both hands  As the feet are born, grasp the feet  Wipe blood and mucus from mouth and nose with sterile gauze; suction mouth and nose again Slide 52 Normal Delivery  Wrap infant in a warm blanket and place on its side, head slightly lower than trunk  Keep infant level with vagina until the cord is cut Slide 53 Normal Delivery  Assign partner to monitor the infant and complete assessment of newborn  Clamp the cord and cut between the clamps Slide 54  Normal Delivery  Observe for delivery of placenta while preparing mother and infant for transport  When delivered, wrap placenta in towel and put in plastic bag; transport placenta to hospital with mother Slide 55 Normal Delivery  Place sterile pad over vaginal opening, lower mother’s legs, help her hold them together  Record time of delivery and transport mother, infant, and placenta to hospital  Vaginal bleeding following delivery (up to 500 cc of blood loss) is normal  A 500-cc blood loss is well tolerated by the mother following delivery Slide 56  Normal Delivery  With excessive blood loss, massage the uterus  Hand with fingers fully extended  Place on lower abdomen above pubis  Massage (knead) over area Slide 57 Normal Delivery  If bleeding continues  Check massage technique and transport immediately  Provide oxygen and ongoing assessment  Regardless of estimated blood loss, if mother appears in shock (hypoperfusion), treat as such and transport prior to uterine massage. Massage en route Slide 58 Newborn Resuscitation Slide 59 Initial Care of the Newborn  Position, dry, wipe, and put newborn in blanket, and cover the head  Repeat suctioning  Assessment of infant—normal findings  Appearance—color: no central (trunk) cyanosis  Pulse—greater than 100 beats/min  Grimace—vigorous and crying  Activity—good motion in extremities  Breathing effort—normal, crying Slide 60 APGAR score  1 min and 5 min. w sign o 1 2 A Appearance Blue pale Body pink, pink ( color ) extremities blue. P Pulse( heart rate) absent Below 100 Over 100 G Grimace( irritability) Nothing grimace Cough, sneezing, crying A Activity(muscle tone) limp Some flexion Active motion R Respiration( respiratory absent Slow, irregular Good crying effort) Slide 61 Initial Care of the Newborn  Stimulate newborn if not breathing  Flick soles of feet  Rub infant’s back Slide 62 Newborn Resuscitation  Resuscitation of the newborn follows the inverted pyramid; after assessment, if signs and symptoms require either cardiac or pulmonary resuscitation, follow the steps of the inverted pyramid Slide 63 Newborn Resuscitation  Breathing effort  If shallow, slow, or absent, provide artificial ventilations  60 breaths/min  Reassess after 30 seconds  If no improvement, continue artificial ventilations and reassessments Slide 64  Newborn Resuscitation  Heart rate  If less than 100 beats/min, provide artificial ventilations  60 breaths/min  Reassess after 30 seconds  If no improvement, continue artificial ventilations and reassessments  If less than 80 beats/min and not responding to bag-valve- mask, start chest compressions  If less than 60 beats/min, start compressions and artificial ventilations Slide 65 Newborn Resuscitation  Colour  If central cyanosis is present with spontaneous breathing and an adequate heart rate, administer free-flow oxygen  Administer oxygen (10-15 L/min) using oxygen tubing held as close as possible to the newborn’s face Slide 66 Abnormal Deliveries  Most infants are born in the head-first or cephalic position  Abnormal delivery situations  Prolapsed cord  Breech presentation  Limb presentation  Multiple births  Passage of meconium  Premature birth Slide 67  Abnormal Deliveries— Prolapsed Cord  Condition in which the cord presents through the birth canal before delivery of the head; presents a serious emergency that endangers the life of the unborn fetus  Size-up  Initial assessment  Mother should have high-flow oxygen  History and physical exam  Assess baseline vitals Slide 68  Abnormal Deliveries— Prolapsed Cord  Treatment based on signs and symptoms  Position mother with head down or buttocks raised, using gravity to lessen pressure in birth canal  Insert sterile gloved hand into vagina, pushing the presenting part of the fetus away from the pulsating cord  Rapidly transport, keeping pressure on presenting part and monitoring pulsations in the cord Slide 69  Abnormal Deliveries— Breech Presentation  Breech presentation occurs when the buttocks or lower extremities are low in the uterus and will be delivered first  Newborn is at great risk for delivery trauma; prolapsed cord is more common; transport immediately on recognition of breech presentation  If delivery does not occur within 10 minutes, take precautions to avoid suffocation Slide 70 Abnormal Deliveries— Breech Presentation  Emergency medical care  Immediate rapid transportation on recognition  Place mother on oxygen  Place mother in head-down position with pelvis elevated The infant cannot be delivered in this position. Transport immediately! Slide 71  Abnormal Deliveries— Limb Presentation  Occurs when a limb of the infant protrudes from the birth canal. Is more commonly a foot when infant is in breech presentation  Immediate rapid transportation on recognition  Place mother on oxygen  Place mother in head-down position with pelvis elevated Airway management is vital for these infants. Slide 72 Abnormal Deliveries— Multiple Births  Be prepared for more than one resuscitation  Call for assistance Slide 73 Abnormal Deliveries— Passage of Meconium  Meconium is amniotic fluid that is greenish or brown- yellow rather than clear. The presence of meconium is an indication of possible fetal distress during labor  Do not stimulate infant before suctioning oropharynx  Suction  Maintain airway  Transport as soon as possible Slide 74 Abnormal Deliveries— Premature Birth  Premature birth is defined as delivery at