OB GYN PDF - Obstetric Emergencies

OB/GYN Responsoft EMS Protocols OB/GYN Page 41 OB/GYN 10/13/2020 Abnormal Deliveries OB/GYN Universal Patient Assessment Oxygen 10 - 15 LPM NRB Mask Childbirth Procedure OB/GYN Prolapsed Cord: An umbilical cord that comes out of the uterus ahead of the fetus. Breech Delivery: A delivery...

OB/GYN Responsoft EMS Protocols OB/GYN Page 41 OB/GYN 10/13/2020 Abnormal Deliveries OB/GYN Universal Patient Assessment Oxygen 10 - 15 LPM NRB Mask Childbirth Procedure OB/GYN Prolapsed Cord: An umbilical cord that comes out of the uterus ahead of the fetus. Breech Delivery: A delivery presenting the feet or the buttocks. Multiple Births: More than one fetus. Meconium Delivery: The first fetal stools in the amniotic fluid. Prolapsed Cord Breech Delivery Meconium Delivery Call for ALS upon recognition. Place mother in head down position with hips elevated Position mother with head down and buttocks elevated. Immediate and rapid transport, notify receiving facility ASAP Insert one gloved hand into the vagina, following the cord as far as possible and gently push baby’s presenting part off of the cord. Make sure to explain this procedure to patient. IV/IO IV/IO If delivery progressing, support legs and buttocks, then assist with delivery of the head If head does not deliver in 4-6 minutes, insert gloved hand into vagina and create an airway for the infant Transport while maintaining this position. Call for ALS upon recognition Do not stimulate before suctioning mouth. Suction mouth then nose with bulb syringe. Maintain airway, Transport as soon as possible. IV/IO Multiple Births: Make sure you have adequate manpower available. Be prepared for more than one (1) resuscitation. Consideration of one (1) ALS unit per infant. Follow appropriate delivery algorithm, based upon scenario. Responsoft EMS Protocols **Amniotic fluid any color other than clear may indicate fetal distress** Page 42 Signs/Notes: Thick = pea soup Common in late birth deliveries More common in low birth weight deliveries 10/13/2020 Childbirth/Labor OB/GYN Three stages of labor: First Stage: Onset of contractions with progressive changes in cervix. Second Stage: Labor begins and fully dilated. Ends with birth. Third Stage: Separation and delivery of placenta. Obstetrical EmergenciesVaginal Bleeding Universal Patient Assessment Have mother lie in preferred birthing position. Yes OB/GYN How far along in the pregnancy is the patient? Time contractions. Was there prenatal care? Has the patient’s water broken? Is there any blood? Has crowning began yet? Is there any other presentation of the fetus? Note: Up to 500 ml blood loss during delivery is normal and well tolerated by the mother. Abnormal vaginal bleeding? No Yes Inspect perineum (No digital vaginal exam) No crowning Crowning Priority symptoms Crowning, patient needs to push. See Abnormal Deliveries Monitor and reassess Document frequency and duration of contractions IV/IO IV/IO Rapid Transport Childbirth Childbirth Procedure Vaginal Bleeding after Delivery Oxygen should be administered to maintain SpO2 >94% If brisk bleeding continues, massage “knead” the uterus over the lower abdomen above the pubis with firm pressure. PREGNANT PEDIATRIC PATIENTS All pediatric patients that are obviously pregnant, or, who have verified their pregnancy will be transported to the nearest hospital with an Obstetrical Unit. If traumatic injuries are involved, then transport to a Trauma Center is indicated. SM Nationwide Children’s Hospital is not equipped to deliver babies. Responsoft EMS Protocols Page 43 If bleeding continues, evaluate massage technique, position for shock. Cardiac Monitor if hemodynamically unstable 10/13/2020 OB/GYN Obstetric Emergencies-Eclampsia Eclampsia: New onset of grand Mal seizure or unexplained coma during pregnancy. Universal Patient Assessment IV/IO IV/IO Cardiac Monitor Vaginal bleeding / Abdominal pain? Seizure (Eclampsia/Toxemia) Assessment and history of pregnancy OB/GYN ECLAMPSIA/TOXEMIA Definition: Toxemia: is the presence of any combination of the following after the 20th week of pregnancy. Can occur for up to 2 weeks post delivery. A. Total body edema B. Hypertension: BP systolic > 140 mmHg, BP diastolic > 90 mmHg or a change in the diastolic pressure > 15 mmHg from antenatal pressure. C. Seizures after the 6th month of pregnancy Eclampsia: is the presence of toxemia plus seizures. Protect patient from seizure activity Suction secretions as needed, transport in left lateral decubitus position Adult Airway Protocol Midazolam (Versed) Versed 2 mg IVP, IO 5 mg IN This dose may be repeated in 5 minutes, if hypotension does not occur and Magnesium Sulfate Sulfate Magnesium 4 gm in 100 ml IV Infusion 0.9% NS, Infuse over 20 - 30 minutes (200 ml/hr) If unable to obtain IV or IO access in a patient with eclampsia you may give Magnesium 10 g IM in two divided 5 g injections with a 3” 20 gauge needle in each buttock. This should only be done if no other access available Stop infusion if hypotension develops, difficulty breathing, decreased deep tendon reflexes or paralysis. Responsoft EMS Protocols Page 44 10/13/2020 OB/GYN Obstetric Emergencies-Vaginal Bleeding Pregnancy complications can occur for several reasons, including; trauma, and preexisting health problems, ex. diabetes, hypertension, and heart disease to name a few. Universal Patient Assessment IV/IO IV/IO Large bore IV Titrate to keep BP > 90 systolic Cardiac Monitor if hemodynamically unstable Oxygen 10 - 15 LPM via NRB Mask Obtain history of pregnancy and estimate amount of bleeding Consider performing orthostatic vital signs Miscarriage < 20 weeks OB/GYN Vaginal Bleeding during Pregnancy: < 20 Weeks (Miscarriage) Miscarriage – Termination of pregnancy before fetus is viable. > 20 Weeks (abruption or Placenta Previa) AbruptionPremature separation of the placenta from the wall of the uterus Placenta Previa- Attachment of the placenta very low in the uterus that completely or part covers the internal cervical opening. Abruption or Placenta Previa > 20 weeks Control bleeding Do not insert packing into vagina Apply external vaginal pads Elevate hips of patient Bring any fetal tissues to hospital. Do not remove anything from the vaginal area. Transport immediately to OB hospital Transport to appropriate facility, on left side. Consider second IV enroute if patient unstable Responsoft EMS Protocols Page 45 10/13/2020 Sexual Assault OB/GYN Sexual assault is sexual contact without the consent of the person assaulted. Unless victim has life threatening injuries, verbally obtain permission to treat before you begin. ALL alleged or suspected sexual assaults must be reported to police. OB/GYN The victim of a sexual assault may display many different emotions. Approach the victim calmly. Universal Patient Assessment ABC’s, assess and treat injuries as usual Protect crime scene. Remove only clothing necessary to assess and treat injuries; then give to law enforcement. Examine genitalia only if profusely bleeding Discourage patient from bathing, douching, changing clothes, voiding, combing hair or cleaning nails. Clean only wounds that are necessary. Transport to a hospital designated as a Rape Crisis Center if possible. Responsoft EMS Protocols Page 46 10/13/2020