Janesville FR

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Janesville FR

  1. 1. Obstetrics/Gynecology Emergency Medical Technician - Basic
  2. 2. Female Reproductive System Uterus Cervix Vagina Urinary Bladder Rectum
  3. 3. Female Reproductive System Uterus Vagina Fallopian tube Ovary Cervix
  4. 4. OB/Gyn Assessment <ul><li>History </li></ul><ul><ul><li>When was your last normal menstrual period (LNMP)? </li></ul></ul><ul><ul><li>Abdominal pain? (location/quality) </li></ul></ul><ul><ul><li>Vaginal bleeding/discharge? </li></ul></ul>
  5. 5. OB/Gyn Assessment <ul><li>History </li></ul><ul><ul><li>Is there a possibility you might be pregnant? </li></ul></ul><ul><ul><ul><li>Missed period? </li></ul></ul></ul><ul><ul><ul><li>N/V </li></ul></ul></ul><ul><ul><ul><li>Increased urinary frequency </li></ul></ul></ul><ul><ul><ul><li>Breast enlargement </li></ul></ul></ul><ul><ul><ul><li>Vaginal discharge </li></ul></ul></ul>
  6. 6. OB/Gyn Assessment <ul><li>History </li></ul><ul><ul><li>If pregnant: </li></ul></ul><ul><ul><ul><li>Para = # of live births </li></ul></ul></ul><ul><ul><ul><li>Gravida = # of pregnancies </li></ul></ul></ul><ul><ul><ul><li>-3 /+ 7 to estimate due date </li></ul></ul></ul>Subtract 3 from the month of the LNMP Add 7 to the date of the LNMP LNMP - 12/9/98 Due date - 9/16/99
  7. 7. OB/Gyn Assessment <ul><li>Vital signs </li></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Tilt test if blood loss is suspected </li></ul></ul><ul><li>Focused exam </li></ul><ul><ul><li>Edema (particularly of face, hands) </li></ul></ul>
  8. 8. Gyn Emergencies
  9. 9. Ectopic Pregnancy <ul><li>Zygote implants in location other than uterine cavity </li></ul><ul><li>95% are in Fallopian tube (tubal ectopic) </li></ul><ul><li>Life threatening! </li></ul>
  10. 10. Ectopic Pregnancy <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Missed period, other signs/symptoms of early pregnancy </li></ul></ul><ul><ul><li>Light vaginal bleed (spotting) 6-8 weeks after LNMP </li></ul></ul><ul><ul><li>Abdominal pain, may radiate to shoulder </li></ul></ul><ul><ul><li>Positive “tilt” test </li></ul></ul><ul><ul><li>Other signs/symptoms of hypovolemic shock </li></ul></ul>
  11. 11. Ectopic Pregnancy <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Abdominal pain may be absent </li></ul></ul><ul><ul><li>Some patients may NOT miss period </li></ul></ul><ul><ul><li>Some patients may have NEGATIVE pregnancy tests </li></ul></ul>
  12. 12. Ectopic Pregnancy Lower abdominal pain or unexplained hypovolemic shock in a woman of child-bearing age equals Ectopic Pregnancy Until Proven Otherwise
  13. 13. Ectopic Pregnancy <ul><li>Management </li></ul><ul><ul><li>100% O 2 </li></ul></ul><ul><ul><li>Supportive care for hypovolemic shock </li></ul></ul><ul><ul><li>Transport immediately </li></ul></ul>
  14. 14. Pelvic Inflammatory Disease <ul><li>Acute or chronic infection </li></ul><ul><li>Involves Fallopian tubes, ovaries, uterus, peritoneum </li></ul><ul><li>Most commonly caused by gonorrhea </li></ul><ul><li>Staph, strep, coliform bacteria also cause infections </li></ul>
  15. 15. Pelvic Inflammatory Disease <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Lower abdominal pain </li></ul></ul><ul><ul><li>Gradual onset over 2-3 days, beginning 1-2 weeks after last period </li></ul></ul><ul><ul><li>Fever, chills </li></ul></ul><ul><ul><li>Nausea, vomiting </li></ul></ul><ul><ul><li>Yellow-green vaginal discharge </li></ul></ul><ul><ul><li>Walks bent forward, holding abdomen </li></ul></ul>
  16. 16. Pelvic Inflammatory Disease <ul><li>Management </li></ul><ul><ul><li>High concentration O 2 </li></ul></ul><ul><ul><li>Transport </li></ul></ul>
  17. 17. Spontaneous Abortion <ul><li>“Miscarriage” </li></ul><ul><li>Pregnancy terminates before 20th week </li></ul><ul><li>Usually occurs in first trimester (first three months) </li></ul>
  18. 18. Spontaneous Abortion <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Vaginal bleeding </li></ul></ul><ul><ul><li>Cramping lower abdominal pain or pain in back </li></ul></ul><ul><ul><li>Passage of fetal tissue </li></ul></ul>
  19. 19. Spontaneous Abortion <ul><li>Complications </li></ul><ul><ul><li>Incomplete abortion </li></ul></ul><ul><ul><li>Hypovolemia </li></ul></ul><ul><ul><li>Infection, leading to sepsis </li></ul></ul>
  20. 20. Spontaneous Abortion <ul><li>Management </li></ul><ul><ul><li>High concentration O 2 </li></ul></ul><ul><ul><li>Shock position </li></ul></ul><ul><ul><li>Transport any tissue to hospital </li></ul></ul><ul><ul><li>Provide emotional support </li></ul></ul>
  21. 21. Pre-eclampsia <ul><li>Acute hypertension after 24th week of gestation </li></ul><ul><li>5-7% of pregnancies </li></ul><ul><li>Most often in first pregnancies </li></ul><ul><li>Other risk factors include young mothers, no prenatal care, multiple gestation, lower socioeconomic status </li></ul>
  22. 22. Pre-eclampsia <ul><li>Triad </li></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Proteinuria </li></ul></ul><ul><ul><li>Edema </li></ul></ul>
  23. 23. Pre-eclampsia <ul><li>Sign and Symptoms </li></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><ul><li>Systolic > 140 mm Hg </li></ul></ul></ul><ul><ul><ul><li>Diastolic > 90mm Hg </li></ul></ul></ul><ul><ul><ul><li>Or either reading > 30 mmHg above patient’s normal BP </li></ul></ul></ul><ul><ul><li>Edema (particularly of hands, face) present early in day </li></ul></ul>
  24. 24. Pre-eclampsia <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Rapid weight gain </li></ul></ul><ul><ul><ul><li>>3lbs/wk in 2nd trimester </li></ul></ul></ul><ul><ul><ul><li>>1lb/wk in 3rd trimester </li></ul></ul></ul><ul><ul><li>Decreased urine output </li></ul></ul><ul><ul><li>Headache, blurred vision </li></ul></ul><ul><ul><li>Nausea, vomiting </li></ul></ul><ul><ul><li>Epigastric pain </li></ul></ul><ul><ul><li>Pulmonary edema </li></ul></ul>
  25. 25. Pre-eclampsia <ul><li>Complications </li></ul><ul><ul><li>Eclampsia </li></ul></ul><ul><ul><li>Premature separation of placenta </li></ul></ul><ul><ul><li>Cerebral hemorrhage </li></ul></ul><ul><ul><li>Retinal damage </li></ul></ul><ul><ul><li>Pulmonary edema </li></ul></ul><ul><ul><li>Lower birth weight infants </li></ul></ul>
  26. 26. Pre-eclampsia <ul><li>Management </li></ul><ul><ul><li>100% O 2 </li></ul></ul><ul><ul><li>Left lateral recumbent position </li></ul></ul><ul><ul><li>Avoid excessive stimulation </li></ul></ul><ul><ul><li>Reduce light in patient compartment </li></ul></ul><ul><ul><li>Avoid use of emergency lights, sirens </li></ul></ul>
  27. 27. Eclampsia <ul><li>Gravest form of pregnancy-induced hypertension </li></ul><ul><li>Occurs in less than 1% of pregnancies </li></ul>
  28. 28. Eclampsia <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Signs, symptoms of pre-eclampsia plus: </li></ul></ul><ul><ul><ul><li>Grand mal seizures </li></ul></ul></ul><ul><ul><ul><li>Coma </li></ul></ul></ul>
  29. 29. Eclampsia <ul><li>Complications </li></ul><ul><ul><li>Same as pre-eclampsia </li></ul></ul><ul><ul><li>Maternal mortality rate: 10% </li></ul></ul><ul><ul><li>Fetal mortality rate: 25% </li></ul></ul>
  30. 30. Eclampsia <ul><li>Management </li></ul><ul><ul><li>100% O 2 ; assist ventilations, as needed </li></ul></ul><ul><ul><li>Left lateral recumbent position </li></ul></ul><ul><ul><li>Reduce light </li></ul></ul><ul><ul><li>Manage like any major motor seizure </li></ul></ul><ul><ul><li>Emergency transport </li></ul></ul><ul><ul><li>Consider ALS intercept for anticonvulsant medication administration </li></ul></ul>
  31. 31. Eclampsia <ul><li>Assess every pregnant patient for </li></ul><ul><ul><li>Increased BP </li></ul></ul><ul><ul><li>Edema </li></ul></ul><ul><li>Take all reports of seizures in pregnant females seriously </li></ul>
  32. 32. Abruptio Placentae <ul><li>Premature separation of placenta from uterus </li></ul><ul><li>High risk groups </li></ul><ul><ul><li>Older pregnant patients </li></ul></ul><ul><ul><li>Hypertensives </li></ul></ul><ul><ul><li>Multigravidas </li></ul></ul>
  33. 33. Abruptio Placentae <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Mild to moderate vaginal bleeding </li></ul></ul><ul><ul><li>Continuous, knife-like abdominal pain </li></ul></ul><ul><ul><li>Rigid, tender uterus </li></ul></ul><ul><ul><li>Signs, symptoms of hypovolemia </li></ul></ul>
  34. 34. Abruptio Placentae Third Trimester Abdominal Pain equals Abruptio Placentae until proven otherwise
  35. 35. Abruptio Placentae Hypovolemic shock out of proportion to visible bleeding equals Abruptio Placentae until proven otherwise
  36. 36. Abruptio Placentae <ul><li>Management </li></ul><ul><ul><li>100% O 2 </li></ul></ul><ul><ul><li>Left lateral recumbent position </li></ul></ul><ul><ul><li>Supportive care for hypovolemic shock </li></ul></ul><ul><ul><li>Rapid transport </li></ul></ul>
  37. 37. Placenta Previa <ul><li>Implantation of placenta over cervical opening </li></ul>
  38. 38. Placenta Previa <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Painless, bright-red vaginal bleeding </li></ul></ul><ul><ul><li>Soft, non-tender uterus </li></ul></ul><ul><ul><li>Signs and symptoms of hypovolemia </li></ul></ul>
  39. 39. Placenta Previa <ul><li>Management </li></ul><ul><ul><li>100% O 2 </li></ul></ul><ul><ul><li>Left lateral recumbent position </li></ul></ul><ul><ul><li>Supportive care for hypovolemic shock </li></ul></ul><ul><ul><li>Never perform a vaginal exam on a pt in the 3rd trimester with vaginal bleeding </li></ul></ul>
  40. 40. Placenta Previa A vaginal exam should NEVER be performed on a patient in the 3rd trimester with vaginal bleeding
  41. 41. Uterine Rupture <ul><li>Causes </li></ul><ul><ul><li>Blunt trauma to pregnant uterus </li></ul></ul><ul><ul><li>Prolonged labor against an obstruction </li></ul></ul><ul><ul><li>Labor against weakened uterine wall </li></ul></ul><ul><ul><ul><li>Old Cesarian section scar </li></ul></ul></ul><ul><ul><ul><li>Grand multiparous patients </li></ul></ul></ul>
  42. 42. Uterine Rupture <ul><li>Signs and Symptoms </li></ul><ul><ul><li>“Tearing” abdominal pain </li></ul></ul><ul><ul><li>Severe hypovolemic shock </li></ul></ul><ul><ul><li>Firm, rigid abdomen </li></ul></ul><ul><ul><li>Possible palpation of fetal parts through abdominal wall </li></ul></ul><ul><ul><li>Vaginal bleeding may or may not be present </li></ul></ul>
  43. 43. Uterine Rupture <ul><li>Management </li></ul><ul><ul><li>100% O 2 </li></ul></ul><ul><ul><li>Anticipate shock </li></ul></ul><ul><ul><li>ALS/helicopter intercept </li></ul></ul>
  44. 44. Emergency Childbirth
  45. 45. Developing Fetus Placenta Amniotic Sac “Bag of waters” Umbilical cord Fetus
  46. 46. Labor <ul><li>1st stage: Onset of contractions to dilation of cervix </li></ul><ul><li>2nd stage: Complete dilation of cervix to delivery of baby </li></ul><ul><li>3rd stage: Delivery of baby to delivery of placenta </li></ul>
  47. 47. Signs of Imminent Delivery <ul><li>Crowning </li></ul><ul><li>Rupture of Amniotic Sac </li></ul><ul><li>Need to bear down </li></ul><ul><li>Sensation of needing to move bowels </li></ul><ul><li>Contractions </li></ul><ul><ul><li>1 to 2 minutes apart </li></ul></ul><ul><ul><li>Regular </li></ul></ul><ul><ul><li>Lasting 45 to 60 seconds </li></ul></ul>
  48. 48. Delivery <ul><li>Place gloved hand on presenting part to prevent “explosive” delivery </li></ul><ul><li>On delivery of head, suction mouth then nose </li></ul>
  49. 49. Delivery <ul><li>Gently guide baby’s head down to deliver upper shoulder </li></ul><ul><li>Gently guide baby’s head up to deliver lower shoulder </li></ul><ul><li>Gently assist with delivery of rest of baby; Do NOT pull </li></ul><ul><li>Note time of delivery of baby </li></ul>
  50. 50. Delivery <ul><li>Control slippery baby during delivery </li></ul><ul><ul><li>Support head, shoulders, feet </li></ul></ul><ul><ul><li>Keep head lower then feet to facilitate drainage of secretions from mouth </li></ul></ul><ul><li>Dry baby </li></ul><ul><li>Keep baby warm </li></ul>
  51. 51. Delivery <ul><li>Clamp, cut cord </li></ul><ul><ul><li>First clamp about 4” from baby </li></ul></ul><ul><ul><li>Second clamp 2” further away from first </li></ul></ul><ul><ul><li>Cut between clamps </li></ul></ul><ul><ul><li>Use umbilical tape to control any bleeding from cord </li></ul></ul>
  52. 52. Delivery <ul><li>Flick baby’s feet, rub back to stimulate </li></ul><ul><li>Do NOT shake infant </li></ul><ul><li>Do NOT slap buttocks </li></ul><ul><li>“Blow by” O 2 if: </li></ul><ul><ul><li>Heart rate < 100 </li></ul></ul><ul><ul><li>Persistent central cyanosis present </li></ul></ul><ul><li>Resuscitate if necessary </li></ul>
  53. 53. Delivery <ul><li>“Deliver” Placenta </li></ul><ul><ul><li>Place placenta in plastic bag and deliver to hospital to be examined for completeness </li></ul></ul><ul><ul><li>If placenta does not deliver within 10 minutes, transport </li></ul></ul>
  54. 54. APGAR Score <ul><li>Developed by Virginia Apgar </li></ul><ul><li>Quick evaluation of infant’s pulmonary, cardiovascular, neurological function </li></ul><ul><li>Useful in identifying infant’s needing resuscitation </li></ul>
  55. 56. APGAR Score Determine at 1 and 5 minutes postpartum!
  56. 57. Maternal Care: Postpartum <ul><li>Bleeding </li></ul><ul><ul><li>Place sterile pad over vaginal opening </li></ul></ul><ul><ul><li>If bleeding is excessive: </li></ul></ul><ul><ul><ul><li>Rapidly transport to hospital </li></ul></ul></ul><ul><ul><ul><li>Uterine massage </li></ul></ul></ul><ul><ul><ul><li>Encourage breastfeeding </li></ul></ul></ul>
  57. 58. Maternal Care: Postpartum <ul><li>Shock </li></ul><ul><ul><li>If mother shows signs, symptoms of shock: </li></ul></ul><ul><ul><ul><li>High concentration O 2 </li></ul></ul></ul><ul><ul><ul><li>Rapid transport </li></ul></ul></ul><ul><ul><ul><li>ALS intercept </li></ul></ul></ul>
  58. 59. Complicated Deliveries
  59. 60. Breech Presentation
  60. 61. Breech Presentation <ul><li>Management </li></ul><ul><ul><li>High concentration O 2 </li></ul></ul><ul><ul><li>Rapid transport </li></ul></ul><ul><ul><li>Prepare for neonatal resuscitation </li></ul></ul><ul><ul><li>Assist delivery </li></ul></ul>
  61. 62. Breech Presentation <ul><li>Management </li></ul><ul><ul><li>If head does not deliver within 3 minutes of body: </li></ul></ul><ul><ul><ul><li>Insert gloved hand into vagina forming “V” around baby’s nose, mouth </li></ul></ul></ul><ul><ul><ul><li>Push vaginal wall away from baby’s face to create airway </li></ul></ul></ul>
  62. 63. Limb Presentation
  63. 64. Limb Presentation <ul><li>Management </li></ul><ul><ul><li>High concentration O 2 </li></ul></ul><ul><ul><li>Rapid transport </li></ul></ul>
  64. 65. Prolapsed Cord <ul><li>Umbilical cord enters vagina before infant’s head </li></ul><ul><li>Pressure of head on cord occludes blood flow, O 2 delivery to fetus </li></ul>
  65. 66. Prolapsed Cord <ul><li>Management </li></ul><ul><ul><li>High concentration O 2 </li></ul></ul><ul><ul><li>Knee-chest position or exaggerated shock position </li></ul></ul><ul><ul><li>Place gloved hand in vagina </li></ul></ul><ul><ul><li>Apply gentle pressure inward to presenting part; relieve pressure on cord </li></ul></ul>
  66. 67. Umbilical Cord around Neck <ul><li>Management </li></ul><ul><ul><li>Upon delivery of head look for cord is looped around neck </li></ul></ul><ul><ul><li>GENTLY slip cord over head if possible </li></ul></ul><ul><ul><li>If cord cannot be slipped over head: </li></ul></ul><ul><ul><ul><li>Clamp in two places </li></ul></ul></ul><ul><ul><ul><li>Cut between clamps with surgical scissors </li></ul></ul></ul>
  67. 68. Amniotic Sac Intact <ul><li>Management </li></ul><ul><ul><li>Use clamp to tear sac, release fluid </li></ul></ul><ul><ul><li>Move sac away from baby’s nose, mouth </li></ul></ul>
  68. 69. Meconium <ul><li>First stool of newborn </li></ul><ul><li>Meconium-stained amniotic fluid </li></ul><ul><ul><li>Baby has had bowel movement in utero </li></ul></ul><ul><ul><li>Greenish, black (pea soup) color </li></ul></ul><ul><ul><li>Indicative of distress </li></ul></ul>
  69. 70. Meconium <ul><li>Meconium can: </li></ul><ul><ul><li>Occlude airway </li></ul></ul><ul><ul><li>Cause pneumonitis </li></ul></ul>
  70. 71. Meconium <ul><li>Management </li></ul><ul><ul><li>Avoid early stimulation of baby to prevent aspiration </li></ul></ul><ul><ul><li>Aggressively suction airway until all meconium is removed </li></ul></ul>
  71. 72. Multiple Births
  72. 73. Multiple Births <ul><li>Consider as possibility if: </li></ul><ul><ul><li>Mother’s abdomen appears abnormally large prior to delivery </li></ul></ul><ul><ul><li>Mother’s abdomen remains large after delivery of first baby </li></ul></ul><ul><ul><li>Contractions continue after delivery of first baby </li></ul></ul>
  73. 74. Multiple Births <ul><li>Delivery </li></ul><ul><ul><li>Clamp cord of first baby before delivery of second </li></ul></ul><ul><ul><li>Usually second baby will deliver shortly after first </li></ul></ul><ul><ul><li>Care for babies, mother, and placenta(s) as you would in a single birth </li></ul></ul>
  74. 75. Multiple Births <ul><li>Multiple babies are usually small </li></ul><ul><li>It is important to keep them warm! </li></ul>
  75. 76. Premature Infants <ul><li>Definition </li></ul><ul><ul><li>< 28 weeks gestation, or </li></ul></ul><ul><ul><li>< 5.5 pounds birth weight </li></ul></ul>
  76. 77. Premature Infants <ul><li>Management </li></ul><ul><ul><li>Keep baby warm </li></ul></ul><ul><ul><li>Keep airway clear </li></ul></ul><ul><ul><li>Assist ventilations if necessary </li></ul></ul><ul><ul><li>Resuscitate if necessary </li></ul></ul><ul><ul><li>Watch umbilical cord for bleeding </li></ul></ul><ul><ul><li>“ Blow by” O 2 </li></ul></ul><ul><ul><li>Avoid contamination </li></ul></ul><ul><ul><li>Consider ALS intercept </li></ul></ul>

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