OB-GYN CME 2007

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OB-GYN CME 2007

  1. 1. OB/GYN CME 11/9/06 Topics Covered: Stages of Pregnancy Pre-Delivery Emergencies Normal Delivery Abnormal Delivery Gynecological Emergencies
  2. 2. Three Stages of Delivery: Dilation, Expulsion, Placental Expulsion •Baby Pushes through Vagina, Is Born • Last Up to an Hour •Contractions 2-3 min Intervals, 1-1.5 mins Each •Crowning Dilation •Cervix Dilates to 10 cm Placental •Expulsion of Placenta •Longest Stage: Up to 18 hours for first time •Placenta Expelled 5-20 min after Birth •Ends When Contractions Are Regular: Come in 3-4 min Intervals, 1 min Each
  3. 3. Assessment (RI Protocols): Determine Whether Immediate Care Is Needed •Is There Evidence of Shock? (Supine Hypotension Syndrome) •Is There Swelling And/Or High Blood Pressure? (Eclampsia) •Is There Bleeding? •What Is the Length of Time Between Contractions? •Is There Crowning? •Have There Been Complications with Pregnancy?
  4. 4. Common Pre-Delivery Emergencies Ectopic Pregnancy: Egg Implanted Outside Uterus •Leading Cause of Maternal Death (1/200 Pregnancies) •Can Cause Rupture of Placenta 2-12 Weeks After Fertilization •Symptoms: Shock, Bluish Discoloration of Navel, Abdominal Pain; Vaginal Bleeding •Transport Pre-eclampsia/Eclampsia •Pre-eclampsia Symptoms: High Blood Pressure and Excessive Swelling in Extremities •Eclampsia Symptoms: Pre-Eclampsia Plus Seizures or Coma •Occurs Most Frequently in First-Time Mothers, Possibly in 20s •Transport Supine Hypotensive Syndrome: Shock •Due to Pressure on Inferior Vena Cava •Reposition Mother on Left Side (Best)
  5. 5. Assessment (RI Protocols): Determine Whether Delivery Is Imminent Signs of Imminent Delivery: Crowning Sensation of Bowel Movement Contractions 2 mins Apart Strong Urge to Push Abdomen Very Hard
  6. 6. Normal Delivery Protocol Crowning: Exert Gentle Pressure on Head; Obtain OB Kit; Turn It Prepare Sterile Area (Prevent Explosive Delivery) Suction Nose and Keep Infant Level with Vagina Mouth; Deliver Each Until Cord Is Cut Shoulder
  7. 7. Normal Delivery Protocol Cut Chord 6” from Neonate; Place Two Clamps 2-3” Apart; Cut Between Clamps Watch Placenta Deliver; Wrap It; Massage Mother’s Abdomen To Stimulate Contractions; Continue Transport; Perform APGAR
  8. 8. Abnormal Delivery Prolapsed Cord: Cord Presents Before Head •Position Mother in Knee-Chest Position •Put Gloved Hand in Vagina; Prevent Head from Placing Pressure on Cord Breech Birth (Rear Presentation) or Limb Presentation •Immediately Transport Multiple Births Meconium: Greenish or Brownish Amniotic Fluid •Sign of Stress During Birth •Suction Nose and Mouth of Infant Premature Birth •Generally Have Different Appearance •Treat More Carefully •Blow Oxygen Across Baby’s Face •Keep Baby Warm APGAR < 4 (or Other Distressing Symptoms) •Neonatal Resuscitation Necessary
  9. 9. Gynecological Emergencies •Generally Uncommon •Most Common: Abdominal Pain, Vaginal Bleeding; Soft-Tissue Injuries •Provide Privacy During Examination (Never Examine the Genitalia of a Sexual Assault Victim) •Place a Napkin Over Vagina If Bleeding (Never Pack Vagina) •Treat and Transport Normally

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