1. OB/GYN CME
11/9/06
Topics Covered:
Stages of Pregnancy
Pre-Delivery Emergencies
Normal Delivery
Abnormal Delivery
Gynecological Emergencies

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. 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. 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. 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. 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. 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. 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. 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