This document discusses childbirth and gynecologic emergencies. It describes the stages of labor and delivery, including recognizing signs of impending delivery. It provides guidance on caring for complications during delivery such as premature birth, breech presentation, and prolapsed cord. The document also addresses miscarriage, vaginal bleeding, and gynecologic issues like sexual assault. For each topic, it outlines how to recognize the emergency and provides steps for care and treatment.

1. Chapter 22
Childbirth and Gynecologic
Emergencies

2. Childbirth and Gynecologic
Emergencies of Pregnancy
(1 of 3)
•Birth canal: Vagina and lower part of
uterus
•Cervix: Opening at lower end of uterus
•Placenta: Organ through which mother
and fetus exchange nourishment and
waste

3. Childbirth and Gynecologic
Emergencies of Pregnancy
(2 of 3)
• Umbilical cord: Extension of placenta
• Amniotic sac: Bag of water surrounding
fetus
• Crowning: Fetus’s head bulges out of
vaginal opening

4. Childbirth and Gynecologic
Emergencies of Pregnancy
(3 of 3)
• Bloody show: Mucus and blood
discharged during labor
• Labor: Process of childbirth
• Miscarriage: Delivery of fetus before it
can live independent of mother

5. Predelivery Emergencies
• Miscarriage
• Usually occurs in first trimester
• Most occur because fetus was not
developing properly

6. Recognizing Miscarriage
• Lower abdominal cramps
• Lower back ache
• Vaginal bleeding
• May be sudden and heavy
• Passage of tissue from vagina

7. Care for Miscarriage
• Reassure the woman.
• Help into comfortable position
• Legs bent
• Place sanitary pad outside of vagina
• Transport expelled tissue to hospital.
• Seek medical care.
• Call 9-1-1 if heavy bleeding or signs
of shock

8. Vaginal Bleeding
• Vaginal bleeding in the third trimester
constitutes an emergency.
• Things to check for:
• Extent of bleeding
• Pulse rate
• Female paramedic

9. Recognizing Vaginal
Bleeding During Pregnancy
• Mild spotting
• Heavy bleeding
• Check for signs of shock.

10. Care for Vaginal Bleeding
During Late Pregnancy
• Place woman on left side.
• Have her place sanitary pad
over outside of vagina.
• Call 9-1-1.
• Treat for shock.

11. Recognizing Vaginal
Bleeding Caused by Injury
• Injuries of external genitalia
• Severe pain
• Blood in vaginal area
• Massive internal vaginal bleeding

12. Care for Injury-Related
Vaginal Bleeding
• Place direct pressure over dressing.
• Apply ice.
• Do not place dressings inside vagina.
• Place victim on left side.
• Seek medical care.

13. Non-Injury-Related Vaginal
Bleeding
• Most likely to be menstrual
• Can indicate more serious conditions:
• Childbirth
• Miscarriage
• Infection

14. Recognizing Signs and
Causes of Non-Injury-Related
Vaginal Bleeding
• Abdominal cramps are a sign of
bleeding.

15. Care for Non-Injury-Related
Vaginal Bleeding
• Reassure victim.
• Help victim into comfortable
position with legs bent.
• Have woman place sanitary
pad over outside of vagina.
• Seek medical care.

16. Imminent Delivery (1 of 2)
• Only transport if:
• First pregnancy
• No straining or crowning
• Have woman wear both lap and
shoulder seat belts.
• If necessary, have her lie on left side.

17. Imminent Delivery (2 of 2)
• No time to transport if:
• Not a first pregnancy
• Crowning or straining
• Call 9-1-1.
• Prepare a private, clean area.

18. Emergency Delivery
• Wear exam gloves.
• Avoid touching vaginal area.
• Do not allow woman to use the toilet.
• Do not hold woman’s legs together.

19. Stages of Labor (1 of 3)
• First stage
• Starts at first
contraction
• Lasts several hours
• Contractions increase
in frequency and
intensity.
• May see bloody show
• Amniotic sac bursts at
end of stage.

20. Stages of Labor (2 of 3)
• Second stage
• 30 minutes to 2
hours
• Cervix dilates
fully
• Baby’s head
passes through
vagina and rest of
body follows.

21. Stages of Labor (3 of 3)
• Third stage
• Afterbirth
• 15 minutes or
more
• Placenta is
expelled

22. Recognizing Impending
Delivery (1 of 2)
• Has woman had a baby before?
• Are contractions less than two minutes
apart?
• Has amniotic sac ruptured?
• Does mother feel like she must move
her bowels?

23. Recognizing Impending
Delivery (2 of 2)
• If yes, check for crowning.
• Explain what you are doing and why.
• Protect woman’s privacy.

24. Delivery Supplies
• Clean sheets, towels, blankets
• Plastic bag or towel
• Clean exam gloves
• Sanitary pads
• Materials to place under woman
• Rubber bulb syringe
• Sterile gauze pads
• Strips of gauze, or clean shoelaces

25. Care During Delivery (1 of 9)
• Wash hands and wear exam gloves.
• Have mother lie in acceptable position.
• Have woman take:
• Short, quick breaths during contractions
• Deep breaths between contractions
• Place absorbent materials under
buttocks.

26. Care During Delivery (2 of 9)
• When head appears:
• Place hand over head and apply slight
pressure.
• Have woman stop pushing.
• Do not push on fontanelles.
• If amniotic sac does not break, tear with
fingers and push from baby’s head and
mouth.

27. Care During Delivery (3 of 9)
• Check umbilical
cord is not wrapped
around neck.
• Gently slip it over
baby’s head.
• Support head.
• Suction mouth and
nostrils.

28. Care During Delivery (4 of 9)
• Support body as
baby emerges.
• Do not pull on
head or touch
armpits.
• Keep baby level
with vagina.

29. Care During Delivery (5 of 9)
• Wipe blood and
mucus from
mouth and nose.
• Dry infant and
stimulate
breathing.
• If baby does not
breathe in 30
seconds, begin
CPR.

30. Care During Delivery (6 of 9)
• Wrap infant, place on side, keep level
with vagina
• Tie the umbilical cord:
• When it stops pulsating
• With gauze or clean shoelace

31. Care During Delivery (7 of 9)
• Cutting the cord:
• No need if transporting to hospital.
• In remote area:
• Tie cord 4" from baby
• Make second tie 2" from first
• Cut between ties

32. Care During Delivery (8 of 9)
• Watch for
placenta.
• Wrap placenta in
towel with 3/4 of
umbilical cord.
• Put in bag
• Keep at level of
infant
• Take to hospital

33. Care During Delivery (9 of 9)
• Place sterile pad over vaginal opening.
• Lower mother’s legs and hold them
together.
• Gently massage abdomen just below navel.

34. Delivery Aftercare
• Monitor mother’s breathing and pulse.
• Replace sheets and blankets.
• Massage uterus.
• Place palm on lower abdomen.
• Use firm, circular motion.
• Encourage mother to breastfeed.

35. Initial Care of the Newborn
(1 of 2)
• Monitor breathing and pulse.
• Pulse rate > 100 bets per minute
• Respiratory rate > 40 breaths per
minute.
• Keep infant warm, dry, comfortable

36. Initial Care of the Newborn
(2 of 2)
• If newborn is motionless:
• Tap bottom of foot or shoulder.
• Perform CPR if unresponsive, is
not breathing, or is gasping.

37. Prolapsed Cord
• Umbilical cord
exits before
infant.
• Baby in danger of
suffocation

38. Care for Prolapsed Cord
• Raise mother’s buttocks.
• Insert gloved fingers into vagina on
either side of cord.
• Do not push cord into vagina.
• Call 9-1-1.

39. Breech Birth Presentation
• Baby’s buttocks
emerge first.
• Place mother in
kneeling, head-
down position.
• Seek medical care.
• Suffocation can
occur.

40. Care for Breech Birth
Presentation
• Place hand in vagina, palm toward
baby’s face.
• Form V with fingers on either side of
baby’s nose.
• Push vaginal wall away from face until
head is delivered.
• Call 9-1-1.
• Have woman continue to push.

41. Limb Presentation
• Arm, leg, or foot
emerges first.
• Position woman
with head down
and pelvis
elevated.
• Call 9-1-1
immediately.

42. Meconium
• Baby’s first feces, in amniotic fluid
• May cause distress and respiratory
problems if breathed into lungs
• Greenish or brownish-yellow amniotic
fluid, almost odorless

43. Care for Baby in Danger of
Inhaling Meconium
• Keep infant in moderate head-down
position.
• Suction mouth and nostrils.
• Keep baby’s airway open.
• Call 9-1-1.

44. Premature Birth
• Delivery before 37th week of gestation
• Smaller and thinner infant
• Proportionately large head
• Cheesy, white coating on skin is
minimal or absent

45. Care for Premature Babies
• Keep warm.
• Keep mouth and nose clear of mucus.
• Monitor breathing.
• Perform CPR if necessary.

46. Gynecologic Emergencies
• Reproductive system problems that
occur in nonpregnant women

47. Sexual Assault and Rape
• Rape
• Fastest growing violent crime in U.S.
• Attempted or actual sexual intercourse
against victim’s will
• Physical injury and psychological
trauma is common.

48. Recognizing Sexual Assault
and Rape (1 of 2)
• Focus on providing care, not
obtaining evidence.
• Preserve evidence.
• Question about injuries only, not
crime.

49. Recognizing Sexual Assault
and Rape (2 of 2)
• Signs:
• Headaches
• Sleeplessness, nightmares
• Nausea, muscle spasms
• Confusion
• Depression
• Anxiety, jumpiness

50. Care for Sexual Assault and
Rape (1 of 2)
• Reassure victim.
• Do not blame or ask a lot of questions.
• Determine which injuries require care.
• Do not examine genitalia unless injury
requires immediate care.
• Encourage victim to preserve evidence.

51. Care for Sexual Assault and
Rape (2 of 2)
• If victim refuses aid:
• Have a friend stay with the victim.
• Protect the victim’s privacy.
• Provide contact of local rape crisis center.
• Get victim to medical care.