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Obstetrics and Gynecology


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Obstetrics and Gynecology

  1. 1. Chapter Obstetrics and Gynecology Twenty
  2. 2. Chapter <ul><li>How to deal with predelivery </li></ul><ul><li>emergencies </li></ul><ul><li>Normal and abnormal deliveries </li></ul><ul><li>How to treat gynecological </li></ul><ul><li>emergencies </li></ul>Twenty CORE CONCEPTS
  3. 3. Anatomy of Pregnancy
  5. 5. <ul><li>Complete patient assessment. </li></ul><ul><li>Base treatment on assessment. </li></ul><ul><li>Bring fetal tissue to hospital. </li></ul><ul><li>Give emotional support to mother. </li></ul>Miscarriage (Spontaneous Abortion)
  6. 6. <ul><li>Complete patient assessment. </li></ul><ul><li>Base treatment on assessment. </li></ul><ul><li>Administer high-concentration </li></ul>oxygen. <ul><li>Handle gently at all times. </li></ul>Seizures during Pregnancy
  8. 8. Childbirth Delivery Kit
  9. 9. <ul><li>Name, age, due date </li></ul><ul><li>First delivery? </li></ul><ul><li>Contractions or pain? </li></ul><ul><li>Bleeding or discharge? </li></ul><ul><li>Crowning? </li></ul>(Continued) Predelivery Evaluation
  10. 10. <ul><li>Frequency/duration of contractions? </li></ul><ul><li>Urge to move bowels? </li></ul><ul><li>Need to push? </li></ul><ul><li>Rock-hard abdomen? </li></ul>Predelivery Evaluation
  11. 11. <ul><li>Based on evaluation </li></ul><ul><li>Number of prior births </li></ul><ul><li>Distance to hospital </li></ul><ul><li>Complications expected </li></ul>Transport Decision
  12. 12. <ul><li>Use body substance isolation. </li></ul><ul><li>Keep mother out of bathroom. </li></ul><ul><li>Do not hold mother’s knees </li></ul><ul><li>together. </li></ul>(Continued) Delivery Precautions
  13. 13. <ul><li>Do not examine vagina internally. </li></ul><ul><li>Consider limitations of scene </li></ul><ul><li>Contact medical direction per </li></ul><ul><li>local protocol. </li></ul>on field delivery. Delivery Precautions
  14. 14. <ul><li>Apply gloves, mask, eye </li></ul><ul><li>protection, gown. </li></ul><ul><li>Control the scene to provide: </li></ul><ul><li>A safe delivery area </li></ul><ul><li>Privacy, comfort </li></ul>(Continued) Delivery Procedures
  15. 15. <ul><li>Have mother lie supine, knees drawn up and spread apart. </li></ul><ul><li>Elevate hips with blanket and pillow. </li></ul>(Continued) Delivery Procedures
  16. 16. Create sterile field around vaginal opening.
  17. 17. Crowning of Infant’s Head Prevent explosive delivery of the head.
  18. 18. <ul><li>If amniotic sac has not broken, puncture sac and pull it away from baby’s face. </li></ul><ul><li>Determine if umbilical cord is around baby’s neck. If so, clamp and cut cord. </li></ul>(Continued) Delivery Procedures
  19. 19. Suction mouth, then nose. Aid in birth of upper shoulder.
  20. 20. Support the trunk. Support the legs.
  21. 21. <ul><li>Wipe blood, mucus from nose and mouth. </li></ul><ul><li>Suction again. </li></ul><ul><li>Warmth is critical! </li></ul><ul><li>Wrap baby in warm towel, </li></ul>head lower than trunk. (Continued) Delivery Procedures
  22. 22. <ul><li>Assign partner to initial care and monitoring. </li></ul><ul><li>Keep infant level with vagina until cord is cut. </li></ul>Delivery Procedures (Continued)
  23. 23. Clamp or tie cord; then cut.
  24. 24. <ul><li>Observe for delivery of placenta. </li></ul><ul><li>When placenta delivers, place in plastic bag for transport to hospital. </li></ul>Delivery Procedures
  25. 25. Delivering the Placenta
  26. 26. <ul><li>Cover vaginal opening with sterile pad. </li></ul><ul><li>Lower mother ’ s knees; help her to hold them together. </li></ul><ul><li>Record time of delivery. </li></ul>(Continued) After-Delivery Procedures
  27. 27. <ul><li>A loss of 500cc is well tolerated. </li></ul>Vaginal Bleeding <ul><li>If blood loss is excessive, massage the uterus. </li></ul><ul><li>Treat for shock. </li></ul>After-Delivery Procedures
  28. 28. Massage uterus to control bleeding.
  30. 30. <ul><li>Position, dry, wipe, wrap. </li></ul><ul><li>Repeat suctioning. </li></ul><ul><li>Cover the head. </li></ul>(Continued) Care of the Newborn
  31. 31. Suctioning the Newborn
  32. 32. = = = = = A P G A R Color: No central cyanosis Greater than 100/minute Vigorous and crying Good extremity motion Normal, crying Normal Assessment Findings — Newborn A ppearance Pulse Grimace Activity Respiratory effort
  34. 34. Inverted Pyramid of Neonatal Resuscitation Resuscitation of the Newborn
  35. 35. Stimulating the Newborn to Breathe
  36. 36. <ul><li>If shallow, slow, or absent: </li></ul><ul><li>Provide artificial ventilations, </li></ul><ul><li>40 – 60/minute. </li></ul><ul><li>Reassess after 30 seconds. </li></ul><ul><li>Continue as necessary. </li></ul>Breathing Effort
  37. 37. Heart Rate <ul><li>If less than 100 /minute: </li></ul><ul><li>Provide artificial ventilations, 40 – 60/minute. </li></ul><ul><li>Reassess after 30 seconds. </li></ul><ul><li>If no improvement, continue ventilations. </li></ul>(Continued)
  38. 38. Heart Rate <ul><li>If less than 60–80/ minute and not responding to ventilation: </li></ul><ul><li>Start chest compressions at rate of 120/min. </li></ul><ul><li>Deliver compressions to the depth of 1/3 to 1/2 the depth of the patient’s chest. </li></ul>(Continued)
  39. 39. Heart Rate If at any time the heart rate is less than 60 , begin ventilations and compressions immediately.
  40. 40. Color If central (trunk) cyanosis is present with adequate breathing and heart rate, administer blow-by oxygen.
  41. 41. Tell new EMT-Bs that it is not uncommon to find patients and family members very nervous. This will make the patient exam and decision making very difficult. The patient or her family may want to rush to the hospital, or they may feel that there just isn’t enough time. Encourage new EMT-Bs to carefully and objectively examine the patient and history as the basis for a transport decision. Assure the patient and family that you are equipped to evaluate the situation and handle delivery at home or in the ambulance. P RECEPTOR P EARL
  43. 43. Abnormal Delivery: Prolapsed Cord
  44. 44. Patient CARE Prolapsed Cord Emergency Care Steps <ul><li>Complete patient assessment. </li></ul><ul><li>Give high-concentration oxygen. </li></ul><ul><li>Position mother with hips elevated or head down. </li></ul>(Continued)
  45. 45. Patient CARE Prolapsed Cord Emergency Care Steps <ul><li>Insert sterile-gloved hand into vagina, pushing the fetus away from the pulsating cord. </li></ul><ul><li>Transport rapidly. </li></ul>
  46. 46. Care for Prolapsed Cord
  48. 48. Patient ASSESSMENT Breech Presentation Signs and Symptoms <ul><li>Baby’s buttocks or lower extremities presenting </li></ul><ul><li>Greater risk with prolapsed cord </li></ul>
  49. 49. Patient CARE Breech Presentation Emergency Care Steps <ul><li>Place mother on oxygen. </li></ul><ul><li>Transport immediately. </li></ul><ul><li>Place mother in head-down position with hips elevated. </li></ul>
  50. 50. Abnormal Delivery: Limb Presentation
  51. 51. Patient ASSESSMENT Limb Presentation Signs and Symptoms <ul><li>Baby’s limb protrudes from birth canal. </li></ul>
  52. 52. Patient CARE Limb Presentation Emergency Care Steps <ul><li>Transport immediately on recognition. </li></ul><ul><li>Place mother in head-down position with hips elevated. </li></ul><ul><li>Place mother on oxygen. </li></ul>
  53. 53. Patient ASSESSMENT Meconium Signs and Symptoms <ul><li>Green or brown amniotic fluid </li></ul>indicates presence of fecal matter. <ul><li>Suggests fetal distress during labor. </li></ul>
  54. 54. Patient CARE Meconium Emergency Care Steps <ul><li>Do not stimulate before suctioning. </li></ul><ul><li>Suction. </li></ul><ul><li>Maintain airway. </li></ul><ul><li>Ventilate if necessary. </li></ul><ul><li>Transport as soon as possible. </li></ul>
  56. 56. Complications of Childbirth <ul><li>Meconium </li></ul><ul><li>Multiple Births </li></ul><ul><li>Premature Births </li></ul>
  57. 57. <ul><li>Delivery procedure is the same for each. </li></ul><ul><li>Prepare for multiple resuscitations. </li></ul><ul><li>Call for assistance. </li></ul>Multiple Births
  58. 58. <ul><li>Always at risk of hypothermia. </li></ul><ul><li>Usually requires resuscitation. </li></ul><ul><li>Should be performed unless physically impossible. </li></ul>Premature Births
  60. 60. <ul><li>Complete patient assessment. </li></ul><ul><li>Base treatment on assessment. </li></ul><ul><li>Apply external vaginal pads. </li></ul><ul><li>Transport. </li></ul>Vaginal Bleeding (Late in Pregnancy)
  61. 61. <ul><li>Treat like any soft-tissue injury. </li></ul><ul><li>Never pack vagina. </li></ul><ul><li>Administer oxygen. </li></ul><ul><li>Perform ongoing assessment. </li></ul>Trauma–External Genitalia
  62. 62. <ul><li>Complete patient assessment and care. </li></ul><ul><li>Maintain nonjudgmental attitude. </li></ul><ul><li>Psychological care is required. </li></ul>(Continued) Sexual Assault
  63. 63. <ul><li>Preserve potential evidence. </li></ul><ul><li>Discourage patient from bathing, voiding. </li></ul><ul><li>Fulfill reporting requirements. </li></ul>Sexual Assault
  64. 64. 1. Describe how to deal with predelivery emergencies. 2. List three abnormal deliveries and how they are handled in the field. 3. How should sexual assault be managed in the field? R EVIEW QUESTIONS