This document discusses childbirth and gynecologic emergencies. It covers topics like the signs and symptoms of miscarriage, vaginal bleeding during pregnancy, emergency delivery procedures, stages of labor, and complications during delivery such as breech birth or prolapsed umbilical cord. It also discusses the initial care of the newborn and gynecologic emergencies in nonpregnant women including sexual assault and rape.

1. Chapter 22
Childbirth and Gynecologic
Emergencies

2. Childbirth and Gynecologic
Emergencies of Pregnancy
• Birth canal: vagina, lower part of uterus
• Cervix: opening at lower end of uterus
• Placenta: organ through which mother and
fetus exchange nourishment and waste

3. • Umbilical cord: extension of placenta
• Amniotic sac: bag of water surrounding
fetus
• Crowning: fetus’s head bulges out of
vaginal opening
Childbirth and Gynecologic
Emergencies of Pregnancy

4. • Bloody show: mucus and blood
discharged during labor
• Labor: process of childbirth
• Miscarriage: delivery of fetus before it can
live independently of mother
Childbirth and Gynecologic
Emergencies of Pregnancy

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

6. Miscarriage: What to Look For
• Cramping in lower abdomen
• Aching in lower back
• Vaginal bleeding
− Could be sudden and heavy
• Passage of tissue from vagina

7. Miscarriage: What to do
• Reassure the woman.
• Help into comfortable position.
• Have her place sanitary pad over the
outside of the vagina.
• Transport expelled tissue to hospital.
• Seek medical care or call 9-1-1.

8. Vaginal Bleeding During
Pregnancy
• Vaginal bleeding in the third trimester
constitutes an emergency.
• Things to check for:
− Extent of bleeding
− Pulse rate
− Female first aid provider

9. Vaginal Bleeding During
Pregnancy: What to Look For
• Mild spotting
• Heavy bleeding
• Signs of shock

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

11. Vaginal Bleeding Caused by
Injury: What to Look For
• Injuries of external genitalia
• Severe pain
• Bleeding in vaginal area
• Massive vaginal bleeding

12. Vaginal Bleeding Caused by
Injury: What to Do
• Place direct pressure over dressing.
• Apply ice.
• Do not place dressings inside vagina.
• Place person on left side.
• If sexual assault, explain need for
evidence preservation.
• Seek medical care.

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

14. Non–Injury-Related Vaginal
Bleeding: What to Look For
• Abdominal cramps
• Blood in vaginal area

15. Non–Injury-Related Vaginal
Bleeding: What to Do
• Reassure person.
• Help her into comfortable position with
legs bent.
• Have woman place sanitary pad over the
outside of vagina.
• Seek medical care.

16. Imminent Delivery
• Only transport if:
− No urge to push or crowning
− First pregnancy
• Have woman wear both lap and shoulder
seat belts.
• If necessary, have her lie on left side.

17. Imminent Delivery
• No time to transport if:
− Crowning or urge to push
− Not a first pregnancy
• Call 9-1-1.
• Prepare a private, clean area.

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

19. Emergency Delivery
• If head does not present first:
− It is a complicated delivery.
− Tell woman to stop pushing.
− Call 9-1-1.

20. Stages of Labor
• First stage
− Starts at first contraction
− Lasts several hours
− Cervix stretches.
− Contractions increase in
frequency and intensity.
− Amniotic sac bursts at end of stage.
© Jones & Bartlett Learning.

21. Stages of Labor
• Second stage
− 30 minutes to 2 hours
− Cervix is fully dilated.
− Baby’s head passes through pelvis and rest of
body follows
© Jones & Bartlett Learning.

22. Stages of Labor
• Third stage
− Afterbirth
− 15 minutes or more
− Placenta is expelled
© Jones & Bartlett Learning.

23. Imminent Delivery:
What to Look For
• Woman has had a baby before
• Contractions less than 2 minutes apart
• Amniotic sac ruptured
• Mother feels like she must move her
bowels

24. Imminent Delivery: What to Do
• Wash hands and wear exam gloves.
• Have mother lie in acceptable position.
• Remind woman to take:
− Short, quick breaths during contractions
− Deep breaths between contractions
• Place absorbent, clean materials under
buttocks.

25. Imminent Delivery: What to Do
• When head appears:
− Place palm over head; apply slight pressure.
− Have woman stop pushing.
− Do not push on fontanelles.
• If amniotic sac does not break, tear with
fingers and push away from baby’s head
and mouth.

26. Imminent Delivery: What to Do
• Check for umbilical
cord wrapped
around neck.
• Support head.
• Suction mouth and
nostrils.
© University of Maryland Shock Trauma Center/MIEMSS.

27. Imminent Delivery: What to Do
• Support body as
baby emerges.
• Do not pull on head
or touch armpits.
• Keep baby level with
vagina.
© University of Maryland Shock Trauma Center/MIEMSS.
© University of Maryland Shock Trauma Center/MIEMSS.

28. Imminent Delivery: What to Do
• Wipe blood and
mucus from mouth
and nose.
• Dry infant and
stimulate breathing.
− If baby does not
breathe in 30
seconds, begin CPR.
© University of Maryland Shock Trauma Center/MIEMSS.

29. Imminent Delivery: What to Do
• Wrap infant, place on side, keep level
with vagina.
• Tie the umbilical cord.
• Cutting the cord
− No need to cut if transporting to hospital.

30. Imminent Delivery: What to Do
• Watch for placenta.
− Wrap in towel with
three quarters of
umbilical cord.
• Place sterile pad over
vaginal opening.
• Gently massage
abdomen.
© University of Maryland Shock Trauma Center/MIEMSS.

31. Delivery Aftercare
• Monitor mother’s breathing and pulse.
• Replace sheets and blankets.
• If blood loss continues, massage uterus.
• Encourage mother to breastfeed.

32. Initial Care of the Newborn
• Monitor breathing and pulse.
• Keep infant warm, dry, comfortable.
• If newborn is motionless:
− Tap bottom of foot or shoulder.
− Perform CPR if unresponsive, not breathing,
or gasping.

33. Prolapsed Cord:
What to Look For
• Umbilical cord
seen before head
© Jones & Bartlett Learning.

34. Prolapsed Cord: What to Do
• Raise mother’s buttocks.
• Insert gloved fingers into vagina on either
side of cord.
− Do not push cord into vagina.
• Call 9-1-1.

35. Breech Birth Presentation:
What to Look For
• Baby’s buttocks
emerge first.
© Jones & Bartlett Learning.

36. Breech Birth Presentation:
What to Do
• Place hand in vagina.
• Form a V with fingers on either side of
baby’s nose.
• Push vaginal wall away from face.
• Call 9-1-1.
• Have woman continue to push.

37. Limb Presentation
• What to look for
− Arm, leg, or foot
emerges first.
• What to do
− Position woman with
head down and
pelvis elevated.
− Call 9-1-1 immediately.
© Jones & Bartlett Learning.

38. Meconium: What to Look For
• Baby’s first feces in amniotic fluid
• May cause distress and respiratory
problems if breathed into lungs
• Green or brown-yellow amniotic fluid,
almost odorless

39. Meconium: What to Do
• Keep infant in moderately head-down
position.
• Suction mouth and nostrils.
• Keep baby’s airway open.
• Call 9-1-1.

40. Premature Birth:
What to Look For
• Birth before 37th week of gestation
• Smaller and thinner infant
• Proportionately larger head
• Cheesy, white coating on skin is minimal
or absent

41. Premature Birth: What to Do
• Keep warm.
• Keep mouth and nose clear of mucus.
• Monitor breathing.
• Perform CPR if necessary.

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

43. Sexual Assault and Rape
• Rape
− Criminal act of forcing another person to
submit to sexual intercourse
− Physical injury and psychological trauma are
common.

44. Sexual Assault and Rape:
What to Look For
• Headaches
• Sleeplessness, nightmares
• Nausea, muscle spasms
• Confusion
• Depression
• Anxiety, jumpiness

45. Sexual Assault and Rape:
What to Do
• Do not ask a lot of questions.
• Do not blame; be supportive.
• Determine which injuries require care.
• Do not expose genitalia unless injury
requires immediate care.
• Try to preserve evidence.

46. Sexual Assault and Rape:
What to Do
• If person refuses aid:
− Have a friend stay with the person.
− Protect the person’s privacy.
− Provide contact of local rape crisis center.
• Get person to medical care.