Obstetrics and Gynecological Emergencies - PowerPoint PPT Presentation

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Obstetrics and Gynecological Emergencies

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Describe how and when to cut the umbilical cord. ... Place fingers into the mother's vagina and push the cord away from the infant's face. ... – PowerPoint PPT presentation

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Title: Obstetrics and Gynecological Emergencies


1
Chapter 17
  • Obstetrics and Gynecological Emergencies

2
Objectives (1 of 3)
  • Identify the following structures uterus,
    vagina, fetus, placenta, umbilical cord, amniotic
    sac, perineum.
  • Identify and explain the use of the contents of
    an obstetrics kit.
  • Identify predelivery emergencies.
  • State indicators of imminent delivery.

3
Objectives (2 of 3)
  • Differentiate the emergency medical care provided
    to a patient with predelivery emergencies from a
    normal delivery.
  • Establish the relationship between body substance
    isolation and childbirth.
  • State the steps to assist in the delivery.

4
Objectives (3 of 3)
  • Describe how and when to cut the umbilical cord.
  • Discuss the emergency medical care of a patient
    with a gynecological emergency.

5
Female Reproductive System
6
Three Stages of Labor
  • First stage
  • Dilation of the cervix
  • Second stage
  • Expulsion of the infant
  • Third stage
  • Delivery of the placenta

7
Predelivery Emergencies
  • Preeclampsia (hypertension)
  • Headache, vision disturbance, edema, anxiety
  • Eclampsia
  • Convulsions resulting from hypertension
  • Supine hypotensive syndrome
  • Low blood pressure from lying supine

8
Hemorrhage
  • Vaginal bleeding that occurs before labor begins
  • If present in early pregnancy, it may be a
    spontaneous abortion or ectopic pregnancy.

9
Ectopic Pregnancy
  • Pregnancy outside of the uterus
  • Occurs once in every 200 pregnancies.
  • Consider with a missed menstrual cycle and
    sudden, severe abdominal pain.
  • History of PID, tubal ligation, or previous
    ectopic pregnancy

10
Placenta Problems
  • Placenta abruptio
  • Premature separation of the placenta
  • Placenta previa
  • Development of placenta over the cervix

11
Trauma and Bleeding
  • Any vaginal bleeding with pregnancy is a serious
    sign.
  • Save all blood-soaked pads and any passed tissue.
  • Do not insert pads into the vagina.
  • Transport promptly with woman on her left side.
  • Signs of shock can be delayed, but the fetus may
    be in trouble.

12
When to Consider Field Delivery
  • Delivery can be expected within a few minutes
  • A natural disaster or other catastrophe makes it
    impossible to reach a hospital
  • No transportation is available

13
Crowning
14
Preparing for Delivery
  • Use proper BSI precautions.
  • Be calm and reassuring while protecting the
    mothers modesty.
  • Contact medical control for a decision to deliver
    on scene or transport.
  • Prepare OB kit.

15
Positioning for Delivery
16
Delivering the Infant (1 of 2)
  • Support the head as it emerges, suction the mouth
    than nose.
  • Check for nuchal cord, cut if necessary.
  • Once the head emerges, the shoulders will be
    visible.

17
Delivering the Infant (2 of 2)
  • Support the head and upper body as the shoulders
    deliver.
  • Handle the infant firmly but gently as the body
    delivers.
  • Clamp the cord and cut it.

18
Complications with Normal Vaginal Delivery
  • Unruptured amniotic sac
  • Puncture the sac and push it away from the baby.
  • Umbilical cord around the neck (nuchal cord)
  • Gently slip the cord over the infants head.
  • Cut cord if necessary.

19
Postdelivery Care
  • Immediately wrap the infant in a towel with the
    head lower than the body.
  • Suction the mouth and nose again.
  • Clamp and cut the cord if not done already.
  • Ensure the infant is pink and breathing well.

20
Delivery of the Placenta
  • Placenta is attached to the end of the umbilical
    cord.
  • It should deliver within 30 minutes.
  • Once the placenta delivers, wrap it and take it
    to the hospital so it can be examined.
  • If the mother continues to bleed, transport
    promptly to the hospital.

21
APGAR Scoring(0 to 10)
  • A Appearance
  • P Pulse
  • G Grimace
  • A Activity
  • R Respirations
  • Scored at 1 and 5 minutes after birth

22
Neonatal Resuscitation
23
Giving Chest Compressions to an Infant (1 of 2)
  • Find the proper position
  • Just below the nipple line
  • Middle third of the sternum
  • Wrap your hands around the body, with your thumbs
    resting at that position.
  • Press your thumbs gently against the sternum,
    compressing ½ to ¾ deep.

24
Giving Chest Compressions to an Infant (2 of 2)
  • Ventilate with a BVM device after every third
    compression.
  • 90 compressions to 30 ventilations per minute
  • Continue CPR while awaiting transport.

25
Breech Delivery
  • Presenting part is the buttocks.
  • Breech delivery is usually slow, giving you time
    to arrange for transport to the hospital.
  • Support the infant as it comes out.
  • Make a V with your gloved fingers then place
    them in the vagina to prevent it from compressing
    infants airway.

26
Rare Presentations
  • Limb presentation
  • This is a very rare occurrence.
  • This is a true emergency that requires immediate
    transport.
  • Prolapsed cord
  • Arrange for immediate transport.
  • Place fingers into the mothers vagina and push
    the cord away from the infants face.

27
Excessive Bleeding
  • Bleeding always occurs with delivery but should
    not exceed 500 mL.
  • Massage the mothers uterus to slow bleeding.
  • Treat for shock.
  • Place pad over vaginal opening.
  • Arrange for immediate transport to hospital.

28
Spontaneous Abortion (Miscarriage)
  • Delivery of the fetus or placenta before the 20th
    week
  • Infection and bleeding are the most important
    complications.
  • Treat the mother for shock.
  • Arrange for immediate transport.
  • Bring tissue that has passed through the vagina
    to the hospital.

29
Twins
  • Twins are usually smaller than single infants.
  • Delivery procedures are the same as that for
    single infants.
  • There may be one or two placentas to deliver.

30
Premature Infants and Procedures
  • Delivery before 8 months or weight less than 5 lb
    at birth.
  • Keep the infant warm.
  • Keep the mouth and nose clear of mucus.
  • Give oxygen.
  • Do not infect the infant.
  • Notify EMS.

31
Fetal Demise
  • An infant that has died in the uterus before
    labor
  • This is a very emotional situation for family and
    providers.
  • The infant may be born with skin blisters, skin
    sloughing, and dark discoloration.
  • Do not attempt to resuscitate an obviously dead
    infant.

32
Delivery Without Sterile Supplies
  • You should always have goggles and sterile gloves
    with you.
  • Use clean sheets and towels.
  • Do not cut or clamp umbilical cord.
  • Keep placenta and infant at same level.

33
Gynecologic Emergencies
  • Soft-tissue injuries can be painful and bleed
    profusely.
  • Treat as other soft-tissue injuries, and never
    insert dressing into the vagina.
  • Have a second rescuer present, preferably female,
    when treating such emergencies.

34
Stresses and Pregnancy
  • More women are now active well into the third
    trimester of pregnancy.
  • Environmental conditions can increase risks to
    mother and fetus.
  • Altitude
  • Diving
  • Temperature and humidity
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