OBGyn' Emergencies made easy

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OB/Gyn. Emergenciesmade easy!

• Presented by
• Mike Helbock, M.I.C.P., NREMT-P
• MSO King County Medic One
• Manager - Training and Education
• Seattle/King County Division
• Emergency Medical Services

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Put this into perspective!

• You are just an observer... there to assist!
• Gods got this figured out...he just needs
  alittle help right now!

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Objectives

• Complications of Pregnancy
• Complications of Labor and Delivery
• Preparing for a Delivery
• Neonatal Resuscitation

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Complications of PG.

• Spontaneous Abortion (miscarriage)
• Ectopic Pregnancy
• Toxemia

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Spontaneous Abortion

• Before 28 weeks
• Moderate to heavy bleeding
• Passage of tissue (save if possible)
• Cramps
• Requires BLS/TLC
• Transport (SICK/NOT SICK)
• ALS if patient presents shocky

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Ectopic Pregnancy

• True Obstetrical Emergency!
• Implantation somewhere other than the uterus
• 6-8 weeks post last period

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Ectopic Pregnancy S/S, Rx

• SICK!
• Acute abd. pain...child bearing female
• Syncope/orthostatic hypotension
• Profound shock/death can ensue!
• Aggressive ABCs...shock protocols
• 100 Oxygen-NRM
• IV access...Large Bore x2...enroute!

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Until proven otherwise

• Any syncopal/near syncopal episode, with/without
  abdominal pain in a child-bearing female,
• is an ECTOPIC
• until proven otherwise

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Toxemia Poisoning of the Blood

• Pre-Eclampsia
• Generally young, first time mother
• Increased blood pressure
• Edema of the hands, face, and feet
• Exaggerated weight gain
• Eclampsia
• All of the above, but add Seizures!
• If untreated...high mortality rate!

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Toxemia Rx

• Quick accurate hx (SICK/NOT SICK)
• ABCs...oxygen
• Transport (greater 7mo. left lateral)
• IV access
• Sz control
• Benzodiazepine
• Magnesium Sulfate

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Complications of LD

• Pre-delivery bleeding
• Prolapsed cord
• Breech Presentation
• Post-delivery bleeding

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Pre-delivery bleeding

• Placenta Previa (third trimester bleed)
• Abnormal placental placement - cervical os
• Often found during pre-natal care
• If torn during delivery
• Profound bleeding
• Profound shock
• High mortality rate for both
• Painless - bright red blood

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Pre-delivery bleeding cont.

• Abruptio Placenta (3rd trimester bleed)
• Premature separation of the placenta
• Can be spontaneous or traumatic in nature
• Variable degrees of separation
• Spotting and stable
• Profound shock with
• - minimal visible blood loss
• Painful

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Pre-delivery bleeding Rx

• Recognize SICK!
• Rapid and aggressive BLS/ALS intervention
• 100 oxygen NRM
• IV access.. x2 enroute
• Elevate feet, patient on side
• Early hospital notification

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Prolapsed cord

• True obstetrical emergency!
• Umbilical cord presents first
• Cord is squeezed between vaginal wall and the
  babies head
• ...reducing oxygen

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Prolapsed cord Rx

• Appreciate not a field delivery!
• Exaggerated shock or knee chest
• Gentle pressure to prevent delivery
• 100 oxygen for mom, via NRM
• Wrap cord with sterile, wet towel - cover with
  another towel (heat loss)
• Early notification and transport

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Breech presentation

• Most common abnormal delivery
• Buttocks/leg first

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Breech presentation cont.

• Keep cool...this can happen
• Allow as much to deliver as possible
• Support presenting parts with your palm
• Generally the head will deliver
• ...if not...

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Breech presentation cont.

• If head doesnt deliver in (3) minutes
• spontaneous respirations and blood flow will be
  hindered
• Place gloved hand into vagina...palm towards
  babies face
• Form a V with fingers
• Push babies face away from vaginal wall

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Breech presentation cont.

• Early notification to receiving hospital
• Transport ASAP!

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Post - delivery bleeding

• Soaking more than (5) pads
• 1 reason...placental retention
• requires aggressive fundal
  massage
• Consider twins (good Hx taking)

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Post - delivery bleeding Rx

• Determine SICK/NOT SICK
• Aggressive fundal massage
• IV access
• Shock position if needed
• 100 oxygen
• Early notification
• Transport

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Preparing for delivery

• Basic guidelines and preparations
• Delivery of the baby
• Care of the newborn
• Delivery of the placenta

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Basic guidelines

• Determine gravida ( pregnancies)
• Determine parity ( deliveries)
• Determine level of pre-natal care
• Perform visual inspection only!
• Determine
• field delivery
• hospital delivery

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Basic guidelines

• Signs of imminent delivery
• rupture of bag of waters
• contractions less than 2 mins. apart
• contractions increasing in intensity
• crowning or presenting part
• mother in need of a bowel movement
• bloody show

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Contraction Profile

duration

interval
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Basic guidelines

• Prepare a clean, elevated work area
• All unnecessary bystanders - out!
• have them boil water and tear sheets!
• Have dad or others...help!
• Remove clothes...
• place (2) towels under pt.
• Drape mom with clean sheets

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Basic guidelines

• Have mother lie on her back
• Spread her thighs, knees bent
• Have OB Kit laid out ready to go!
• Suction, scissors and clamp at your side!
• One rescuer is the OB Doc...the other is the
  Pediatrician!

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Delivery of the baby

• During contractions...bear down
• Contractions subside..cleansing breath
• as head delivers, suction mouth then nose!
• deliver top (anterior) shoulder first
• deliver lower (posterior) shoulder
• deliver buttocks and hips last
• Hang-on, the little rascal is slippery!

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Care for the Newborn

• Assess
• ABCs, Dry off and warm the newborn
• Repeat suction of mouth and nose
• APGAR
• Check pulsationsclamp and cut
• (6-8 inches out, 2-3 inches apart)
• No complications...offer newborn to mom for
  suckling

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Care for the Newborn cont.

• Assessing APGAR _at_ 1 and 5 minutes

Appearance
Pulse
Grimace
Activity
Respirations
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Delivery of the Placenta

• Usually delivers within 20 minutes
• Care for the newborn and mother
• Perform aggressive fundal massage
• promotes uterine contractions
• helps deliver the placenta
• If no delivery in 15-20 mins.transport!
• Offer solid skills at all times!

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Neonatal Resuscitation

• Determine SICK/NOT SICK
• If SICK, remember (PSS)
• Position
• Suction
• Stimulation
• Continue to dry and warm the newborn
• AIRWAY, AIRWAY, AIRWAY!

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Neonatal Resuscitation
Graphic Courtesy of PEPP
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Neonatal Resuscitationcont.

• If heart rate drops below 60 after PSS and
  ventilation...Start CPR!

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Conclusion... Part 1

• Remember...youre there to assist
• Stay cool, be a professional
• Have an OB Doc and a Pediatrician
• Talk to mom, inform as needed

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Conclusion... Part 2

• Take (2) full breaths...(3) different times
  during the call
• Care for mom and newborn separately
• Remember (PSS) and
• AIRWAY, AIRWAY, AIRWAY!

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Congratulations to all!