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