View
234
Download
2
Category
Tags:
Preview:
Citation preview
Home
OBSTETRICS AND GYNECOLOGY
OBSTETRICS AND GYNECOLOGY
Home
Lesson Objective:Lesson Objective:
Indicate procedures for emergency (pre -hospital) childbirth.
Lesson Objective:Lesson Objective:
Indicate procedures for emergency (pre -hospital) childbirth.
Home
OVERVIEWOVERVIEW
Anatomy ReviewAnatomy Review Beginning of LaborBeginning of Labor Predelivery EmergenciesPredelivery Emergencies Preparing for DeliveryPreparing for Delivery Delivering the BabyDelivering the Baby
Home
OVERVIEW cont.OVERVIEW cont.
Postdelivery CarePostdelivery Care Resuscitation of the NewbornResuscitation of the Newborn Abnormal Deliveries & ComplicationsAbnormal Deliveries & Complications Gynecologic EmergenciesGynecologic Emergencies
Home
FetusFetus UterusUterus PlacentaPlacenta Umbilical CordUmbilical Cord Amniotic SacAmniotic Sac CervixCervix
Anatomy ReviewAnatomy Review
Home
The Stages of Labor The Stages of Labor
1st Stage - 1st contraction until cervix is fully 1st Stage - 1st contraction until cervix is fully dilated.dilated.
2nd Stage - full dilation until birth.2nd Stage - full dilation until birth. 3rd Stage - birth of baby, until delivery of placenta3rd Stage - birth of baby, until delivery of placenta
Home
Signs of LaborSigns of Labor
Beginning of regular contractionsBeginning of regular contractions Bloody showBloody show Rupture of the amniotic sac (water Rupture of the amniotic sac (water
breaks)breaks)
Home
Predelivery EmergenciesPredelivery Emergencies
MiscarriageMiscarriage SeizuresSeizures Vaginal BleedingVaginal Bleeding TraumaTrauma
Home
Miscarriage Miscarriage
Delivery of fetus & placenta before 20 Delivery of fetus & placenta before 20 weeksweeks
Danger - bleeding & infectionDanger - bleeding & infection
Home
Treatment Treatment
Initial assessment Initial assessment History & physical examHistory & physical exam
Ask if she is pregnant Ask if she is pregnant Ask date of last cycleAsk date of last cycle
Home
TreatmentTreatment
Apply external vaginal padsApply external vaginal pads Collect tissuesCollect tissues TransportTransport
Home
Seizures Seizures Seizures Seizures
EclampsiaEclampsia - related to high blood - related to high blood pressure pressure
Home
TreatmentTreatment
Initial assessmentInitial assessment HX & vitalsHX & vitals Transport on left sideTransport on left side Monitor airway & give OMonitor airway & give O22
TransportTransport
Home
Vaginal BleedingVaginal BleedingVaginal BleedingVaginal Bleeding
Early pregnancy - may be normalEarly pregnancy - may be normal Later stages of pregnancyLater stages of pregnancy
Placenta abruptio Placenta abruptio - placenta - placenta separates prematurely separates prematurely
Placenta previa Placenta previa - placenta develops - placenta develops over & covers the mouth of the over & covers the mouth of the uterusuterus
Home
Placenta abruptio Placenta abruptio - - placenta separates placenta separates prematurelyprematurely
Placenta previa Placenta previa - - placenta develops placenta develops over & covers the over & covers the mouth of the mouth of the uterusuterus
Home
TreatmentTreatmentTreatmentTreatment
BSIBSI Initial assessmentInitial assessment History and physical examHistory and physical exam
Ask patient if she has any pain.Ask patient if she has any pain.
Home
TreatmentTreatmentTreatmentTreatment
Transport on left sideTransport on left side Sterile pad or sanitary napkinSterile pad or sanitary napkin Save any tissueSave any tissue TransportTransport
Home
TraumaTraumaTraumaTrauma
Severe bleedingSevere bleeding Injury to fetus Injury to fetus
Home
TreatmentTreatmentTreatmentTreatment
Initial assessmentInitial assessment OO22
Place on left sidePlace on left side Control external bleedingControl external bleeding TransportTransport
Home
Preparing for DeliveryPreparing for DeliveryPreparing for DeliveryPreparing for Delivery
Assessing the need for emergency Assessing the need for emergency deliverydelivery
First decision - whether or not you First decision - whether or not you have time to transport?have time to transport?
Home
Decision based on three factors:Decision based on three factors:
Is the delivery imminentIs the delivery imminent Hospital cannot be reached due to Hospital cannot be reached due to
a natural disaster, weather, or a natural disaster, weather, or traffic conditionstraffic conditions
No transportation is availableNo transportation is available
Home
EquipmentEquipment
Surgical scissors-1 pairSurgical scissors-1 pair Hemostats or cord clamps-3Hemostats or cord clamps-3 Umbilical tape/sterile cordUmbilical tape/sterile cord Small rubber bulb syringeSmall rubber bulb syringe Towels-5Towels-5
Home
EquipmentEquipment
1 dozen 2” x 10” gauze sponges1 dozen 2” x 10” gauze sponges Rubber glovesRubber gloves Baby blanket-1Baby blanket-1 Sanitary napkinsSanitary napkins Plastic bagPlastic bag
Home
Delivering The BabyDelivering The Baby
Position and supportPosition and support Flat, sturdy surfaceFlat, sturdy surface Lie with knees drawn up and Lie with knees drawn up and
spread apartspread apart Elevate buttocks with blanketsElevate buttocks with blankets
Home
Position and supportPosition and supportPosition and supportPosition and support
Create sterile fieldCreate sterile field One towel under buttocksOne towel under buttocks One between her legsOne between her legs One across her abdomenOne across her abdomen
Partner at headPartner at head Reassure/comfortReassure/comfort Assist airway Assist airway
Home
Delivering the HeadDelivering the Head Place fingers on bony part of skullPlace fingers on bony part of skull If amniotic sac does not break, or has not If amniotic sac does not break, or has not
broken:broken: Use clamp to punctureUse clamp to puncture Push away from nose and mouthPush away from nose and mouth
Home
Delivering the HeadDelivering the Head
Umbilical cord around neck?Umbilical cord around neck? Slip over shoulderSlip over shoulder Clamp and cut itClamp and cut it
Home
Delivering the BodyDelivering the Body
Support head and Support head and bodybody
Grasp feetGrasp feet Support with both Support with both
handshands Baby will be Baby will be
slipperyslippery Do not squeeze Do not squeeze
neck or chestneck or chest
Home
Home
Post Delivery CarePost Delivery Care
Initial care of babyInitial care of baby Set baby downSet baby down Same level or lower than birth canalSame level or lower than birth canal On side with head slightly lower than On side with head slightly lower than
bodybody Continue to aspirateContinue to aspirate
Home
Initial care of the babyInitial care of the baby
Wrap in blanketWrap in blanket Warm prior if possibleWarm prior if possible Leave only face exposeLeave only face expose
If not breathing, perform CPRIf not breathing, perform CPR
Home
Cutting the Umbilical cordCutting the Umbilical cord
Clamp with two clampsClamp with two clamps Four fingers width from the babyFour fingers width from the baby Two to six inches apartTwo to six inches apart
Cut between clampsCut between clamps
Home
Apgar scoreApgar score
1 and 5 minutes1 and 5 minutes Healthy baby will score 10Healthy baby will score 10 Five areasFive areas
Home
APGARAPGAR AAppearanceppearance - pink shortly after birth - pink shortly after birth PPulseulse- greater than 100/min- greater than 100/min GGrimacerimace - crying, or withdrawing in - crying, or withdrawing in
response to stimuliresponse to stimuli AActivityctivity - resistance or muscle tone - resistance or muscle tone
when attempts are made to straighten when attempts are made to straighten legslegs
RRespirationsespirations - regular and rapid - regular and rapid
Home
Delivery of PlacentaDelivery of Placenta
Normal DeliveryNormal Delivery Within a few Within a few
minutes of baby’s minutes of baby’s birthbirth
Usually less than Usually less than 250 ml blood loss250 ml blood loss
Record delivery Record delivery timetime
Take to hospitalTake to hospital
Home
Delivery of Placenta Delivery of Placenta Provide prompt transportProvide prompt transport
If not delivered within 30 minutesIf not delivered within 30 minutes 250ml of bleeding occurs before 250ml of bleeding occurs before
delivery of placentadelivery of placenta Significant bleeding occurs after Significant bleeding occurs after
delivery of placentadelivery of placenta Do not pull cord!Do not pull cord!
Home
Home
Click for Video
Home
Resuscitation of NewbornResuscitation of Newborn Assessing the babyAssessing the baby
RespirationsRespirations PulsePulse
Artificial VentilationArtificial Ventilation Use BVMUse BVM 40- 60 breaths per minute40- 60 breaths per minute
Home
Resuscitation of NewbornResuscitation of Newborn
Chest compressionsChest compressions Heart rate is < 60 bpm, or between Heart rate is < 60 bpm, or between
60- 80 bpm and not rising60- 80 bpm and not rising Both thumbs on middle third of the Both thumbs on middle third of the
sternum or one thumb over the sternum or one thumb over the otherother
Home
Abnormal DeliveriesAbnormal Deliveries
Prolapsed Prolapsed umbilical cordumbilical cord
Cord comes out Cord comes out before babybefore baby
Do not replace!Do not replace! Danger: Decreased Danger: Decreased
OO22 to the baby to the baby
Home
TreatmentTreatment Place mother with legs and buttocks Place mother with legs and buttocks
elevatedelevated Exert gentle counter pressure with gloved Exert gentle counter pressure with gloved
handhand Wrap moistened sterile towel around cordWrap moistened sterile towel around cord OxygenOxygen Keep warmKeep warm TransportTransport
Home
Breech DeliveryBreech Delivery
Presenting part Presenting part - - buttocks or feetbuttocks or feet
TreatmentTreatment Position and Position and
drape motherdrape mother Allow buttocks Allow buttocks
and feet to deliverand feet to deliver Support legs and Support legs and
trunktrunk
Home
TreatmentTreatment
Head usually delivers on its ownHead usually delivers on its own If not within 3 minutes of buttocks If not within 3 minutes of buttocks
and trunk, do not pull!and trunk, do not pull! Cup hand over baby’s face/mouth Cup hand over baby’s face/mouth
and transportand transport Head delivers- procedures the Head delivers- procedures the
samesame
Home
Limb PresentationLimb Presentation
Presenting part single arm, leg, or Presenting part single arm, leg, or footfoot
Cannot successfully deliver in the Cannot successfully deliver in the fieldfield
Home
TreatmentTreatment
Give mother OGive mother O22
Place mother on back, head lower Place mother on back, head lower than pelvisthan pelvis
Cover with sterile towelCover with sterile towel TransportTransport
Home
Multiple BirthsMultiple Births
1st baby is small1st baby is small Abdomen still largeAbdomen still large Contractions about 10 minutes after Contractions about 10 minutes after
first babyfirst baby
Home
TreatmentTreatment
Cut cord on first babyCut cord on first baby Follow normal delivery proceduresFollow normal delivery procedures May be considered prematureMay be considered premature
Home
Premature InfantsPremature Infants
Premature Premature - born before 8th month or - born before 8th month or weighing less than 5 1/2 lbs.weighing less than 5 1/2 lbs. Judge weightJudge weight Thinner, smaller, redder than full Thinner, smaller, redder than full
termterm Head largerHead larger
Home
5 important steps in management5 important steps in management5 important steps in management5 important steps in management
Keep warmKeep warm 90-95 degrees F90-95 degrees F
Keep mouth, nose, and throat clear Keep mouth, nose, and throat clear Make sure cord not bleedingMake sure cord not bleeding
Apply additional clamps or tiesApply additional clamps or ties Slightest bleeding seriousSlightest bleeding serious
Home
5 important steps in management5 important steps in management5 important steps in management5 important steps in management
Increase OIncrease O22 in enviroment in enviroment Make tent over headMake tent over head Aim OAim O22 at top of tent at top of tent Do not administer directlyDo not administer directly
Avoid infectionAvoid infection Use sterile equipmentUse sterile equipment Avoid unnecessary handlingAvoid unnecessary handling
Increase OIncrease O22 in enviroment in enviroment Make tent over headMake tent over head Aim OAim O22 at top of tent at top of tent Do not administer directlyDo not administer directly
Avoid infectionAvoid infection Use sterile equipmentUse sterile equipment Avoid unnecessary handlingAvoid unnecessary handling
Home
Gynecologic EmergenciesGynecologic Emergencies
Trauma to external genetaliaTrauma to external genetalia Treat as other bleeding and soft Treat as other bleeding and soft
tissue injuriestissue injuries OO22
Never pack vaginaNever pack vagina TransportTransport
Home
Alleged Sexual Assault and RapeAlleged Sexual Assault and Rape
Patient may refuse assistancePatient may refuse assistance
Home
TreatmentTreatment
BSIBSI AirwayAirway Nonjudgmental attitude during Nonjudgmental attitude during
SAMPLESAMPLE Crime scene protectionCrime scene protection
Home
TreatmentTreatment
Examine genitalia only if profuse Examine genitalia only if profuse bleedingbleeding
Use same sex providers if possibleUse same sex providers if possible Discourage bathing, voiding, or Discourage bathing, voiding, or
cleaning woundscleaning wounds
Home
The EndThe End
Recommended