Upload
antony-sebastian
View
241
Download
0
Embed Size (px)
Citation preview
8/3/2019 Obstetric & Gynecological Emergencies
1/79
1
Obstetric and GynecologicalEmergencies
8/3/2019 Obstetric & Gynecological Emergencies
2/79
2
Anatomy of Pregnancy
Fetus
Uterus
Cervix Bloody show
Placenta
Afterbirth
Umbilical cord
Amniotic sac
Vagina
8/3/2019 Obstetric & Gynecological Emergencies
3/79
3
Fetus The developing baby during pregnancy
Full-term pregnancy last approximately 280 days
or39 to 40 weeks from day of last normalmenstrual cycle
9 calendar months
9
months divided into3
-3
month trimesters EDC (estimated date of confinement)
Approximate date of birth
Based on date of mothers last menstrual period
8/3/2019 Obstetric & Gynecological Emergencies
4/79
4
Uterus Organ that contains the developing fetus
Smooth muscle and blood vessels
Allow for great expansion
Forcible contractions during labor & delivery
Rapid contractions after delivery
Constricts blood vessels and prevents
hemorrhage
8/3/2019 Obstetric & Gynecological Emergencies
5/79
5
Cervix Neck of the uterus
Contains mucus plug
Seals uterine opening
Prevents contamination
Effacement - thinning of cervix
Mucus plug appears as pink-tinged vaginal
discharge or bloody show
Signals the first stage of labor
8/3/2019 Obstetric & Gynecological Emergencies
6/79
6
Placenta Disk-shaped inner lining
Attaches to uterine wall after egg is
fertilized
Contains blood vessels
Allows for oxygen and nourishment for fetus
Eliminates carbon dioxide and waste
8/3/2019 Obstetric & Gynecological Emergencies
7/79
7
Afterbirth
Placenta separates from uterine wall after
delivery of infant
Usually weighs about 1 pound, or generally 1
sixth of infants weight
Placenta needs to be saved and examined
8/3/2019 Obstetric & Gynecological Emergencies
8/79
8
Umbilical Cord Infants lifeline
1 inch wide and 22 inches long
Attaches fetus to placenta
1 vein carries oxygenated blood & nutrients to
fetus
2 arteries carry deoxygenated blood & waste to
placenta
Protected by Whartons jelly
8/3/2019 Obstetric & Gynecological Emergencies
9/79
9
Amniotic Sac
Bag of waters
Insulates and protects the fetus during pregnancy
Varies from 500 to 1,000 milliliters
Rupturing indicates that labor has started
Helps lubricate birth canal & remove bacteria
Part of sac serves as resilient wedge to help withdilation of cervix
8/3/2019 Obstetric & Gynecological Emergencies
10/79
10
Vagina Lower part of birth canal
8 to 12 centimeters in length
Undergoes changes during pregnancy to
allow for passage of the infant at birth
8/3/2019 Obstetric & Gynecological Emergencies
11/79
11
Labor Pains Contraction of uterus
Pains generally start in lower back & as
labor progresses, pain becomes more
noticeable in lower abdomen
Intervals last from 30 seconds to 1 minute
& occur at 2 to 3 minute intervals
8/3/2019 Obstetric & Gynecological Emergencies
12/79
12
Braxton-Hicks Contractions False labor
Caused by changes in uterus as it adjusts in
size and shape
Can happen any time during pregnancy
8/3/2019 Obstetric & Gynecological Emergencies
13/79
13
First Stage of Labor Longest stage
Beginning of contractions to full dilation
Cervix thins (effacement)
Contractions (cramp-like pains)
Bloody show before or during this stage
Amniotic sac may break before or during thisstage
1st child, stage can average 18 hours or more
8/3/2019 Obstetric & Gynecological Emergencies
14/79
14
Second Stage of Labor Baby enters birth canal and is born
Fergusons Reflex
Urge to push as babys body puts pressure on
the perineum (area between vagina & rectum)
Crowning - presenting part from vaginal
opening Cephalic presentation - head first
Breech birth - buttocks or both feet
8/3/2019 Obstetric & Gynecological Emergencies
15/79
15
Third Stage of Labor Delivery of placenta or afterbirth
Placenta separates from uterine wall and is
expelled
8/3/2019 Obstetric & Gynecological Emergencies
16/79
16
Predelivery Emergencies
8/3/2019 Obstetric & Gynecological Emergencies
17/79
17
Supine Hypotensive Syndrome Near birth, weight of uterus, fetus, placenta,
& amniotic fluid can be as much as 20-24
pounds
If mother is supine weight can compress
inferior vena cava, reducing venous return
to the heart, reducing cardiac output.(amount of blood pumped by the heart in 1
minute)
8/3/2019 Obstetric & Gynecological Emergencies
18/79
18
Signs and Symptoms/ Treatment Vertigo
Possible syncope
Drop in blood pressure
AssessA,B,Cs
All third trimester patients should be transported
on their left side Place a pillow or blanket behind their back to
ensure proper positioning
8/3/2019 Obstetric & Gynecological Emergencies
19/79
19
Miscarriage/Spontaneous Abortion
Fetus & placenta delivered before the 28th
week of pregnancy
When it happens on its own
Dont waste time trying to determine if a
miscarriage has occurred
8/3/2019 Obstetric & Gynecological Emergencies
20/79
20
InducedAbortion
Deliberate actions taken to stop pregnancy
Therapeutic abortion
Done as a legal medical procedure
Criminal abortion
Illegal attempt to stop abortion
Use drugs, chemicals, poisons, to induce labor
Insert objects into the vagina to disrupt pregnancy
8/3/2019 Obstetric & Gynecological Emergencies
21/79
21
Signs & Symptoms Cramping abdominal pain
Bleeding moderate to severe, bright or dark
red
Passage of tissue or blood clots
NOTE: Ask about starting date of LMP. If
more than 24 weeks, prepare OB kit.
8/3/2019 Obstetric & Gynecological Emergencies
22/79
22
Self Induced/Non Medical Abortions
Pain is much greater
Bleeding usually more severe
May be high fever from infection
8/3/2019 Obstetric & Gynecological Emergencies
23/79
23
Emergency Care Big Os
Monitor vitals
Sanitary napkin over vagina Treat for shock
Immediate transport
Replace and save blood soaked pads
Save all tissue
If poison was ingested contact med-control
Provide emotional support
8/3/2019 Obstetric & Gynecological Emergencies
24/79
24
Note: Use the term miscarriage when speaking
with family or where bystanders can hear
you. Most people associate spontaneousabortion with self-induced abortion.
8/3/2019 Obstetric & Gynecological Emergencies
25/79
25
Seizure Can be life-threatening emergency
Provide care based on signs & symptoms
Protect patient from hurting themselves
Transport on left side
Minimize lights and sirens Provide support
8/3/2019 Obstetric & Gynecological Emergencies
26/79
26
Vaginal Bleeding Can often occur late in pregnancy
With or without pain
Excessive bleeding can be life-threatening
Assure ABCs
Big Os Apply sanitary napkin and transport
Treat for hypoperfusion
8/3/2019 Obstetric & Gynecological Emergencies
27/79
27
Trauma Treat as you would any other trauma patient
Pay close attention to abdominal pain,
cramping
Asses for vaginal bleeding or loss of
amniotic fluid
Do not touch the vagina
Tilt spine board so patient is left lateral
8/3/2019 Obstetric & Gynecological Emergencies
28/79
28
General Care Predelivery Emergencies
Airway
Big Os
Ensure adequate circulation
Treat for shock
Control bleeding
Never place anything into vagina Provide same care as for any other patient
Transport left lateral recumbent
8/3/2019 Obstetric & Gynecological Emergencies
29/79
29
Active Labor & Normal Delivery
8/3/2019 Obstetric & Gynecological Emergencies
30/79
30
Assessment
Same as for any predelivery emergency
Transport unless delivery is expected within
a few minutes
8/3/2019 Obstetric & Gynecological Emergencies
31/79
31
On Scene Delivery vs..Transport Patients first delivery?
How long has patient been pregnant?
Any bleeding or discharge? Any contractions or pain present?
What is the frequency and duration of
contractions?
Is the patient crowning?
Feel the urge to push?
Is uterus hard upon palpation?
8/3/2019 Obstetric & Gynecological Emergencies
32/79
32
3 Cases When Delivery Must be Assisted
No suitable transportation
Hospital or physician cant be reached due
to bad weather
Natural disaster, or if delivery is imminent
8/3/2019 Obstetric & Gynecological Emergencies
33/79
33
Signs & Symptoms of Probable Delivery
Crowning has occurred
Contractions closer than 2 minutes apart,
intense, last 30 to 90 seconds Patient has the urge to push
Patients abdomen is hard
If birth does not occur within 10 minutes,contact medical control for permission to
transport
8/3/2019 Obstetric & Gynecological Emergencies
34/79
34
Delivery BSI precautions
Do not touch vaginal area except to deliver
& in the presence of your partner
Dont allow the patient to use the bathroom
Do not hold the mothers legs together
Use sterile OB kit
8/3/2019 Obstetric & Gynecological Emergencies
35/79
35
Things to Remember Stay calm
Explain that you are trained to help
Ensure mothers comfort, modesty, & peace
of mind
Be able to recognize your limitations
8/3/2019 Obstetric & Gynecological Emergencies
36/79
36
Emergency Care Position patient
Create sterile field around vaginal opening
Monitor patient for vomiting
Continually assess for crowning
Place glove fingers on bony part of infant'sskull when it crowns
Puncture amniotic sac if not already broken
8/3/2019 Obstetric & Gynecological Emergencies
37/79
37
Determine position of umbilical cord
Suction infants airway
As torso is born support with 2 hands
Grasp feet as they are born
Clean and suction mouth and nose Dry, wrap, and position infant
On back, level with vagina until cord is cut
Emergency Care Cont...
8/3/2019 Obstetric & Gynecological Emergencies
38/79
38
Assign care of infant to partner and you
continue care of mother
Clamp, tie ,& cut cord as pulsation ceases
1st clamp 6 to 7 inches from infant
2nd clamp 3 inches from first
Deliver placenta
Usually delivers within 10 to 20 minutes
Do not delay transport for delivery of placenta
Emergency Care Cont...
8/3/2019 Obstetric & Gynecological Emergencies
39/79
39
Place placenta in towel and plastic bag
Place 1 or2 sanitary napkins over vaginal
opening Record time of delivery and transport
500cc normal blood loss
Excessive blood loss appears Provide big Os
Massage uterus
Emergency Care Cont...
8/3/2019 Obstetric & Gynecological Emergencies
40/79
40
Active Labor with Abnormal
Delivery
8/3/2019 Obstetric & Gynecological Emergencies
41/79
41
A
ssessment Perform all assessments as with any other
delivery emergency
8/3/2019 Obstetric & Gynecological Emergencies
42/79
42
Signs and Symptoms Fetal presentation other than head
Abnormal color or smell of amniotic fluid
Labor before 38th week of pregnancy
Recurrence of contractions after first infant
is born
8/3/2019 Obstetric & Gynecological Emergencies
43/79
43
General Emergency Care Immediate transport
Big Os
Continuous monitoring of vital signs
8/3/2019 Obstetric & Gynecological Emergencies
44/79
8/3/2019 Obstetric & Gynecological Emergencies
45/79
45
Prolapsed Cord Umbilical cord presents first
Cord is pinched off between the head and vaginal wall
Transport mother in knee chest position or elevate hips Wrap cord in moist sterile towel soaked with saline, then a
warm dry towel to prevent heat loss
Insert sterile fingers into vagina to gently lift head or
buttocks to decrease pressure on cord Transport in this position and check for pulsation in the
cord
8/3/2019 Obstetric & Gynecological Emergencies
46/79
46
Breech Birth Involves buttocks or both feet first
Can involve limb presentations
8/3/2019 Obstetric & Gynecological Emergencies
47/79
47
Emergency Care Transport immediately
Big Os
Position mother in Trendelenberg with
pelvis elevated
If prolonged delivery of head, form a V
with 2 fingers and place in vaginal opening
to maintain airway for infant
8/3/2019 Obstetric & Gynecological Emergencies
48/79
48
Multiple Births Most mothers know if they are expecting twins
If abdomen appears to be unusually large after 1st
delivery, there may be another baby. Usually will deliver within minutes after the 1st
Second baby may be breech
Can share placentas or have their own Use same delivery method
Be sure to identify which baby was 1st or2nd
8/3/2019 Obstetric & Gynecological Emergencies
49/79
49
Meconium Staining
Indication of fetal distress during labor
Passing of bowel movement
Amniotic fluid is a greenish or brownish-yellow incolor
Suction the infants mouth and nose as soon as the
head emerges
Do not stimulate breathing before suctioning
8/3/2019 Obstetric & Gynecological Emergencies
50/79
50
Premature Birth
Infant weighing less than 5pounds or born before the
38th week
Dry infant and maintain warmth
Use gentle suction
Prevent bleeding from umbilical cord
Administer Oxygen by blow by method
Oxygen tubing inch above infants face or tent Prevent contamination
Keep infant warm and heat vehicle
8/3/2019 Obstetric & Gynecological Emergencies
51/79
51
Newborn Infant
Assessment
8/3/2019 Obstetric & Gynecological Emergencies
52/79
52
APGAR
Appearance
Pulse
Grimace
Activity
Respiration
Gives a good indication of the infants condition Should be performed 1 minute after birth and 4
minutes later
8/3/2019 Obstetric & Gynecological Emergencies
53/79
53
APGAR Scale
Ranges from 0 to 10 points
7-10 points -newborn should be active,
routine care
4-6 points - newborn is moderately
depressed. Provide stimulation & oxygen
0-3 points - severely depressed. Provide
extensive care with BVM & CPR.
8/3/2019 Obstetric & Gynecological Emergencies
54/79
54
Appearance
Skin or entire body blue or pale 0 points
Blue hands & feet with pink skin at the core
1 point (acrocyanosis)
Extremities and trunk pink2 points
8/3/2019 Obstetric & Gynecological Emergencies
55/79
55
Pulse
Count heart rate for at least 30 seconds
apical pulse
No pulse - 0 points
Pulse rate under 100 - 1 point
Pulse rate over 100 award 2 points
8/3/2019 Obstetric & Gynecological Emergencies
56/79
56
Grimace
Gently flick the soles of the infants feet &
observe facial expressions
No reflex activity to stimulation - 0 points
Some facial grimace - 1 point
Grimace, cough, sneeze, or cry - 2 points
8/3/2019 Obstetric & Gynecological Emergencies
57/79
57
Activity
Flexion of arms and legs
Resistance when you try to extend them
Limp , displays no extremity movement - 0
points
Some flexion without active movement - 1
point
Actively moving - 2 points
8/3/2019 Obstetric & Gynecological Emergencies
58/79
58
Respiration
No respiratory effort - 0 points
Slow irregular breathing effort, weak cry - 1
point
Strong cry and good respirations - 2 points
Be sure to stimulate breathing by flicking
the soles of the feet or rubbing the infantsback in a circular motion
8/3/2019 Obstetric & Gynecological Emergencies
59/79
59
Signs & Symptoms Severely Depressed Newborn
Respiratory rate over60 per minute
Diminished breath sounds
Heart rate over 180 or under 100 per min.
Obvious signs of trauma from delivery
Poor or absent skeletal muscle tone
Respiratory arrest, or severe distress
Meconium staining
Weak pulses
Cyanotic body Poor peripheral perfususion
Lack of or poor response to stimulation
Apgar score under 4
8/3/2019 Obstetric & Gynecological Emergencies
60/79
60
Emergency Care
Airway & warmth are most crucial for newborn
BVM 40 to 60 per min. if
Breathing is shallow,gasping, slow, or absent
Heart rate less than 100
Core remains cyanotic even with blow by O2
Heart rate drops below 60 or between 60 to80 with no increase, begin CPR
Follow AHA guidelines
8/3/2019 Obstetric & Gynecological Emergencies
61/79
6
1
Dry, Warm, Position, Suction, Tactile Stimuli
Oxygen
Bag-Valve-MaskVentilation
Chest Compressions
Medications
Inverted Pyramid Neonatal Resuscitation
8/3/2019 Obstetric & Gynecological Emergencies
62/79
62
Placenta Previa
Placenta is low and may cover the uterine
outlet
Can tear or separate from uterus
Results in painless hemorrhaging
Placenta has no nerve endings
8/3/2019 Obstetric & Gynecological Emergencies
63/79
63
Assessment History
Having born more than 2 children
Early vaginal bleeding or spotting
Previous cesarean section
Recent sexual intercourse
Bright red vaginal bleeding during third trimester
Soft uterus without tenderness upon palpation Present fetal heart tones & movement
8/3/2019 Obstetric & Gynecological Emergencies
64/79
64
Emergency Care
Big Os
Control bleeding
Treat for shock
Immediate transport
8/3/2019 Obstetric & Gynecological Emergencies
65/79
65
Abruptio Placenta
Normal placenta tears away from the
uterine wall during the last trimester
Little or no external vaginal bleeding
Severe abdominal pain
Patient may feel a tearing sensation
Uterine sensory fibers detect placenta
separation
8/3/2019 Obstetric & Gynecological Emergencies
66/79
66
Assessment History
History of hypertension
Born more than 2 children
Previous abruption or placenta previa
Recent strenuous exercise
Abdominal trauma
Sharp severe abdominal pain
Possible dark red vaginal bleeding
Blood loss out of proportion for degree of shock
Possible uterine contractions
Tender, rigid, firm abdomen
Absent fetal heart tones
8/3/2019 Obstetric & Gynecological Emergencies
67/79
67
Emergency Care
Big Os
Control bleeding (if necessary)
Treat for shock
Immediate transport
8/3/2019 Obstetric & Gynecological Emergencies
68/79
68
Toxemia/Preeclampsia
Poisoning of the blood during pregnancy
Most frequent in last trimester
Women in 20s first time pregnancy
At risk mothers:
Diabetes
Heart disease
Renal problems
Hypertension
8/3/2019 Obstetric & Gynecological Emergencies
69/79
69
Signs & Symptoms/Preeclampsia
Hypertension
Edema
Excessive weight gain
Extreme swelling of face, hands, and feet
Severe cases
Headache
Sensitivity to light
Visual difficulties
Pain in upper abdomen
Apprehension and shakiness
8/3/2019 Obstetric & Gynecological Emergencies
70/79
70
Eclampsia
Second stage of toxemia
Difference between preeclampsia and eclampsia is the
onset of seizures or coma.
During seizure placenta can separate from uterine wall
Death can also result from
Cerebral hemorrhage
Respiratory arrest Renal failure
Circulatory collapse
8/3/2019 Obstetric & Gynecological Emergencies
71/79
71
Emergency Care
Big Os
Suction (if necessary)
If seizure begins, positive pressure ventilation
Transport in a calm and quiet manner as possible
8/3/2019 Obstetric & Gynecological Emergencies
72/79
72
Ruptured Uterus
Uterine wall thins too much around cervix
as fetus grows
Uterine wall ruptures
Fetus released into abdominal cavity
Mortality to mother usually 5 to 20%
Infant mortality over50%
Requires immediate surgery
8/3/2019 Obstetric & Gynecological Emergencies
73/79
73
Assessment Findings
Previous uterine rupture
Abdominal trauma
Large fetus
Born more than 2 children
Prolonged or difficult labor
Tearing or shearing sensation in abdomen
Constant severe abdominal pain
Nausea
Signs of shock Vaginal bleeding (minor, or heavy)
Cessation of noticeable uterine contractions
Palpation of infant in abdominal cavity
8/3/2019 Obstetric & Gynecological Emergencies
74/79
74
Emergency Care
Big Os
Control bleeding
Treat for shock
Immediate transport
8/3/2019 Obstetric & Gynecological Emergencies
75/79
75
Ectopic Pregnancy
Implantation of a fertilized egg outside the
uterus
Leading cause of maternal death in the firsttrimester
Any female of childbearing age with acute
abdominal pain is said to have an ectopicpregnancy until proven otherwise
8/3/2019 Obstetric & Gynecological Emergencies
76/79
76
Assessment History Previous ectopic pregnancies
History of PID
Missed menstrual cycles
Sudden, sharp, or knife-like abdominal pain localized on one side
Vaginal spotting Pain radiating to one or both shoulders
Tender, bloated abdomen
Palpable mass in abdomen
Weakness or dizziness when sitting or standing
Decreased BP. (late sign) Increased heart rate
Shock
Bluish discoloration around naval (late sign)
Urge to defecate
8/3/2019 Obstetric & Gynecological Emergencies
77/79
77
Emergency Care
Big Os
Treat for shock
Constantly reassess vital signs
Immediate transport
8/3/2019 Obstetric & Gynecological Emergencies
78/79
78
Stillborn Infants
Baby dies sometime before birth
Death is obvious
Blisters
Foul odor
Skin or tissue deterioration
Discoloration
Softened head If baby is born in respiratory or cardiac arrest
begin resuscitative measures
8/3/2019 Obstetric & Gynecological Emergencies
79/79
Emergency Care
Never lie to parents
Allow mother to see baby if she wants to
Baptize the baby if asked
Document time if death