Obstertric & Gynecological Emergencies Flashcards
Female Genitalia
• External – Labia – Perineum – Mons pubis • Internal – Vagina – Ovaries – Fallopian tubes
Female Reproductive Cycle
Menstruation
• Menstruation
– Stimulated by estrogen and progesterone
– Ovaries release ovum
– Uterus walls thicken
– Fallopian tubes move egg (peristalsis)
– Uterine walls expelled (bleeding 3–5 days)
Female Reproductive Cycle
Fertilization
• Fertilization – Sperm reaches ovum – Ovum becomes embryo – Embryo implants in uterus – Fetal stage begins
Supine Hypotensive Syndrome
- Placenta, infant, and amniotic fluid total 20–24 lbs.
- When supine, mass compresses inferior vena cava
- Cardiac output decreases
- Dizziness and drop in blood pressure
Assessing the Woman in Labor
- Feel the urge to push?
- Examine for crowning
- Feel for uterine contractions
- Take vital signs
Childbirth - Findings Indicating
Possible Need for Resuscitation
- No prior prenatal care
- Premature delivery
- Labor induced by trauma
- Multiple births
- History of pregnancy problems (especially placenta previa and breech presentation)
- Labor induced by drug use (especially narcotics) and alcohol
- Meconium staining when water breaks
Steps for Imminent Delivery
- Control scene
- Proper PPE
- Place mother on bed, floor, or ambulance stretcher
- Remove clothing obstructing vagina
- Position assistant and OB kit
Delivery - Off-Duty Delivery Supplies
- Clean sheets and towels
- Heavy, flat twine or new shoelaces
- Towel or plastic bag (for placenta)
- Clean, unused rubber gloves and eye protection
Assessing the neonate
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Delivery
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After Delivery - Keeping the baby warm
- Heat retention is high priority
- Dry baby
- Discard wet blankets
- Wrap baby in a dry blanket (infant swaddler or “space blanket”)
- Cover head
Cutting the Umbilical Cord
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Neonatal Resuscitation
- Drying, warming, positioning, suction, tactile stimulation
- Oxygen
- BVM
- Chest Compressions
- Intubation
- Medications
Neonatal Resucitation
steps and placement
What are the first steps in neonatal resuscitation
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What is Central Cyanosis - Neonate
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Neoborn - When is artificial ventilation required, and what is the rate of artificial ventilation
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Caring for the Mother
- Mother at risk for serious bleeding, infection, emboli
- Deliver placenta
- Control vaginal bleeding
- Comfort
Delivering the Placenta
• Afterbirth: placenta with umbilical cord, amniotic sac membranes, and tissues
lining uterus
• Placental delivery starts with labor pains
• May take 30 minutes or longer
• Begin transport in 10 minutes (do not wait to deliver placenta)
Controlling Vaginal Bleeding
massage uterus
Providing Comfort to the Mother
- Take vital signs frequently
- Acts of kindness will be appreciated and remembered
- Wipe face and hands with damp washcloth
- Replace blood-soaked sheets and blankets
• What are your responsibilities in caring for the mother?
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• What is considered to be the usual blood loss during childbirth?
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Give examples of acts of kindness toward the mother during childbirth.
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Complication of childbirth
Breech Presentation
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Complication of childbirth
Limb Presentation
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Complication of childbirth
Prolapsed Umbilical Cord
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Multiple Births
- Have appropriate resources
- Clamp or tie cord of first baby
- Assist with delivery of second baby
- Placenta and cord care are same as single delivery
- Keep babies and mother warm
Premature Birth
• Keep baby warm • Keep airway clear • Provide ventilations and chest compressions • Watch umbilical cord for bleeding • Oxygen (blow by) • Call ahead to emergency department
Meconium
- Don’t stimulate infant before suctioning
- Suction mouth, then nose
- Maintain open airway
- Provide ventilations and/or chest compressions
• Why is it important to have your partner or another person (birthing coach or other adult acceptable to the mother) observing as you help the mother through childbirth?
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Emergencies in Pregnancy
- Excessive prebirth bleeding
- Ectopic pregnancy
- Seizures in pregnancy
- Miscarriage and abortion
- Trauma in pregnancy
- Stillbirths
- Accidental death of pregnant woman
Excessive Prebirth Bleeding
- Main sign is unusually profuse bleeding
- Abdominal pain may or may not be felt
- Assess for signs of shock
- High-concentration oxygen and transport
- Place sanitary napkin over vagina
Excessive Prebirth Bleeding
Abruptio Placentae: Uterine Bleeding Placenta, Bleeding may be minimal
Ectopic Pregnancy
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Seizures in Pregnancy
- Existing preeclampsia
- Elevated blood pressure
- Excessive weight gain
- Excessive swelling to face, ankles hands, and feet
- Altered mental status or headache
Miscarriage and Abortion
- Cramping, abdominal pains
- Bleeding: moderate to severe
- Discharge of tissue and blood from vagina
Trauma in Pregnancy
- Pulse beats 10-15 faster than non pregnant women
- Blood loss may be 30%–35% before signs/symptoms appear
- Ask patient if she received blows to abdomen
Trauma in Pregnancy
Ruptured Uterus - Placenta, abdominal wall, torn edge of the uterus, uterus, bleeding
Stillbirths
- Do not resuscitate if it is obvious the baby died some time before birth
- Resuscitate if baby is born in cardiac or respiratory arrest
- Prepare to provide life support
- Emotional support for family
Accidental Death of Pregnant Woman
- Chance to save unborn child
- Begin CPR on mother immediately
- Continue CPR until emergency cesarean section can be performed or you are relieved in emergency department
Gyn emergencies:Vaginal Bleeding
Vaginal Bleeding
• Treat as potential life threat
• Check for associated abdominal pain
• Monitor for hypovolemic shock
Trauma to the External Genitalia - Female
- Observe MOI
- Look for signs of severe blood loss and shock
- Consider additional internal injuries
Sexual Assault
- Treat immediate life threats
- Do not disturb potential evidence
- Examine genitals only if severe bleeding is present
- Discourage bathing, voiding, or cleansing wounds
- Fulfill mandated reporting requirements
Think about it: when arriving at a crime scene, what are the key things to keep in mind as you respond - Sexual Assault
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Chapter Review OB/Gyn
- Although birth is a natural process that usually takes place without complications, involvement of EMS usually indicates something unusual has happened.
- The EMT’s role at a birth is generally to provide reassurance and to assist the mother in the delivery of her baby.
Chapter Review OB/Gyn
• During normal delivery, determine if there should be immediate transport or if birth is
imminent and will take place at the scene.
• If birth is to take place at the scene, have equipment ready and appropriate resources on hand Always be prepared for resuscitation.
Chapter Review OB/Gyn
• Complications of delivery are a true emergency. Be prepared to initiate rapid transport.
• There may also be pre-delivery
emergencies or emergencies associated with pregnancy that you must be prepared to treat.
Chapter Review OB/Gyn
• Stillbirth and death of the mother and sexual assault are difficult emergencies
the EMT is occasionally called upon to manage. Emotional care for these issues may be as important as medical care.
Remember: OB/Gyn
Female reproductive organs present new anatomy and specific potential emergencies. EMTs should recognize the
different anatomy and be prepared to address reproductive emergencies.
• A growing fetus creates massive change to the mother’s body. All systems undergo major alterations.
continued
Remember: OB/Gyn
- Assessment of the woman in labor is designed to predict imminent delivery and to recognize likely resuscitation.
- The urge to push and crowning indicate imminent delivery. Transport typically should be deferred for a home delivery.
Remember: OB/Gyn
- Lack of prenatal care, premature labor, multiple gestation, and underlying conditions indicate a likelihood of neonatal resuscitation.
- Childbirth requires a high level of personal protective equipment.
Remember: OB/Gyn
- The most important aspect of care for a neonate is keeping the baby warm. Resuscitation may be indicated by assessing breathing and heart rate.
- After delivery there are two patients to care for: the infant and the mother.
Remember: OB/Gyn
• EMTs should be familiar with the
pathophysiology and emergency treatment of the various complications of childbirth.
• Care of the sexual assault patient must include medical, legal, and psychological
considerations.
Questions to consider: OB/Gyn
- What is the difference between abrupt placenta and placentae previa?
- How do you care for a prolapsed cord?
- What do you do if the bag of water is still intact during delivery?
Critical Thinking: OB gyn
You are called to a pregnant woman in labor. During your evaluation you find that
it is the woman’s first pregnancy, the baby’s head is not crowning, and contractions are 10 minutes apart.
Critical Thinking: OB gyn
• You ask the mother if she feels the need to move her bowels, and she says no. Do you prepare for delivery at the scene? Or
do you transport the mother to the hospital?
Internal organs diagram pg 839
review everything on 839
body of the uterus
fimbriae - finger like projection to pick up the egg from ovary
day 1 mensturation
day 14 premium day for fertilization**
normally 28 day cycle
day 1 of bleeding
day 14egg released
hormones thicken the wall of the uterus and prepare for implantation after fertilizaiton
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implantation (pg 841)
placenta starts off first - exchanges nutrients and gases
drugs do pass the placenta
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supine hypotensive syndrome*****
last trimester - 20 pounds
110/70 - flat on back
90/40 - what happened ?
Pg 843
elevate the spine board raise up the right side so they are laying on the left side
dizziness and a drop in BP caused when the mother is in a supine position & the weight of the uterus, infant, placenta, and amniotic fluid compresses the inferior vena cava, reducing return of blood to the heart
limits preload back to the heart and BP drops
First stage of labor
start of contractions to full dilation of the cervix 10cm** (full dilation subjective)
Second stage of labor
full dilation of the cervix - baby enters the birth canal until birth
Third stage
birth of baby to birth of the placenta (afterbirth (placenta, umbilical cord, and some tissues from the amitotic sac and the lining of the uterus)
Once the baby delivers pack up and go. Save the placenta so it can be examined by the OB
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rub the uterus - women is going to urinate as it is a natural diuretic
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let the baby nurse to release pytocin…
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pg 844 . what is the contraction interval as compared to what is the contraction
start watch when started - how long it lasts (duration)
Frequency start of one to the start of the next
contraction time, or duration
time from the beginning of a contraction to when the uterus relaxes (start to end)
contraction interval, or frequency
time from the start of one contraction to the beginning of the next (start to start)
pg 843 braxton hix
irregular pre-labor contraction of the uterus
1st pregnancy
16-24 hours
what to ask
review the slides and review - assessing the woman in labor
- ask her name, age & expected due date
- seen a doctor
- when labor pains started and how often she is having pains
- has her bag of waters broken
- does she feel the need to push
- examine for crowning
- feel for uterine contractions
- take vital signs
crowning
can see a presenting part
possible need for resuscitation
premature - before 37 weeks
pg 848
no prenatal care premature delivery labor induced by trauma multiple births hx of problems with the pregnancy meconium staining
complication of meconium staining
pneumonia possible
suction the mouth first and then the nose
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baby starts head first facing down, the shoulders start to come out and the baby turns
suction as soon as the head is out - mouth suction first - no mucos or amniotic fluid
hold the baby level with the vagina to prevent transfusing
clamp 7” from baby and then 3”
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rub the babies back
start to cry
dry him off and put the
loose most heat from the head
silver swadler and a head bonnet
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pg 857 neonatal resucition - things at the bottom of the triangle don’t work well
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- Drying warm position suction tactile
- O2
- BVM
- Chest Compression
ALS
Intubation & medications
ratio with two 15:2
ratio with on 30:2
APGAR pg 854
how well the neonate is doing
an apgar of 8 on a one minute neonate is a good score
0-2 0 bad 2 good
best 10 worst 0
scoring method on how well the neonate is doing made up of Apperance Pulse Grimace Activity Respiratory Effort
begin transport immediately not in 10 minutes as the book says
allow to nurse and massage the fundus
normal blood loss
1200cc before it is a problem
breech
butt comes out
mouth and nose between fingers to create an airway
limb presentation
treat with diesel - fly in helicopter
can not deliver in the field
call physician
prolapsed umbilical cord
cord comes out before the head
lift up on the head to take the pressure off the head
umbilical 2 arteries and one vein
multiple births
just two delivers
premature birth
review slide
know the definition of pre
born less than 37 weeks or weighs less than 5 1/2 pounds
meconium
gets into the mouth and nose and gets into the lungs
868 emergencies in birth
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Abruptio placentae
placenta separated abruptly from the uterine wall - complete separation baby will be dead within 4-6 minutes
marginal - the baby can survive
ectopic pregnancy
tubal pregnancy
will rupture at 6 weeks - fetus dies, much bleeding, have to take the ovary and the tube
unexplained syncope - ectopic bleeding out
placental previa
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baby can develop outside the uterus implant in the abdominal wall
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eclampsia pg 868
tend to occur late in pregnancy - result of pre-eclampsia with hypertension classic triad************* -put on some weight -edema -BP is up (more than 140/90) -protein in the urine
toxcemia of the pregnancy
which of the following is not*** a symptom of pre-ecalmpsia
not blood in the urine
only difference between eclamplsia and pre-ecampsia is a seizure*******
move from one to the other with a seizure
on the test
turn the lights down in the ambulance
keep it calm
make it a nice transport
to prevent seizure
20% chance of the neonate dying for eery seizure
trauma in pregnancy
review - goes into shock the body will shunt body from the baby to the mother
reduce blood flow to the fetus and it will die
still births
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gyn emergencies
vaginal blending think ectopic
sexual assault
most often driven by law enforcement
have to go the TGH or the crisis center
