Chapter 34:OBGYN Emergenicies

When the Stork Delivers to the Snow Bowl

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Anatomy and Physiology

The Reproductive Cycle

• Menstruation cycle is about 28 days• Gestation: The time between conception and birth • 3 trimesters, 12 weeks each

After 12-13 weeks uterus emerges from the protection of pelvic bones• At full term uterus can be found in all 4 quadrants

of abdomen• Born before 37 weeks- premature

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Important Physiological Changes

• Blood volume rises after 28 weeks• Heart rate increases by 15-20 bpm• Slight increase in respiratory rate• BP decreases during mid pregnancy, normal

by final trimester• Can lose 35% blood volume without showing

signs of shock• Fetus can go into shock

Common OBGYN Emergencies

• Abdominal pain• Dysmenorrhea• Cystitis• Ovarian cysts• Pelvic inflammatory disease• Ectopic pregnancy

• Vaginal Bleeding

• GI Trauma

• Sexual Assault

Pregnancy• Possible complications• Hemorrhage: vaginal bleeding during first trimester may signal a

miscarriage or ectopic pregnancy• Pregnancy-Induced Hypertension (PIH): develops after 20th week

of gestation, more common in 1st time pregnancy, twin pregnancies, and women with preexisting diabetes

• Miscarriage: Primary Sign: Spotting or bleeding accompanied by lower abdominal cramping

• Supine Hypotensive Syndrome: BP> 140/90: When the uterus enlarges, compressing the vena cava, resulting in abnormally low blood pressure

WHAT DO I DO?!

SO IN ALL OTHER CASES, I’M SUPPOSED TO DELIVER THIS THING??

That’s gross

Pregnancy

Pregnancy

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Transport to Hospital if…

• It will take less than 20 min to get there• The umbilical cord is visible inside the vagina

(prolapsed cord)• -If any part of the baby other than the top it the head

is visible in the vagina (a breech delivery)• -If woman says her DR said she would need a C-section• -If this delivery is a woman’s first and the amount of

the baby’s head that is visible is smaller than 1 in across

Pregnancy

How to Deliver a Baby and not Dissolve into Tears

1. Use a disposable sterile OB delivery kit2. Assist the mother, if necessary, in removing her clothing and

place in semi-fowler’s position. 3. Time the contractions4. Once the baby is crowning, allow the mother to push5. Deliver head and shoulders6. Should transportation be delayed more than 20 minutes, you

will need to cut the umbilical cord7. Delivery of the placenta***Always transport mother and baby to the hospital or other

ALS point

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Newborn Care: APGAR• Appearance• Pulse• Grimace or irritability• Activity or muscle tone• Respirations

Possible Trauma

• Ruptured uterus• S/S: sharp pain following direct trauma to abdomen, irregular

abdomen• Abruptio placenta• S/S: Vaginal bleeding, abdominal pain, constant uterine

contractions, expanding uterine height• Premature labor• Rupture of membranes: amniotic sac or uterus

Abruptio Placenta

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Amniotic Sac Rupture

Management

• Initial management• Scene safe• ABCDs• SAMPLE• OPQRST• DCAP-BTLS• ALS if needed

• Management following trauma

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