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Home OBSTETRICS AND GYNECOLOGY

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Slide 2 Home OBSTETRICS AND GYNECOLOGY Slide 3 Home Lesson Objective: Lesson Objective: Indicate procedures for emergency (pre -hospital) childbirth. Slide 4 Home OVERVIEW n Anatomy Review n Beginning of Labor n Predelivery Emergencies n Preparing for Delivery n Delivering the Baby Slide 5 Home OVERVIEW cont. n Postdelivery Care n Resuscitation of the Newborn n Abnormal Deliveries & Complications n Gynecologic Emergencies Slide 6 Home n Fetus n Uterus n Placenta n Umbilical Cord n Amniotic Sac n Cervix Anatomy Review Slide 7 Home The Stages of Labor n 1st Stage - 1st contraction until cervix is fully dilated. n 2nd Stage - full dilation until birth. n 3rd Stage - birth of baby, until delivery of placenta Slide 8 Home Signs of Labor Beginning of regular contractions Beginning of regular contractions Bloody show Bloody show Rupture of the amniotic sac (water breaks) Rupture of the amniotic sac (water breaks) Slide 9 Home Predelivery Emergencies n Miscarriage n Seizures n Vaginal Bleeding n Trauma Slide 10 Home Miscarriage n Delivery of fetus & placenta before 20 weeks n Danger - bleeding & infection Slide 11 Home Treatment n Initial assessment n History & physical exam u Ask if she is pregnant u Ask date of last cycle Slide 12 Home Treatment n Apply external vaginal pads n Collect tissues n Transport Slide 13 HomeSeizuresSeizures n Eclampsia - related to high blood pressure Slide 14 Home Treatment n Initial assessment n HX & vitals n Transport on left side n Monitor airway & give O 2 n Transport Slide 15 Home Vaginal Bleeding n Early pregnancy - may be normal n Later stages of pregnancy u Placenta abruptio - placenta separates prematurely u Placenta previa - placenta develops over & covers the mouth of the uterus Slide 16 Home n Placenta abruptio - placenta separates prematurely n Placenta previa - placenta develops over & covers the mouth of the uterus Slide 17 HomeTreatmentTreatment n BSI n Initial assessment n History and physical exam u Ask patient if she has any pain. Slide 18 HomeTreatmentTreatment n Transport on left side n Sterile pad or sanitary napkin n Save any tissue n Transport Slide 19 HomeTraumaTrauma n Severe bleeding n Injury to fetus Slide 20 HomeTreatmentTreatment n Initial assessment n O 2 n Place on left side n Control external bleeding n Transport Slide 21 Home Preparing for Delivery Assessing the need for emergency delivery n First decision - whether or not you have time to transport? Slide 22 Home n Decision based on three factors: u Is the delivery imminent u Hospital cannot be reached due to a natural disaster, weather, or traffic conditions u No transportation is available Slide 23 Home Equipment n Surgical scissors-1 pair n Hemostats or cord clamps-3 n Umbilical tape/sterile cord n Small rubber bulb syringe n Towels-5 Slide 24 Home Equipment n 1 dozen 2 x 10 gauze sponges n Rubber gloves n Baby blanket-1 n Sanitary napkins n Plastic bag Slide 25 Home Delivering The Baby Position and support n Flat, sturdy surface n Lie with knees drawn up and spread apart n Elevate buttocks with blankets Slide 26 Home Position and support n Create sterile field u One towel under buttocks u One between her legs u One across her abdomen n Partner at head u Reassure/comfort u Assist airway Slide 27 Home Delivering the Head n Place fingers on bony part of skull n If amniotic sac does not break, or has not broken: u Use clamp to puncture u Push away from nose and mouth Slide 28 Home Delivering the Head n Umbilical cord around neck? u Slip over shoulder u Clamp and cut it Slide 29 Home Delivering the Body n Support head and body n Grasp feet n Support with both hands u Baby will be slippery u Do not squeeze neck or chest Slide 30 Home Slide 31 Post Delivery Care Initial care of baby n Set baby down n Same level or lower than birth canal n On side with head slightly lower than body n Continue to aspirate Slide 32 Home Initial care of the baby n Wrap in blanket u Warm prior if possible u Leave only face expose n If not breathing, perform CPR Slide 33 Home Cutting the Umbilical cord n Clamp with two clamps u Four fingers width from the baby u Two to six inches apart n Cut between clamps Slide 34 Home Apgar score n 1 and 5 minutes n Healthy baby will score 10 n Five areas Slide 35 Home APGAR n Appearance - pink shortly after birth n Pulse- greater than 100/min n Grimace - crying, or withdrawing in response to stimuli n Activity - resistance or muscle tone when attempts are made to straighten legs n Respirations - regular and rapid Slide 36 Home Delivery of Placenta n Normal Delivery u Within a few minutes of babys birth u Usually less than 250 ml blood loss u Record delivery time u Take to hospital Slide 37 Home Delivery of Placenta n Provide prompt transport u If not delivered within 30 minutes u 250ml of bleeding occurs before delivery of placenta u Significant bleeding occurs after delivery of placenta n Do not pull cord! Slide 38 Home Slide 39 Click for Video Slide 40 Home Resuscitation of Newborn n Assessing the baby u Respirations u Pulse n Artificial Ventilation u Use BVM u 40- 60 breaths per minute Slide 41 Home Resuscitation of Newborn n Chest compressions u Heart rate is < 60 bpm, or between 60- 80 bpm and not rising u Both thumbs on middle third of the sternum or one thumb over the other Slide 42 Home Abnormal Deliveries Prolapsed umbilical cord n Cord comes out before baby n Do not replace! n Danger: Decreased O 2 to the baby Slide 43 Home Treatment n Place mother with legs and buttocks elevated n Exert gentle counter pressure with gloved hand n Wrap moistened sterile towel around cord n Oxygen n Keep warm n Transport Slide 44 Home Breech Delivery n Presenting part - buttocks or feet n Treatment u Position and drape mother u Allow buttocks and feet to deliver u Support legs and trunk Slide 45 Home Treatment n Head usually delivers on its own u If not within 3 minutes of buttocks and trunk, do not pull! u Cup hand over babys face/mouth and transport u Head delivers- procedures the same Slide 46 Home Limb Presentation n Presenting part single arm, leg, or foot n Cannot successfully deliver in the field Slide 47 Home Treatment n Give mother O 2 n Place mother on back, head lower than pelvis n Cover with sterile towel n Transport Slide 48 Home Multiple Births n 1st baby is small n Abdomen still large n Contractions about 10 minutes after first baby Slide 49 Home Treatment n Cut cord on first baby n Follow normal delivery procedures n May be considered premature Slide 50 Home Premature Infants n Premature - born before 8th month or weighing less than 5 1/2 lbs. u Judge weight u Thinner, smaller, redder than full term u Head larger Slide 51 Home 5 important steps in management n Keep warm u 90-95 degrees F n Keep mouth, nose, and throat clear n Make sure cord not bleeding u Apply additional clamps or ties u Slightest bleeding serious Slide 52 Home 5 important steps in management n Increase O 2 in enviroment u Make tent over head u Aim O 2 at top of tent u Do not administer directly n Avoid infection u Use sterile equipment u Avoid unnecessary handling n Increase O 2 in enviroment u Make tent over head u Aim O 2 at top of tent u Do not administer directly n Avoid infection u Use sterile equipment u Avoid unnecessary handling Slide 53 Home Gynecologic Emergencies Trauma to external genetalia u Treat as other bleeding and soft tissue injuries u O 2 u Never pack vagina u Transport Slide 54 Home Alleged Sexual Assault and Rape Patient may refuse assistance Slide 55 Home Treatment u BSI u Airway u Nonjudgmental attitude during SAMPLE u Crime scene protection Slide 56 Home Treatment n Examine genitalia only if profuse bleeding n Use same sex providers if possible n Discourage bathing, voiding, or cleaning wounds Slide 57 Home The End The End