obstretric review.ppt

8/14/2019 obstretric review.ppt

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OBSTETRICS AND

GYNECOLOGY
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Lesson Objective:

Indicate procedures for emergency(pre -hospital) childbirth.


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OVERVIEW

Anatomy ReviewBeginning of LaborPredelivery EmergenciesPreparing for Delivery

Delivering the Baby


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OVERVIEW cont.

Postdelivery CareResuscitation of the NewbornAbnormal Deliveries & ComplicationsGynecologic Emergencies


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FetusUterusPlacentaUmbilical Cord

Amniotic Sac

Cervix

Anatomy Review


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The Stages of Labor

1st Stage - 1st contraction until cervix isfully dilated.

2nd Stage - full dilation until birth.3rd Stage - birth of baby, until delivery ofplacenta


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Signs of Labor

Beginning of regular contractionsBloody showRupture of the amniotic sac (waterbreaks)


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Predelivery Emergencies

Miscarriage

SeizuresVaginalBleeding

Trauma


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Miscarriage

Delivery of fetus & placenta before 20weeks

Danger - bleeding & infection


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Treatment

Initial assessmentHistory & physical exam

Ask if she is pregnantAsk date of last cycle


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Treatment

Apply external vaginal pads

Collect tissuesTransport


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Seizures

Eclampsia - related to high bloodpressure


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Treatment

Initial assessmentHX & vitalsTransport on left sideMonitor airway & give O 2

Transport


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Vaginal Bleeding

Early pregnancy - may be normalLater stages of pregnancy

Placenta abruptio - placentaseparates prematurelyPlacenta previa - placenta developsover & covers the mouth of theuterus


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Placenta abruptio -placenta separates

prematurely

Placenta previa -placenta developsover & covers themouth of theuterus


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Treatment

BSIInitial assessment

History and physical examAsk patient if she has any pain.


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Treatment

Transport on left sideSterile pad or sanitary napkinSave any tissueTransport


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Trauma

Severe bleedingInjury to fetus


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Treatment

Initial assessmentO 2Place on left sideControl external bleedingTransport


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Preparing for DeliveryAssessing the need for emergency

delivery

First decision - whether or not youhave time to transport?


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Decision based on three factors:

Is the delivery imminent

Hospital cannot be reached due toa natural disaster, weather, ortraffic conditions

No transportation is available


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Equipment

Surgical scissors-1 pairHemostats or cord clamps-3

Umbilical tape/sterile cordSmall rubber bulb syringeTowels-5


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Equipment

1 dozen 2 x 10 gauze sponges Rubber gloves

Baby blanket-1Sanitary napkinsPlastic bag


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Delivering The Baby

Position and support Flat, sturdy surfaceLie with knees drawn up andspread apart

Elevate buttocks with blankets


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Position and support

Create sterile fieldOne towel under buttocksOne between her legs

One across her abdomenPartner at head

Reassure/comfortAssist airway


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Delivering the HeadPlace fingers on bony part of skullIf amniotic sac does not break, or has notbroken:

Use clamp to puncturePush away from nose and mouth


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Delivering the Head

Umbilical cord around neck?Slip over shoulderClamp and cut it


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Delivering the Body

Support head andbody

Grasp feetSupport with bothhands

Baby will beslipperyDo not squeezeneck or chest


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Post Delivery Care

Initial care of baby Set baby downSame level or lower than birth canalOn side with head slightly lower thanbodyContinue to aspirate


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Initial care of the baby

Wrap in blanketWarm prior if possibleLeave only face expose

If not breathing, perform CPR


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Cutting the Umbilical cord

Clamp with two clamps

Four fingers width from the babyTwo to six inches apart

Cut between clamps


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Apgar score

1 and 5 minutesHealthy baby will score 10Five areas


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APGAR

Appearance - pink shortly after birthPulse - greater than 100/minGrimace - crying, or withdrawing in

response to stimuliActivity - resistance or muscle tonewhen attempts are made to

straighten legsRespirations - regular and rapid


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Delivery of Placenta

Normal DeliveryWithin a few

minutes of babysbirthUsually less than250 ml blood lossRecord deliverytimeTake to hospital


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Delivery of Placenta

Provide prompt transportIf not delivered within 30 minutes250ml of bleeding occurs before

delivery of placentaSignificant bleeding occurs afterdelivery of placenta

Do not pull cord!


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Resuscitation of Newborn

Assessing the babyRespirationsPulse

Artificial VentilationUse BVM40- 60 breaths per minute


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Resuscitation of Newborn

Chest compressionsHeart rate is < 60 bpm, or between60- 80 bpm and not risingBoth thumbs on middle third of thesternum or one thumb over the

other


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Abnormal Deliveries

Prolapsedumbilical cord

Cord comes outbefore babyDo not replace!

Danger: DecreasedO 2 to the baby


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Treatment

Place mother with legs and buttockselevatedExert gentle counter pressure with

gloved handWrap moistened sterile towel aroundcord

OxygenKeep warmTransport


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Breech Delivery

Presenting part -buttocks or feet

Treatment Position anddrape mother

Allow buttocksand feet todeliverSupport legsand trunk


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Treatment

Head usually delivers on its ownIf not within 3 minutes of buttocksand trunk, do not pull!Cup hand over babys face/mouthand transport

Head delivers- procedures thesame


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Limb Presentation

Presenting part single arm, leg, orfoot

Cannot successfully deliver in thefield


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Treatment

Give mother O 2 Place mother on back, head lowerthan pelvisCover with sterile towelTransport


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Multiple Births

1st baby is smallAbdomen still largeContractions about 10 minutes afterfirst baby


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Treatment

Cut cord on first babyFollow normal delivery proceduresMay be considered premature


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Premature Infants

Premature - born before 8th month orweighing less than 5 1/2 lbs.

Judge weightThinner, smaller, redder than fulltermHead larger


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5 important steps in management

Keep warm90-95 degrees F

Keep mouth, nose, and throat clearMake sure cord not bleeding

Apply additional clamps or tiesSlightest bleeding serious


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5 important steps in management

Increase O 2 in enviromentMake tent over headAim O 2 at top of tentDo not administer directly

Avoid infection

Use sterile equipmentAvoid unnecessary handling


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Gynecologic Emergencies

Trauma to external genetalia Treat as other bleeding and soft

tissue injuriesO 2 Never pack vagina

Transport


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Alleged Sexual Assault and Rape

Patient may refuse assistance


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Treatment

BSIAirwayNonjudgmental attitude duringSAMPLECrime scene protection


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Treatment

Examine genitalia only if profusebleeding

Use same sex providers if possibleDiscourage bathing, voiding, orcleaning wounds


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The End

obstretric review.ppt

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