chapter 22 childbirth and gynecologica emergencies

Chapter 22Childbirth and Gynecologic

Emergencies

Childbirth and Gynecologic Emergencies of Pregnancy

(1 of 3)

•Birth canal: Vagina and lower part of uterus•Cervix: Opening at lower end of uterus•Placenta: Organ through which mother and fetus exchange nourishment and waste

Childbirth and Gynecologic Emergencies of Pregnancy

(2 of 3)

• Umbilical cord: Extension of placenta • Amniotic sac: Bag of water surrounding

fetus• Crowning: Fetus’s head bulges out of

vaginal opening

Childbirth and Gynecologic Emergencies of Pregnancy

(3 of 3)

• Bloody show: Mucus and blood discharged during labor

• Labor: Process of childbirth• Miscarriage: Delivery of fetus before it

can live independent of mother

Predelivery Emergencies• Miscarriage

• Usually occurs in first trimester• Most occur because fetus was not

developing properly

Recognizing Miscarriage• Lower abdominal cramps• Lower back ache• Vaginal bleeding

• May be sudden and heavy• Passage of tissue from vagina

Care for Miscarriage• Reassure the woman.• Help into comfortable position

• Legs bent• Place sanitary pad outside of vagina• Transport expelled tissue to hospital.• Seek medical care.• Call 9-1-1 if heavy bleeding or signs

of shock

Vaginal Bleeding

• Vaginal bleeding in the third trimester constitutes an emergency.

• Things to check for:• Extent of bleeding• Pulse rate• Female paramedic

Recognizing Vaginal Bleeding During Pregnancy

• Mild spotting• Heavy bleeding • Check for signs of shock.

Care for Vaginal Bleeding During Late Pregnancy• Place woman on left side.• Have her place sanitary pad

over outside of vagina.• Call 9-1-1.• Treat for shock.

Recognizing Vaginal Bleeding Caused by Injury

• Injuries of external genitalia• Severe pain• Blood in vaginal area• Massive internal vaginal bleeding

Care for Injury-Related Vaginal Bleeding

• Place direct pressure over dressing.• Apply ice.• Do not place dressings inside vagina.• Place victim on left side.• Seek medical care.

Non-Injury-Related Vaginal Bleeding

• Most likely to be menstrual• Can indicate more serious conditions:

• Childbirth• Miscarriage• Infection

Recognizing Signs and Causes of Non-Injury-Related

Vaginal Bleeding

• Abdominal cramps are a sign of bleeding.

Care for Non-Injury-Related Vaginal Bleeding

• Reassure victim.• Help victim into comfortable

position with legs bent.• Have woman place sanitary

pad over outside of vagina.• Seek medical care.

Imminent Delivery (1 of 2)

• Only transport if:• First pregnancy• No straining or crowning

• Have woman wear both lap and shoulder seat belts.

• If necessary, have her lie on left side.

Imminent Delivery (2 of 2)

• No time to transport if:• Not a first pregnancy • Crowning or straining

• Call 9-1-1.• Prepare a private, clean area.

Emergency Delivery• Wear exam gloves.• Avoid touching vaginal area.• Do not allow woman to use the toilet. • Do not hold woman’s legs together.

Stages of Labor (1 of 3)

• First stage • Starts at first

contraction • Lasts several hours• Contractions increase

in frequency and intensity.

• May see bloody show• Amniotic sac bursts at

end of stage.

Stages of Labor (2 of 3)

• Second stage • 30 minutes to 2

hours• Cervix dilates

fully• Baby’s head

passes through vagina and rest of body follows.

Stages of Labor (3 of 3)

• Third stage• Afterbirth• 15 minutes or

more• Placenta is

expelled

Recognizing Impending Delivery (1 of 2)

• Has woman had a baby before?• Are contractions less than two minutes

apart?• Has amniotic sac ruptured?• Does mother feel like she must move

her bowels?

Recognizing Impending Delivery (2 of 2)

• If yes, check for crowning.• Explain what you are doing and why.• Protect woman’s privacy.

Delivery Supplies• Clean sheets, towels, blankets• Plastic bag or towel• Clean exam gloves• Sanitary pads• Materials to place under woman• Rubber bulb syringe• Sterile gauze pads• Strips of gauze, or clean shoelaces

Care During Delivery (1 of 9)

• Wash hands and wear exam gloves.• Have mother lie in acceptable position.• Have woman take:

• Short, quick breaths during contractions• Deep breaths between contractions

• Place absorbent materials under buttocks.

Care During Delivery (2 of 9)

• When head appears:• Place hand over head and apply slight

pressure.• Have woman stop pushing.• Do not push on fontanelles.

• If amniotic sac does not break, tear with fingers and push from baby’s head and mouth.

Care During Delivery (3 of 9)

• Check umbilical cord is not wrapped around neck.• Gently slip it over

baby’s head.• Support head.• Suction mouth and

nostrils.

Care During Delivery (4 of 9)

• Support body as baby emerges.

• Do not pull on head or touch armpits.

• Keep baby level with vagina.

Care During Delivery (5 of 9)

• Wipe blood and mucus from mouth and nose.

• Dry infant and stimulate breathing.• If baby does not

breathe in 30 seconds, begin CPR.

Care During Delivery (6 of 9)

• Wrap infant, place on side, keep level with vagina

• Tie the umbilical cord:• When it stops pulsating• With gauze or clean shoelace

Care During Delivery (7 of 9)

• Cutting the cord:• No need if transporting to hospital.• In remote area:

• Tie cord 4" from baby• Make second tie 2" from first• Cut between ties

Care During Delivery (8 of 9)

• Watch for placenta.

• Wrap placenta in towel with 3/4 of umbilical cord.• Put in bag• Keep at level of

infant• Take to hospital

Care During Delivery (9 of 9)

• Place sterile pad over vaginal opening.• Lower mother’s legs and hold them

together.• Gently massage abdomen just below navel.

Delivery Aftercare• Monitor mother’s breathing and pulse.• Replace sheets and blankets.• Massage uterus.

• Place palm on lower abdomen.• Use firm, circular motion.

• Encourage mother to breastfeed.

Initial Care of the Newborn (1 of 2)

• Monitor breathing and pulse.• Pulse rate > 100 bets per minute• Respiratory rate > 40 breaths per

minute.• Keep infant warm, dry, comfortable

Initial Care of the Newborn (2 of 2)

• If newborn is motionless:• Tap bottom of foot or shoulder.• Perform CPR if unresponsive, is

not breathing, or is gasping.

Prolapsed Cord• Umbilical cord

exits before infant.

• Baby in danger of suffocation

Care for Prolapsed Cord• Raise mother’s buttocks.• Insert gloved fingers into vagina on

either side of cord.• Do not push cord into vagina.• Call 9-1-1.

Breech Birth Presentation• Baby’s buttocks

emerge first.• Place mother in

kneeling, head-down position.

• Seek medical care.• Suffocation can

occur.

Care for Breech Birth Presentation

• Place hand in vagina, palm toward baby’s face.

• Form V with fingers on either side of baby’s nose.

• Push vaginal wall away from face until head is delivered.

• Call 9-1-1.• Have woman continue to push.

Limb Presentation• Arm, leg, or foot

emerges first.• Position woman

with head down and pelvis elevated.

• Call 9-1-1 immediately.

Meconium• Baby’s first feces, in amniotic fluid• May cause distress and respiratory

problems if breathed into lungs• Greenish or brownish-yellow amniotic

fluid, almost odorless

Care for Baby in Danger of Inhaling Meconium

• Keep infant in moderate head-down position.

• Suction mouth and nostrils.• Keep baby’s airway open.• Call 9-1-1.

Premature Birth• Delivery before 37th week of gestation• Smaller and thinner infant• Proportionately large head• Cheesy, white coating on skin is

minimal or absent

Care for Premature Babies• Keep warm.• Keep mouth and nose clear of mucus.• Monitor breathing.• Perform CPR if necessary.

Gynecologic Emergencies• Reproductive system problems that

occur in nonpregnant women

Sexual Assault and Rape• Rape

• Fastest growing violent crime in U.S.• Attempted or actual sexual intercourse

against victim’s will• Physical injury and psychological

trauma is common.

Recognizing Sexual Assault and Rape (1 of 2)

• Focus on providing care, not obtaining evidence.

• Preserve evidence.• Question about injuries only, not

crime.

Recognizing Sexual Assault and Rape (2 of 2)

• Signs:• Headaches• Sleeplessness, nightmares• Nausea, muscle spasms• Confusion• Depression• Anxiety, jumpiness

Care for Sexual Assault and Rape (1 of 2)

• Reassure victim.• Do not blame or ask a lot of questions.• Determine which injuries require care.• Do not examine genitalia unless injury

requires immediate care.• Encourage victim to preserve evidence.

Care for Sexual Assault and Rape (2 of 2)

• If victim refuses aid:• Have a friend stay with the victim.• Protect the victim’s privacy.• Provide contact of local rape crisis center.

• Get victim to medical care.