obstetric and gynecological emergencieschapter 24 obstetric and gynecological limmer et al.,...
TRANSCRIPT
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CHAPTER 24
Obstetric and Gynecological
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Gynecological Emergencies
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Key Terms
Fetus
A baby as it develops in the womb.
Newly Born
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Newly Born
A baby at the time of birth.
Infant
A baby in its first year of life.
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ReproductiveReproductiveAnatomyAnatomy
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AnatomyAnatomy
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Stages of Delivery
1st Stage Dilation, “Predelivery”
2nd Stage Delivery
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Delivery
3rd Stage Delivery of placenta, “After-delivery”
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Predelivery Evaluation
Name, age, due date?
First delivery?
Contractions or pain? Onset?
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Bleeding or discharge?
Crowning?
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Frequency/duration of
contractions?
Feel the urge to move bowels?
Predelivery Evaluation
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Feel the need to push?
Rock-hard abdomen?
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Transport Decision
Based on assessment
Birth imminent if contractions less
than 2 min apart
Number of prior births
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Number of prior births
Distance to hospital
Complications expected
Transport on left side to prevent
hypotension
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NormalNormalDeliveryDelivery
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DeliveryDelivery
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Childbirth Delivery KitChildbirth Delivery Kit
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Delivery Precautions
Use BSI.
Keep the mother out of bathroom.
Do not hold mother’s knees
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Do not hold mother’s knees
together.
Continued…
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Delivery Precautions
Do not examine vagina internally.
Consider limitations of scene on
field delivery.
Contact medical direction per local
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Contact medical direction per local
protocol.
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Delivery Procedures
Control the scene to provide:
A safe delivery area
Privacy, comfort
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Have mother lie supine, knees
drawn up and spread apart.
Elevate hips with blanket and
pillow.
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Create sterile field around vaginal opening.Create sterile field around vaginal opening.
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Crowning of Infant’s HeadCrowning of Infant’s Head
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Delivery of the HeadDelivery of the Head——Prevent explosivePrevent explosivedelivery.delivery.
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Delivery of the headDelivery of the head
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Delivery Procedures
If amniotic sac has not broken,
puncture sac and pull away from
baby's face.
If umbilical cord is around baby’s
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If umbilical cord is around baby’s
neck, clamp and cut cord.
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Suction mouth, then nose.Suction mouth, then nose.
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Aid in birth of upper shoulder.Aid in birth of upper shoulder.
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Support the trunk.Support the trunk.
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Support the legs.Support the legs.
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Delivery Procedures
Wipe blood and mucus from nose
and mouth.
Suction again.
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Warmth is critical!
Wrap baby in warm towel, head
lower than trunk.
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Have partner provide initial care
and monitoring.
Keep infant level with vagina until
cord is cut.
Delivery Procedures
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cord is cut.
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Clamp or tie cord; then cut.Clamp or tie cord; then cut.
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Observe for delivery of placenta..
When placenta delivers, place in
plastic bag for transport to
hospital.
Delivery Procedures
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hospital.
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Delivering theDelivering thePlacentaPlacenta
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After-Delivery Procedures
Cover vaginal opening with
sterile pad.
Lower mother's knees; help her
to hold them together.
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to hold them together.
Record time of delivery.
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A loss of 500 cc is
well tolerated.
If blood loss is
excessive, massage
Vaginal
Bleeding
After-Delivery Procedures
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excessive, massage
the uterus.
Treat for shock.
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Massage uterus to control bleeding.Massage uterus to control bleeding.
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Care of theCare of theNewly BornNewly Born
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Newly BornNewly BornChildChild
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Care of the Newly Born
Position, dry, wipe, wrap.
Repeat suctioning.
Cover the head.
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Suctioning the Newly BornSuctioning the Newly Born
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Normal AssessmentFindings – Newly Born
A = Appearance Color: No central cyanosis
P = Pulse Greater than 100/min
G = Grimace Vigorous & crying
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G = Grimace Vigorous & crying
A = Activity Good extremity motion
R = Respiratory Effort
Normal & crying
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Stimulating the Newly Born to BreatheStimulating the Newly Born to Breathe
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ResuscitationResuscitationof the Newly Bornof the Newly Born
ChildChild
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ChildChild
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Inverted Pyramid for theInverted Pyramid for theResuscitation of the Newly BornResuscitation of the Newly Born
Drying. Warming. Positioning.Suction. Tactile Stimulation.
Oxygen
Bag-Mask Ventilation
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Intubation
Medi-cations
ChestCompressions
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Breathing Effort
If shallow, slow, or absent:
Provide artificial ventilations,
40-60/minute.
Reassess after 30 seconds.
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Reassess after 30 seconds.
Continue as necessary.
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Heart Rate
If less than 100/minute:
Provide artificial ventilations,
40-60/minute.
Reassess after 30 seconds.
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Reassess after 30 seconds.
If no improvement, continue
ventilations.
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Heart Rate
If less than 60-80/minute and not
responding to ventilation:
Start chest compressions at rate of
120/min.
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120/min.
Deliver compressions to a depth of
1/3 to 1/2 the depth of the patient’s
chest.
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Heart Rate
If at any time the heart rate is less
than 60, begin ventilations and
compressions immediately.
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Color
If central (trunk) cyanosis is present
with adequate breathing and heart
rate, administer blow-by oxygen.
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AbnormalAbnormalDeliveriesDeliveries
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Breech Presentation
Baby’s buttocks or lower
extremities presenting
Greater risk of trauma,
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Greater risk of trauma,
prolapsed cord
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Emergency Care forBreech Presentation
Place mother on oxygen.
Transport immediately.
Place mother in head-down
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Place mother in head-down
position with hips elevated.
Do not pull on baby.
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Prolapsed CordProlapsed Cord
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Emergency Care forProlapsed Cord
Complete patient assessment.
Administer high-concentration
oxygen.
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oxygen.
Position mother with hips
elevated or head down.
Continued…
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Wrap exposed cord in moist,
sterile towel; keep cord warm.
Insert sterile-gloved hand into
Emergency Care forProlapsed Cord
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Insert sterile-gloved hand into
vagina, pushing the fetus away
from the pulsating cord.
Transport rapidly.
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Care for Prolapsed CordCare for Prolapsed Cord
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Limb PresentationLimb Presentation
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Emergency Care forLimb Presentation
Administer oxygen to mother.
Transport immediately.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Place mother in head-down position
with hips elevated.
Care is similar to prolapsed cord.
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Multiple Births
Delivery procedure is the same for
each.
Prepare for multiple resuscitations.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Call for assistance.
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Premature Birth
Increased risk of hypothermia
Usually requires resuscitation
Should be performed unless
physically impossible
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
physically impossible
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Meconium Staining
Green or brown amniotic fluid
indicates presence of fecal matter.
Suggests fetal distress during labor.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Emergency Care of Meconium Staining
Do not stimulate before suctioning.
Suction.
Maintain airway.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Maintain airway.
Ventilate if necessary.
Transport as soon as possible.
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PredeliveryPredeliveryEmergenciesEmergencies
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Signs & Symptoms ofVaginal Bleeding(Late in Pregnancy)Late in Pregnancy)
Profuse bleeding from vagina
May have abdominal pain
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
May have abdominal pain
May exhibit signs of shock
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Vaginal Bleeding Treatment
Perform patient assessment.
Treat based on findings.
Apply external vaginal pads.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Transport.
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Signs & Symptoms ofEctopic Pregnancy
Abdominal pain
Occasional vaginal bleeding
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Rapid/weak pulse (late sign)
Hypotension (very late sign)
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Treatment ofEctopic Pregnancy
Perform patient assessment.
Rapid transport.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Administer oxygen.
Position for shock.
Treat for shock.
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Treating SeizuresDuring Pregnancy
Maintain airway; administer oxygen.
Transport patient on left side.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Handle gently at all times.
Maintain warmth.
Prepare for delivery.
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Miscarriage(Spontaneous Abortion)
Perform patient assessment.
Treat for shock.
Apply pads to vagina; do not pack.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Apply pads to vagina; do not pack.
Administer oxygen.
Bring fetal tissue to hospital.
Give emotional support.
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Gynecological Gynecological EmergenciesEmergencies
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
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Trauma During Pregnancy
Greatest danger is from bleeding
and shock.
Blunt trauma to abdomen puts
mother & fetus at high risk.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
mother & fetus at high risk.
Continued…
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Trauma During Pregnancy
Treat injuries as any trauma patient.
Transport patient on left side.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Greatest cause of fetal death is
maternal death!
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Trauma – External Genitalia
Treat like any soft-tissue injury.
Never pack vagina.
Administer oxygen.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Administer oxygen.
Perform ongoing assessment.
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Sexual Assault
Complete patient assessment and
care.
Show nonjudgmental attitude.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Psychological care required.
Maintain privacy from bystanders.
Continued…
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Sexual Assault
Preserve potential evidence.
Discourage patient from bathing,
voiding.
Perform local reporting
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Perform local reporting
requirements.
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1. Describe the anatomy of the
reproductive system.
2. List the items you will need in a
Review Questions
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
2. List the items you will need in a
childbirth kit.
3. What factors will determine
whether you should transport or
deliver at scene?
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4. Describe the normal delivery
process.
5. Describe the following, and the care
for each:
Review Questions
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
for each:
Limb presentation
Prolapsed cord
Breech presentation
Meconium
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What should be first priority when
Street ScenesStreet Scenes
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
What should be first priority when
entering the scene?
Should ALS assistance be
requested?
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What questions should you ask the
Street ScenesStreet Scenes
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
What questions should you ask the
mother or the father?
What immediate care should be
provided to the newly born?
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What care should your partner be
Street ScenesStreet Scenes
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
What care should your partner be
giving to the mother?
What information should be relayed
to the ALS responding unit?
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Sample Documentation
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ