review dasar obstetri

8/13/2019 Review Dasar Obstetri

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Lesson Objective:

Indicate procedures for emergency

(pre -hospital) childbirth.
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program


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OVERVIEW

Anatomy Review

Beginning of Labor

Predelivery Emergencies

Preparing for Delivery

Delivering the Baby


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OVERVIEW cont.

Postdelivery Care

Resuscitation of the Newborn

Abnormal Deliveries & Complications

Gynecologic Emergencies


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FetusUterus

Placenta

Umbilical Cord

Amniotic Sac

Cervix

Anatomy Review


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The Stages of Labor

1st Stage - 1st contraction until cervix is

fully dilated.

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

placenta


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Signs of Labor

Beginning of regular contractions

Bloody show

Rupture of the amniotic sac (waterbreaks)


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Predelivery Emergencies

Miscarriage

SeizuresVaginal

Bleeding

Trauma


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Miscarriage

Delivery of fetus & placenta before 20

weeks

Danger - bleeding & infection


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Treatment

Initial assessment

History & physical exam

Ask if she is pregnant

Ask date of last cycle


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Treatment

Apply external vaginal pads

Collect tissues Transport


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Seizures

Eclampsia- related to high blood

pressure


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Treatment

Initial assessment

HX & vitals

Transport on left side

Monitor airway & give O2

Transport


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Vaginal Bleeding

Early pregnancy - may be normal

Later stages of pregnancy

Placenta abruptio - placenta

separates prematurely

Placenta previa - placenta develops

over & covers the mouth of the

uterus


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Treatment

BSI

Initial assessment

History and physical exam

Ask patient if she has any pain.


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Treatment

Transport on left side

Sterile pad or sanitary napkin

Save any tissue

Transport


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Trauma

Severe bleeding

Injury to fetus


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Treatment

Initial assessment

O2

Place on left side

Control external bleeding

Transport


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Decision based on three factors:

Is the delivery imminent

Hospital cannot be reached due toa natural disaster, weather, or

traffic conditions

No transportation is available


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Equipment

Surgical scissors-1 pair

Hemostats or cord clamps-3

Umbilical tape/sterile cordSmall rubber bulb syringe

Towels-5


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Equipment

1 dozen 2 x 10 gauze sponges

Rubber gloves

Baby blanket-1Sanitary napkins

Plastic bag


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Delivering The Baby

Position and support

Flat, sturdy surface

Lie with knees drawn up and

spread apart

Elevate buttocks with blankets


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Position and support

Create sterile fieldOne towel under buttocks

One between her legs

One across her abdomen

Partner at head

Reassure/comfort

Assist airway


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Delivering the Head Place fingers on bony part of skull

If amniotic sac does not break, or has not

broken:

Use clamp to puncture

Push away from nose and mouth


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Delivering the Head

Umbilical cord around neck?

Slip over shoulder

Clamp and cut it


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Delivering the Body

Support head and

body

Grasp feet Support with both

hands

Baby will be

slippery

Do not squeeze

neck or chest


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Post Delivery Care

Initial care of baby Set baby down

Same level or lower than birth canal

On side with head slightly lower thanbody

Continue to aspirate


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Initial care of the baby

Wrap in blanket

Warm prior if possible

Leave 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 minutes

Healthy baby will score 10

Five areas


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APGAR

Appearance- pink shortly after birth Pulse- greater than 100/min

Grimace- crying, or withdrawing in

response to stimuli Activity- resistance or muscle tone

when attempts are made to

straighten legs Respirations- regular and rapid


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Delivery of Placenta

Normal Delivery

Within a few

minutes of babysbirth

Usually less than

250 ml blood loss

Record delivery

time

Take to hospital


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Delivery of Placenta

Provide prompt transportIf not delivered within 30 minutes

250ml of bleeding occurs before

delivery of placentaSignificant bleeding occurs after

delivery of placenta

Do not pull cord!


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review dasar obstetri

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