Ch22 presentation childbirth_and_gynecologic
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Transcript of Ch22 presentation childbirth_and_gynecologic
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Chapter 22
Childbirth and Gynecologic Emergencies
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Childbirth and Gynecologic Emergencies of Pregnancy
• Birth canal: vagina, lower part of uterus• Cervix: opening at lower end of uterus• Placenta: organ through which mother and
fetus exchange nourishment and waste
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• 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
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• Bloody show: mucus and blood discharged during labor
• Labor: process of childbirth• Miscarriage: delivery of fetus before it can
live independently of mother
Childbirth and Gynecologic Emergencies of Pregnancy
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Predelivery Emergencies
• Miscarriage− Usually occurs in first trimester− Most occur because fetus was not developing
properly.
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Miscarriage: What to Look For
• Cramping in lower abdomen• Aching in lower back• Vaginal bleeding
− Could be sudden and heavy• Passage of tissue from vagina
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Miscarriage: What to do
• Reassure the woman.• Help into comfortable position.• Have her place sanitary pad over the
outside of the vagina.• Transport expelled tissue to hospital.• Seek medical care or call 9-1-1.
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Vaginal Bleeding During Pregnancy
• Vaginal bleeding in the third trimester constitutes an emergency.
• Things to check for:− Extent of bleeding− Pulse rate− Female first aid provider
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Vaginal Bleeding During Pregnancy: What to Look For
• Mild spotting• Heavy bleeding• Signs of shock
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Vaginal Bleeding During Pregnancy: What to Do
• Place woman on left side.• Have her place sanitary pad over the
outside of the vagina.• Call 9-1-1.• Treat for shock.
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Vaginal Bleeding Caused by Injury: What to Look For
• Injuries of external genitalia• Severe pain• Bleeding in vaginal area• Massive vaginal bleeding
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Vaginal Bleeding Caused by Injury: What to Do
• Place direct pressure over dressing.• Apply ice.• Do not place dressings inside vagina.• Place person on left side.• If sexual assault, explain need for
evidence preservation.• Seek medical care.
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Non–Injury-Related Vaginal Bleeding
• Most likely to be menstrual• Can indicate more serious conditions
− Childbirth− Miscarriage− Infection
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Non–Injury-Related Vaginal Bleeding: What to Look For
• Abdominal cramps• Blood in vaginal area
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Non–Injury-Related Vaginal Bleeding: What to Do
• Reassure person.• Help her into comfortable position with
legs bent.• Have woman place sanitary pad over the
outside of vagina.• Seek medical care.
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Imminent Delivery
• Only transport if:− No urge to push or crowning− First pregnancy
• Have woman wear both lap and shoulder seat belts.
• If necessary, have her lie on left side.
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Imminent Delivery
• No time to transport if:− Crowning or urge to push− Not a first pregnancy
• Call 9-1-1.• Prepare a private, clean area.
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Emergency Delivery
• Wear exam gloves.• Do not touch vaginal area.• Do not allow the mother to use the toilet.• Do not hold woman’s legs together.
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Emergency Delivery
• If head does not present first:− It is a complicated delivery.− Tell woman to stop pushing.− Call 9-1-1.
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Stages of Labor
• First stage− Starts at first contraction− Lasts several hours− Cervix stretches.− Contractions increase in
frequency and intensity.− Amniotic sac bursts at end of stage.
© Jones & Bartlett Learning.
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Stages of Labor
• Second stage− 30 minutes to 2 hours− Cervix is fully dilated.− Baby’s head passes through pelvis and rest of
body follows
© Jones & Bartlett Learning.
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Stages of Labor
• Third stage− Afterbirth− 15 minutes or more− Placenta is expelled
© Jones & Bartlett Learning.
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Imminent Delivery: What to Look For
• Woman has had a baby before• Contractions less than 2 minutes apart• Amniotic sac ruptured• Mother feels like she must move her
bowels
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Imminent Delivery: What to Do
• Wash hands and wear exam gloves.• Have mother lie in acceptable position.• Remind woman to take:
− Short, quick breaths during contractions− Deep breaths between contractions
• Place absorbent, clean materials under buttocks.
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Imminent Delivery: What to Do
• When head appears:− Place palm over head; apply slight pressure.− Have woman stop pushing.− Do not push on fontanelles.
• If amniotic sac does not break, tear with fingers and push away from baby’s head and mouth.
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Imminent Delivery: What to Do
• Check for umbilical cord wrapped around neck.
• Support head.• Suction mouth and
nostrils.© University of Maryland Shock Trauma Center/MIEMSS.
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Imminent Delivery: What to Do
• Support body as baby emerges.
• Do not pull on head or touch armpits.
• Keep baby level with vagina.
© University of Maryland Shock Trauma Center/MIEMSS.
© University of Maryland Shock Trauma Center/MIEMSS.
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Imminent Delivery: What to Do
• Wipe blood and mucus from mouth and nose.
• Dry infant and stimulate breathing.− If baby does not
breathe in 30 seconds, begin CPR. © University of Maryland Shock Trauma Center/MIEMSS.
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Imminent Delivery: What to Do
• Wrap infant, place on side, keep level with vagina.
• Tie the umbilical cord.• Cutting the cord
− No need to cut if transporting to hospital.
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Imminent Delivery: What to Do
• Watch for placenta.− Wrap in towel with
three quarters of umbilical cord.
• Place sterile pad over vaginal opening.
• Gently massage abdomen.
© University of Maryland Shock Trauma Center/MIEMSS.
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Delivery Aftercare
• Monitor mother’s breathing and pulse.• Replace sheets and blankets.• If blood loss continues, massage uterus.• Encourage mother to breastfeed.
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Initial Care of the Newborn
• Monitor breathing and pulse.• Keep infant warm, dry, comfortable.• If newborn is motionless:
− Tap bottom of foot or shoulder.− Perform CPR if unresponsive, not breathing,
or gasping.
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Prolapsed Cord: What to Look For
• Umbilical cord seen before head
© Jones & Bartlett Learning.
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Prolapsed Cord: What to Do
• Raise mother’s buttocks.• Insert gloved fingers into vagina on either
side of cord.− Do not push cord into vagina.
• Call 9-1-1.
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Breech Birth Presentation: What to Look For
• Baby’s buttocks emerge first.
© Jones & Bartlett Learning.
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Breech Birth Presentation: What to Do
• Place hand in vagina.• Form a V with fingers on either side of
baby’s nose.• Push vaginal wall away from face.• Call 9-1-1.• Have woman continue to push.
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Limb Presentation
• What to look for− Arm, leg, or foot
emerges first.• What to do
− Position woman with head down and pelvis elevated.
− Call 9-1-1 immediately.© Jones & Bartlett Learning.
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Meconium: What to Look For
• Baby’s first feces in amniotic fluid• May cause distress and respiratory
problems if breathed into lungs• Green or brown-yellow amniotic fluid,
almost odorless
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Meconium: What to Do
• Keep infant in moderately head-down position.
• Suction mouth and nostrils.• Keep baby’s airway open.• Call 9-1-1.
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Premature Birth: What to Look For
• Birth before 37th week of gestation• Smaller and thinner infant• Proportionately larger head• Cheesy, white coating on skin is minimal
or absent
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Premature Birth: What to Do
• Keep warm.• Keep mouth and nose clear of mucus.• Monitor breathing.• Perform CPR if necessary.
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Gynecologic Emergencies
• Reproductive system problems that occur in nonpregnant women
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Sexual Assault and Rape
• Rape− Criminal act of forcing another person to
submit to sexual intercourse− Physical injury and psychological trauma are
common.
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Sexual Assault and Rape: What to Look For
• Headaches• Sleeplessness, nightmares• Nausea, muscle spasms• Confusion• Depression• Anxiety, jumpiness
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Sexual Assault and Rape: What to Do
• Do not ask a lot of questions.• Do not blame; be supportive.• Determine which injuries require care.• Do not expose genitalia unless injury
requires immediate care.• Try to preserve evidence.
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Sexual Assault and Rape: What to Do
• If person refuses aid:− Have a friend stay with the person.− Protect the person’s privacy.− Provide contact of local rape crisis center.
• Get person to medical care.