Obstetrical (OB)Emergencies

Medical Terminology (OB)

•Prenatal: existing or occurring before birth.

•Perinatal: occurring at or near the time of birth.

Medical Terminology (OB)

•Postpartum: the maternal period after delivery.

Medical Terminology (OB)

•Gravida: # of the current and past pregnancies combined.

•Parity: # of live children born.

Medical Terminology (OB)

• G4P3 might be a pregnant mom who has 3 children.

• These will be broken down even more in the detailed records (miscarriages, twins, etc).

Ectopic Pregnancy

• Occurs when a fertilized ovum implants anywhere other than the endometrium of the uterine cavity.

Ectopic Pregnancy

Ectopic Pregnancy

Ectopic Pregnancy

• 90%+ fallopian tubes.

• 6% abdominal.

• 1% ovarian and cervical.

Ectopic Pregnancy• 1 in 200 pregnancies.

• Leading cause of first trimester death.

• 11% of maternal deaths in US.

Ectopic Pregnancy

• Rupture occurs 2-12 weeks gestation.

• Early detection important!!!

Ectopic Pregnancy• “Classic triad” of symptoms:

• Abdominal pain.

• Vaginal bleeding.

• Amenorrhea (or oligomenorrhea).

“Miscarriage”

• Technically called a spontaneous abortion (SAB).

• Occurs before 20 weeks gestation.

“Miscarriage”

• Occurs in 1 in 10 pregnancies.

• Early miscarriages may not be detected by mother.

• After 20 weeks gestation, called a preterm birth.

Causes of Miscarriage

• Hormonal problems, infections or health problems in the mother.

• Lifestyle (i.e. smoking, drug use, malnutrition, excessive caffeine and exposure to radiation or toxic substances).

• Implantation of the egg into the uterine lining does not occur properly.

Risk Factors for Miscarriage

• Maternal age.

• Maternal trauma.

• Increase in maternal age.

Risk Factors for Miscarriage• Women under the age of 35 years old

have about a 15% chance of miscarriage.

• Women who are 35-45 years old have a 20-35% chance of miscarriage.

• Women over the age of 45 can have up to a 50% chance of miscarriage.

Threatened Miscarriage

• Some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed.

• This bleeding is often the result of implantation.

Inevitable or Incomplete Miscarriage

• Abdominal or back pain accompanied by bleeding with an open cervix.

• Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is rupture of the membranes.

• Bleeding and cramps may persist if the miscarriage is not complete.

Complete Miscarriage

• Embryo or products of conception (POC) have emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping.

• A complete miscarriage can be confirmed by an ultrasound or by having a surgical curettage performed.

Missed Miscarriage

• Women can experience a miscarriage without knowing it. This is when embryonic death has occurred but there is not any expulsion of the POC. It is not known why this occurs.

• Signs of this may be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.

Recurrent Miscarriage (RM):

• Defined as 3 or more consecutive first trimester miscarriages.

• Occurs in 1% of couples trying to conceive.

L & D: Labor & Delivery

Parturition: the process by which the baby is born.

Medical Terminology (OB)

Beginning of Labor

•Fetus descends into birth canal.

•Relief of pressure in upper abdomen...

Beginning of Labor

• ... and increase in pressure in the pelvis. May see “bloody show.”

First Stage of Labor

•Begins with onset of regular contractions and ends with complete dilation of the cervix (10 cm).

First Stage of Labor

•In most pregnancies, the amniotic sac ruptures toward the end of this stage.

Second Stage of Delivery

•Begins with full dilation and ends with delivery of the infant.

Crowning:• The presenting part of the

fetus (usually the head) emerges from the vaginal opening.

• Birth is imminent!

Third Stage of Labor

• Begins with delivery of the infant and ends with delivery of the placenta and contraction of the uterus.

Third Stage of Labor

• Uterine contraction can be stimulated by massaging the abdomen or having the baby breast feed immediately.

Placenta

Doctor will inspect and palpate placenta to ensure it is complete and that all of the POC have been expelled.

Assisting in an Uncomplicated Delivery

• Never say, “I delivered a baby!” unless you actually delivered the baby (meaning, you’re the new mom!)

• Your role is to assist and support, to evaluate and care for any potential problems, and to provide care for the newborn when he/she is delivered.

Assisting in an Uncomplicated Delivery

Items to have on hand if possible:

• Gloves.

• Clamps for umbilical cord (wide ribbon or string will work).

• Scissors to cut cord.

• Bulb suction to suction the infant’s mouth and nose.

Assisting in an Uncomplicated Delivery

Items to have on hand if possible:• Sanitary napkins to help with bleeding

control.• Towels to dry off baby.• Baby blanket (or any clean blanket) to keep

baby warm.• Plastic bag to contain the placenta after

delivery.

Assisting in an Uncomplicated Delivery

Signs of impending delivery:

• Crowning.

• Feeling of need to move bowels.

• Increasing vaginal pressure.

• Increased need to push.

Assisting in an Uncomplicated Delivery

• Take patient’s vital signs.

• Get pertinent medical history—any known complications, if mom has had prenatal care, if pregnancy is multiples, etc.

• Get past pregnancy history.

Assisting in an Uncomplicated Delivery

• If you suspect birth is imminent, visually inspect for crowning.

• Perform this with another emergency care provider present to avoid any allegations of inappropriate behavior.

• You will NOT check for dilation.

Assisting in an Uncomplicated Delivery

• After baby is born, clamp (or tie) cord at about four fingers width away from the infant and the second clamp two finger widths further away.

• Cut the cord between the two clamps or ties.

Assisting in an Uncomplicated Delivery

• Gently dry the infant (stimulate infant more firmly if baby is not responding well).

• Place wet towels to the side.

• Wrap baby in baby blanket and cover head (not face!) to keep warm.

Assisting in an Uncomplicated Delivery

• Allow mom to hold and/or breastfeed baby if she is able.

• Placenta should deliver within a few minutes. Place in plastic bag.

• Provide mom with sanitary napkins for bleeding.

Risk Factors for Complications

• Maternal age (young or old).

• Absence of prenatal care.

• Maternal lifestyle (alcohol, tobacco, drug use).

• Maternal illness.

Risk Factors for Complications

• Problems in previous pregnancies or deliveries.

• Previous cesarean.

• Multigravida (two or more previous pregnancies).

Symptoms of Preeclampsia•Elevated Blood

Pressure

•Peripheral Edema

•Sudden Weight Gain

•Headaches

•Changes in Vision

Preeclampsia• Disease occurs after 20

weeks gestation, often near full term (40 wks).

• Can lead to Eclampsia.

Preeclampsia• Diagnosed by the “classic

triad” of symptoms:

•Hypertension, proteinuria, and edema.

Preeclampsia

•Should always be considered with

Blood Pressure.

Eclampsia•Signs and symptoms of preeclampsia .

•+ seizures.

Placental Abruption

• Also called Abruptio Placentae.

• Partial or complete detachment of a normally implanted placenta at more than 20 weeks gestation.

Abruptio Placentae

Visible Bleeding

Abruptio Placentae

No Visible Bleeding

Abruptio Placentae

Abruptio Placentae

• Characterized by sudden, third-trimester dark red bleeding and pain.

• Tender abdomen and rigid uterus.

Placenta Previa•Placental implantation in the lower uterine segment encroaching on or covering the cervical opening.

Placenta Previa

Placenta Previa• Painless, bright red bleeding

without contractions.

• It is more common in multiparous mothers.

• The cause is unknown.

Uterine Rupture

• Spontaneous or traumatic rupture of the uterine wall.

• Sudden “tearing” pain, bleeding, signs of shock.

Breech Birth•Three to four percent of pregnancies are breech births.

• Complications that increase the chances of a breech birth baby include premature childbirth, high levels of amniotic fluid and multiple birth pregnancies.

Breech Birth—“External Version”•During an "external version" a doctor attempts to move the baby out of breech position while the baby is still in the uterus by physically manipulating the baby.

•Usually done between weeks thirty and forty of a pregnancy.

•Fifty percent chance of success.

Vaginal Delivery when Breech•Vaginal childbirth is possible with a breech birth.

•Risks to both baby and mother are greater.

•Breech birth complications include damage to the umbilical cord during childbirth, a serious event that can be fatal to the baby or the mother.

• If complications develop, an emergency cesarean section is required.

Planned C-Section when Breech•If a breech birth is diagnosed in conjunction with other pregnancy complications, or if vaginal childbirth is not an option, a planned C-section may be arranged.

•A planned C-section gives the mother the option of regional anesthetic, so she can be awake for her baby's birth.

Multiples• About half of twins and nearly all higher-

order multiples are premature (born before 37 weeks).

Shoulder Dystocia

• Shoulder dystocia: describes difficulty delivering a baby's shoulders.

• "Dystocia" means "a difficult childbirth."

• Shoulder dystocia is often caused if the baby is especially large (but can happen with a baby of any size).

Prolapsed Cord

• Create an airway for the baby by placing fingers into vaginal opening in front of baby’s face and make a “V”.

Occurs when cord presents before baby.

Prolapsed Cord

• Place mother in a knee-chest position to reduce pressure on the cord.

• Place wet dressings over cord and wrap in towel to keep warm.

Prolapsed cord with breech presentation.