Obstetrics and Gynecological Emergencies You are having a WHAT!?!? BABY.

Obstetrics and Gynecological Emergencies

You are having a WHAT!?!?

BABY


• Terms & Definitions– Crowning

• When the presenting part of the baby first bulges from the vaginal opening

– Cephalic presentation - Head first– Breech presentation

• Limb • Frank

LABOR

• First Stage• Begins with regular contractions, then thinning and

gradual dilation of the cervix and ends when the cervix if fully dilated

• Second Stage• Begins when the baby’s head enters the birth canal

until the baby is born

• Third Stage• Following the birth of the baby until the placenta is

delivered

Your Role

• Materials Needed– Need OB kit (if available)– Gloves– Towels and drapes– 4 x 4s– Bulb syringe– Umbilical tape or clamps– Scissors or scalpel for cutting the cord


– A baby blanket– Several sanitary napkins– Plastic bag– Standard BSI precautions


• Evaluating the Mother– Patient name, age– Which pregnancy?– Gravida, Para and AB– How long in labor– Ask the patient if she feels the need to move

her bowels– Check for Crowning**– Time uterine contractions


– Vital signs if time allows– Remember if this first baby and crowing or urge to

push is not present then transport can be effect– DO NOT LET MOTHER GO TO THE

BATHROOM


• Preparing for Delivery– Control the scene– BSI– Position the patient– Remove clothing that can obstruct view of

delivery– Position OB kit or available materials


The Delivery


Sign 0 1 2

Appearance(Skin Color)

Blue/Pale Body PinkExtremitiesBlue

Completelypink

Pulse Rate Absent Below 100 Above 100

Grimace NoResponse

Grimaces Cries

Activity Limp Someflexion ofextremities

Activemotion

Respiratory Absent Slow andirregular

Strong Cry

Total Score


• Controlling vaginal bleeding after delivery – DO PLACE ANYTHING IN THE VAGINA– Have mother lower her legs– Massage the fundus– Nursing the baby can help the uterus contract

and return to normal


Complications of the Delivery


• Supine Hypotensive Syndrome– The weight of the baby, placenta and

amniotic fluid can compress the vena cava– Care

• Place mother on lateral left side


• Breach Birth– Never pull on the babies legs– High flow oxygen– If body delivers support the body and prevent

an explosive delivery of the head– If necessary to create an airway, place two

fingers of gloved hand into vagina making a “V” with your fingers to create an airway. Hope position until EMS arrives or baby delivers


• Prolapsed Umbilical Cord– Mother in head down and buttocks up

(kneeling with buttocks up) – High flow oxygen– Check cord for a pulse– Wrap the cord in a towel to keep warm– Insert gloved fingers in the vaginal and

pressure gently on the babies head or buttocks to take pressure off the cord


• Limb Presentation– High flow oxygen– Do Not pull on the baby


• Multiple Births– Clamp the cord of the first baby – 2nd baby may be born before or after the

placenta– Care for first infant– Maintain body temperature of the infants


• Premature Birth– Keep baby WARM– Keep airway clear– Provide ventilation and chest

compressions as needed– Watch the umbilical cord for bleeding– Oxygen using blow by method– Avoid contamination, Do Not breath into

the face of the baby


• Pre-birth bleeding– If you have any pre-birth bleeding place a

pad at the opening of the vagina– Save any tissue which is passed


• Pre-Eclampsia– High blood pressure and swelling of the

extremities– The pregnant female needs to be

monitored closely

• Eclampsia– Seizures that occur during pregnancy– Seizures are a dire emergency, the mother

should be transported by EMS


• Vital Signs

• Treat for shock

• Place a napkin over the vaginal opening

• Transport CODE 3

• Replace all blood soaked pads and keep

• Save all tissue expelled

• Emotional support for the patient


Trauma In Pregnancy- Patient Assessment– Pulse will be 10-15 beats higher– A pregnant female has 30-35% more blood

so signs of shock will be delayed– Ask patient about any blows to the back,

pelvis or abdomen– Ask if the patient is bleeding or has any

discharge (water has broken)


Treatment for Pregnant Trauma Patient– High flow oxygen– Be ready to suction due due to nausea and

possible vomiting– Activate EMS– Provide emotional support


GYN EMERGENCIES


Vaginal Bleeding

Can be potentially life-threatening– Follow BSI precautions– Assure airway– Assess and treat for shock– Provide oxygen– Activate EMS if bleeding is severe


Trauma to the External Genitalia– Scene size up and look at the mechanism

of injury– During initial assessment look for signs of

shock– Control bleeding with direct pressure

– If signs of shock high flow O2


Sexual Assault– Treat scene as a crime scene– Perform ABC’s– Take care not to destroy evidence on the scene– Activate EMS– Provide comfort for the patient– Discourage the patient from bathing, voiding, or

cleansing any wounds

Obstetrics and Gynecological Emergencies You are having a WHAT!?!? BABY.

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