1 / 56

OBSTETRICS AND GYNECOLOGY

OBSTETRICS AND GYNECOLOGY. Lesson Objective: Indicate procedures for emergency (pre -hospital) childbirth. OVERVIEW. Anatomy Review Beginning of Labor Predelivery Emergencies Preparing for Delivery Delivering the Baby. OVERVIEW cont. Postdelivery Care Resuscitation of the Newborn

ivan
Download Presentation

OBSTETRICS AND GYNECOLOGY

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. OBSTETRICS AND GYNECOLOGY

  2. Lesson Objective:Indicate procedures for emergency (pre -hospital) childbirth.

  3. OVERVIEW • Anatomy Review • Beginning of Labor • Predelivery Emergencies • Preparing for Delivery • Delivering the Baby

  4. OVERVIEW cont. • Postdelivery Care • Resuscitation of the Newborn • Abnormal Deliveries & Complications • Gynecologic Emergencies

  5. Anatomy Review • Fetus • Uterus • Placenta • Umbilical Cord • Amniotic Sac • Cervix

  6. 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

  7. Signs of Labor • Beginning of regular contractions • Bloody show • Rupture of the amniotic sac (water breaks)

  8. Predelivery Emergencies • Miscarriage • Seizures • Vaginal Bleeding • Trauma

  9. Miscarriage • Delivery of fetus & placenta before 20 weeks • Danger - bleeding & infection

  10. Treatment • Initial assessment • History & physical exam • Ask if she is pregnant • Ask date of last cycle

  11. Treatment • Apply external vaginal pads • Collect tissues • Transport

  12. Seizures • Eclampsia - related to high blood pressure

  13. Treatment • Initial assessment • HX & vitals • Transport on left side • Monitor airway & give O2 • Transport

  14. 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 Vaginal Bleeding

  15. Placenta abruptio - placenta separates prematurely • Placenta previa - placenta develops over & covers the mouth of the uterus

  16. Treatment • BSI • Initial assessment • History and physical exam • Ask patient if she has any pain.

  17. Treatment • Transport on left side • Sterile pad or sanitary napkin • Save any tissue • Transport

  18. Trauma • Severe bleeding • Injury to fetus

  19. Treatment • Initial assessment • O2 • Place on left side • Control external bleeding • Transport

  20. Preparing for Delivery Assessing the need for emergency delivery • First decision - whether or not you have time to transport?

  21. Decision based on three factors: • Is the delivery imminent • Hospital cannot be reached due to a natural disaster, weather, or traffic conditions • No transportation is available

  22. Equipment • Surgical scissors-1 pair • Hemostats or cord clamps-3 • Umbilical tape/sterile cord • Small rubber bulb syringe • Towels-5

  23. Equipment • 1 dozen 2” x 10” gauze sponges • Rubber gloves • Baby blanket-1 • Sanitary napkins • Plastic bag

  24. Delivering The Baby Position and support • Flat, sturdy surface • Lie with knees drawn up and spread apart • Elevate buttocks with blankets

  25. Position and support • Create sterile field • One towel under buttocks • One between her legs • One across her abdomen • Partner at head • Reassure/comfort • Assist airway

  26. 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

  27. Delivering the Head • Umbilical cord around neck? • Slip over shoulder • Clamp and cut it

  28. Delivering the Body • Support head and body • Grasp feet • Support with both hands • Baby will be slippery • Do not squeeze neck or chest

  29. Post Delivery Care Initial care of baby • Set baby down • Same level or lower than birth canal • On side with head slightly lower than body • Continue to aspirate

  30. Initial care of the baby • Wrap in blanket • Warm prior if possible • Leave only face expose • If not breathing, perform CPR

  31. Cutting the Umbilical cord • Clamp with two clamps • Four fingers width from the baby • Two to six inches apart • Cut between clamps

  32. Apgar score • 1 and 5 minutes • Healthy baby will score 10 • Five areas

  33. 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

  34. Delivery of Placenta • Normal Delivery • Within a few minutes of baby’s birth • Usually less than 250 ml blood loss • Record delivery time • Take to hospital

  35. Delivery of Placenta • Provide prompt transport • If not delivered within 30 minutes • 250ml of bleeding occurs before delivery of placenta • Significant bleeding occurs after delivery of placenta • Do not pull cord!

  36. Click for Video

  37. Resuscitation of Newborn • Assessing the baby • Respirations • Pulse • Artificial Ventilation • Use BVM • 40- 60 breaths per minute

  38. Resuscitation of Newborn • Chest compressions • Heart rate is < 60 bpm, or between 60- 80 bpm and not rising • Both thumbs on middle third of the sternum or one thumb over the other

  39. Abnormal Deliveries Prolapsed umbilical cord • Cord comes out before baby • Do not replace! • Danger: Decreased O2 to the baby

  40. Treatment • Place mother with legs and buttocks elevated • Exert gentle counter pressure with gloved hand • Wrap moistened sterile towel around cord • Oxygen • Keep warm • Transport

  41. Breech Delivery • Presenting part - buttocks or feet • Treatment • Position and drape mother • Allow buttocks and feet to deliver • Support legs and trunk

  42. Treatment • Head usually delivers on its own • If not within 3 minutes of buttocks and trunk, do not pull! • Cup hand over baby’s face/mouth and transport • Head delivers- procedures the same

  43. Limb Presentation • Presenting part single arm, leg, or foot • Cannot successfully deliver in the field

  44. Treatment • Give mother O2 • Place mother on back, head lower than pelvis • Cover with sterile towel • Transport

  45. Multiple Births • 1st baby is small • Abdomen still large • Contractions about 10 minutes after first baby

  46. Treatment • Cut cord on first baby • Follow normal delivery procedures • May be considered premature

  47. Premature Infants • Premature - born before 8th month or weighing less than 5 1/2 lbs. • Judge weight • Thinner, smaller, redder than full term • Head larger

  48. 5 important steps in management • Keep warm • 90-95 degrees F • Keep mouth, nose, and throat clear • Make sure cord not bleeding • Apply additional clamps or ties • Slightest bleeding serious

More Related