OB EMS E mergencies Presented by Jodi McGraw, M.D.

1. OB EMS EmergenciesPresented by Jodi McGraw, M.D.

2. History • Gravida (gravidity)= number of pregnancies • Para (parity)= number viable gestational age pregnancies • Eg. G3P2 (third pregnancy & 2 deliveries) • G5P2 (1,1,3,2)=full term, preterm, miscarriage or abortions, living • Trauma in OB, treat the Mom • O2, 2x large bore IV’s, left lateral • Position if able based on trauma. • Treat the injuries

3. Documentation • Medical documentation obtained at • Patient visits for patient record

4. Documentation • Symptoms since LMP, genetic screening • Infection history, physical exam

5. Documentation • Additional notes for visit

6. Documentation • Typical format for OB visit details

7. Documentation • Labs & education at visits

8. Documentation • Labs for 2nd & 3rd trimesters

9. Documentation • Plans & education

10. ER Physician Brief • 19 yo G1P0 at 39 EGA, no local medical care, uncomplicated pregnancy, negative GBS at 36 weeks, no meds, NKDA, healthy • Contractions q3 min • Fluid leaking (?clear), but not bleeding • +fetal movement A few potential problems: • Edema • 60# weight gain • Elevated blood pressure, leg swelling, • Bleeding, abdominal pain, SOB

11. EMS OB Delivery Kit • Remember PPE • Use a towel to dry/swaddle baby, if needed

12. OB Instruments • This is what our OB tray looks like • Basic EMS kit will have essentials

13. Documentation • Record and document events as able • Most important times: infant birth time placenta delivery time

14. PreEclampsia • Elevated blood pressure and • Proteinuria • (edema not required) • Worst complication is seizure/HELLP (hemolysis, elevated LFT’s, low platelets) • In pregnancy, eclampsia seizures treated with Mg IV • Benzodiazepines do not stop seizures in eclampsia • IV x 2, O2, can check reflexes

15. Prolapsed Cord • Cord dangling out of vagina or cervix • Compresses baby’s lifeline • EMERGENCY! Notify ER! • Elevate pelvis and manually • Push infants head off the cord • Without compressing the cord • Emergent Cesarean! IV x 2, O2

16. Abruptio Placentae • Typically severe abdominal pain (not just with contractions) • Bleeding extent may not be apparent • EMERGENCY! • Start O2, IV x 2, position

17. Normal Delivery • Pushing can be >2 hours in primiparous • Patient, but may be 1-2 hours in multiparous • May be precipitous • If preterm, expect precipitous & consider • Malpresentations- eg breech • Chin first does not deliver! Neck can not hyperextend • Clamp x 2 & cut cord between clamps • Placenta may take ~1-20 minutes

18. Breech Delivery • 3-4% of deliveries, injuries e.g. clavicle fractures more common • Prematurity is risk • Deliver spontaneous until umbilicus is at introitus • Then, support trunk • Remove 1 arm at a time • Head most difficult: • Flex neck

19. shoulder Dystocia • Hcall for Help! • EEvaluate for Episiotomy • LLegs – McRoberts maneuver • PsupraPubicPressure • EEnter, rotational maneuvers • RRemove the posterior • RRoll the patient to her hands & knees

20. Hemorrhage • 2nd & 3rd trimester bleeding: placenta previa uterine rupture placenta abruption vasa Previa • Postpartum hemorrhage- compress • O2, IV x 2, compression, position

21. Demo with Mannequin: Noelle • Awesome! • Please feel welcome to participate and ask questions

22. Summary • Good history • Evaluate for complications • Bleeding/hemorrhage • DVT • Pre-eclampsia • delivery

23. Thank You With Great Appreciation for all you do! Questions? Practice with mannequin?