Chapter 22

1. Chapter 22 Childbirth and Gynecologic Emergencies

2. Childbirth and Gynecologic Emergencies of Pregnancy (1 of 2) • Birth canal: Vagina and lower part of uterus • Cervix: Small opening at lower end of uterus • Placenta: Mother and fetus exchange nourishment and waste through this organ • Umbilical cord: Extension of placenta through which fetus receives nourishment • Amniotic sac: Bag of fluid that cushions fetus

3. Childbirth and Gynecologic Emergencies of Pregnancy (2 of 2) • Crowning: Fetus’s head presses against vaginal opening • Bloody show: Mucus and blood discharged as labor begins • Labor: Process of childbirth • Miscarriage: Delivery of fetus before it can live independent of mother

4. Predelivery Emergencies • Miscarriage • Usually during first 3 months • Most occur because fetus was not developing properly • Emotionally upsetting • Have a woman help the victim.

5. Recognizing Miscarriage • Cramping pain in lower abdomen • Aching lower back • Vaginal bleeding • Passage of tissue from vagina

6. Care for Miscarriage • Reassure the woman. • Help into comfortable position with legs bent. • Have woman place sanitary pad over outside of vagina. • Transport tissue from vagina to hospital with woman. • Transport to medical care. • Call 9-1-1 if bleeding is heavy or signs of shock.

7. Vaginal Bleeding During Late Pregnancy • Late pregnancy • Last 3 months • Usually an emergency • Find out amount of bleeding • Have a woman help the victim if possible.

8. Recognizing Vaginal Bleeding During Late Pregnancy • Signs of shock could result from heavy bleeding.

9. Care for Vaginal Bleeding During Late Pregnancy • Place woman on left side. • Have woman place sanitary pad over outside of vagina. • Call 9-1-1.

10. Vaginal Bleeding Caused by Injury • Difficult to determine source of bleeding • Can be difficult to care for due to: • Modesty • Pain

11. Recognizing Vaginal Bleeding Caused by Injury • Injuries of external female genitalia • Severe pain • Blood in vaginal area • Massive internal vaginal bleeding

12. Care for Injury-Related Vaginal Bleeding • Direct pressure over bulky dressing or sanitary pad • Apply ice. • Do not place dressings into vagina. • Place victim on left side. • Seek medical care.

13. Non-Injury-Related Vaginal Bleeding • Most likely to be menstrual • Can indicate more serious conditions: • Miscarriage • Childbirth • Infection

14. Recognizing Non-Injury-Related Vaginal Bleeding • Abdominal cramps

15. Care for Non-Injury-Related Vaginal Bleeding • Reassure woman. • Help into comfortable position with legs bent. • Have woman place sanitary pad over outside of vagina. • Seek medical care.

16. Delivery • Unplanned time or place = emergency • Can be stressful for first aider • Can be a happy event

17. Imminent Delivery (1 of 3) • Consider transport if woman is not straining or crowning and this is first pregnancy. • If transport is possible, place woman on left side. • Prevents possible drop in blood pressure.

18. Imminent Delivery (2 of 3) • If straining or crowning, prepare to assist delivery. • Call EMS. • Find private, clean area. • Wear gloves, more protection if possible. • Do not touch vaginal area except during delivery. • Do not let mother use toilet. • Do not hold mother’s legs together.

19. Imminent Delivery (3 of 3) • If head is not presenting, delivery will be complicated. • Tell mother not to push. • Attempt to calm and reassure. • Call 9-1-1.

20. Stages of Labor (1 of 4) • Three-stage process: • Uterine contractions • Delivery of baby • Delivery of placenta

21. Stages of Labor (2 of 4) • First stage • Contractions last several hours, aching in back/cramps in abdomen • Contractions grow shorter, increase in intensity • Amniotic sac breaks • If amniotic sac breaks prematurely or not during labor, seek medical care.

22. Stages of Labor (3 of 4) • Second stage • 30 minutes to 2 hours • Neck of cervix fully opens • Baby is born • Baby’s head normally comes out first

23. Stages of Labor (4 of 4) • Third stage • 15 minutes or more • Placenta is expelled

24. Recognizing Impending Delivery (1 of 2) • Has woman had a baby before? • How frequent are the contractions? • Has amniotic sac ruptured? • Does mother feel like she must move her bowels?

25. Recognizing Impending Delivery (2 of 2) • If yes, examine for crowning: • Bulging at vaginal opening • Part of baby is visible • Explain what you are doing • Protect woman’s privacy • Use blanket to shield from others

26. Delivery Procedures • Supplies: • Clean sheets, towels, blankets • Plastic bag or towel • Clean, unused medical exam gloves • Sanitary pads • Newspapers, plastic, cloth sheet • Rubber bulb syringe • Sterile gauze pads • Strips of gauze, new or clean shoelaces

27. Care During Delivery (1 of 6) • Take infection-control precautions. • Have mother lie on back with knees drawn up, legs spread apart, or other safe position. • Have woman take short, quick breaths during contractions. • Have woman take deep breaths between contractions. • Place absorbent, clean materials under mother’s buttocks.

28. Care During Delivery (2 of 6) • Elevate mother’s buttocks with blankets or pillow. • When baby’s head appears, gently place your palm on top of the head. • Have woman stop pushing. • Do not push on fontanels. • If amniotic sac does not break, tear it with your fingers and push away from baby’s head and mouth.

29. Care During Delivery (3 of 6) • If umbilical cord is wrapped around neck, gently slip over baby’s shoulder. • Or, alleviate pressure on cord • Support head. • Suction baby’s mouth and nostrils. • Support body with both hands as baby emerges. • Do not pull on baby or touch armpits.

30. Care During Delivery (4 of 6) • Keep baby level with vagina. • Wipe blood and mucus from baby’s mouth and nose. • Dry the infant. • Rub baby’s back, flick soles of feet. • If baby does not breathe in 30 seconds, begin CPR. • Wrap baby in warm blanket, place on side. • Maintain at level of vagina.

31. Care During Delivery (5 of 6) • When umbilical cord stops pulsating, tie with gauze. • Do not cut cord unless in remote location. • If so, tie cord 4 inches away from baby. • Make second tie 2 inches from first tie. • Cut between ties. • Watch for delivery of placenta. • Do not pull umbilical cord.

32. Care During Delivery (6 of 6) • Wrap placenta in towel with 3/4 of umbilical cord. • Place towel in plastic bag, keep bag at level of infant. • Take placenta to hospital. • Place sterile pad over vaginal opening. • Lower mother’s legs, help her hold them together. • Gently massage woman’s abdomen just below navel.

33. Delivery Aftercare • Monitor mother’s breathing and pulse. • Replace blood-soaked sheets, blankets. • Massage uterus if blood loss continues. • Place palm on mother’s lower abdomen. • Massage • Mother may breast feed after delivery of placenta. • This helps control bleeding.

34. Initial Care of the Newborn (1 of 2) • Pulse should be more than 100 beats/min. • Respiratory rate should be more than 40 breaths/min. • Baby is often crying. • Position, dry baby, keep warm, stimulate to breathe • Repeat suctioning.

35. Initial Care of the Newborn (2 of 2) • CPR if does not breathe in 30 seconds. • Ensure that airway is open. • Give one rescue breath every 3 seconds. • Reassess after 1 minute.

36. Abnormal Deliveries • Most births are normal, natural. • Complications can arise. • Stay calm, deliberate, gentle. • Call 9-1-1.

37. Prolapsed Cord • Umbilical cord comes through the birth canal before the head. • Cord is squeezed between baby’s head and mother’s body. • Oxygen to baby could be stopped. • Baby in danger of suffocation

38. Recognizing Prolapsed Cord • Umbilical cord is seen before baby’s head.

39. Care for Prolapsed Cord • Raise mother’s buttocks. • Insert gloved fingers into vagina on either side of cord. • Push baby away from cord. • Do not push cord into vagina. • Call 9-1-1.

40. Breech Birth Presentation • Baby’s buttocks emerge before the head • Most common type of abnormal delivery • Place mother in kneeling, head-down position. • Seek medical care. • Suffocation can occur.

41. Recognizing Breech Birth Presentation • Baby’s buttocks come out first.

42. Care for Breech Birth Presentation • Place one hand in vagina, position palm toward baby’s face. • Form a “V” with fingers on either side of baby’s nose. • Push vaginal wall away from baby’s face until head is delivered. • Call 9-1-1. • Have woman continue to push

43. Limb Presentation • Arm, leg, or foot of the infant protrudes from birth canal • Foot more commonly presents when infant is in breech presentation

44. Recognizing Limb Presentation • Arm, leg, or foot appears first.

45. Care for Limb Presentation • Place mother in head-down position with pelvis elevated. • Do not pull on baby or push limb back in. • Call 9-1-1.

46. Meconium • Baby’s first feces, in amniotic fluid • Associated with fetal distress during labor, greater risk of infant death • Danger if baby breathes into lungs

47. Recognizing Meconium • Greenish or brownish-yellow amniotic fluid • Tarry • Almost odorless

48. Care for Baby in Danger of Inhaling Meconium • Keep infant in moderate head-down position. • Suction mouth and nostrils. • Try not to stimulate infant to breathe before suctioning. • Keep baby’s airway open. • Call 9-1-1.

49. Premature Birth • Baby weighing less than 5.5 lb or born before 7 months • Need special care • Smaller, less developed • Cardiovascular and respiratory systems often immature

50. Recognizing Premature Birth • Difficult without scale to weigh • Smaller and thinner than full-term infant • Head proportionately large compared to body • Cheesy, white coating on skin is minimal or absent