Post on 04-Jun-2018
transcript
8/14/2019 obstretric review.ppt
1/56
Home
OBSTETRICS AND
GYNECOLOGY
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
2/56
Home
Lesson Objective:
Indicate procedures for emergency(pre -hospital) childbirth.
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
3/56
Home
OVERVIEW
Anatomy ReviewBeginning of LaborPredelivery EmergenciesPreparing for Delivery
Delivering the Baby
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
4/56
Home
OVERVIEW cont.
Postdelivery CareResuscitation of the NewbornAbnormal Deliveries & ComplicationsGynecologic Emergencies
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
5/56
Home
FetusUterusPlacentaUmbilical Cord
Amniotic Sac
Cervix
Anatomy Review
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
6/56
Home
The Stages of Labor
1st Stage - 1st contraction until cervix isfully dilated.
2nd Stage - full dilation until birth.3rd Stage - birth of baby, until delivery ofplacenta
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
7/56
Home
Signs of Labor
Beginning of regular contractionsBloody showRupture of the amniotic sac (waterbreaks)
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
8/56
Home
Predelivery Emergencies
Miscarriage
SeizuresVaginalBleeding
Trauma
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
9/56
Home
Miscarriage
Delivery of fetus & placenta before 20weeks
Danger - bleeding & infection
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
10/56
Home
Treatment
Initial assessmentHistory & physical exam
Ask if she is pregnantAsk date of last cycle
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
11/56
Home
Treatment
Apply external vaginal pads
Collect tissuesTransport
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
12/56
Home
Seizures
Eclampsia - related to high bloodpressure
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
13/56
Home
Treatment
Initial assessmentHX & vitalsTransport on left sideMonitor airway & give O 2
Transport
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
14/56
Home
Vaginal Bleeding
Early pregnancy - may be normalLater stages of pregnancy
Placenta abruptio - placentaseparates prematurelyPlacenta previa - placenta developsover & covers the mouth of theuterus
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
15/56
Home
Placenta abruptio -placenta separates
prematurely
Placenta previa -placenta developsover & covers themouth of theuterus
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
16/56
Home
Treatment
BSIInitial assessment
History and physical examAsk patient if she has any pain.
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
17/56
Home
Treatment
Transport on left sideSterile pad or sanitary napkinSave any tissueTransport
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
18/56
Home
Trauma
Severe bleedingInjury to fetus
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
19/56
Home
Treatment
Initial assessmentO 2Place on left sideControl external bleedingTransport
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
20/56
Home
Preparing for DeliveryAssessing the need for emergency
delivery
First decision - whether or not youhave time to transport?
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
21/56
Home
Decision based on three factors:
Is the delivery imminent
Hospital cannot be reached due toa natural disaster, weather, ortraffic conditions
No transportation is available
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
22/56
Home
Equipment
Surgical scissors-1 pairHemostats or cord clamps-3
Umbilical tape/sterile cordSmall rubber bulb syringeTowels-5
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
23/56
Home
Equipment
1 dozen 2 x 10 gauze sponges Rubber gloves
Baby blanket-1Sanitary napkinsPlastic bag
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
24/56
Home
Delivering The Baby
Position and support Flat, sturdy surfaceLie with knees drawn up andspread apart
Elevate buttocks with blankets
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
25/56
Home
Position and support
Create sterile fieldOne towel under buttocksOne between her legs
One across her abdomenPartner at head
Reassure/comfortAssist airway
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
26/56
Home
Delivering the HeadPlace fingers on bony part of skullIf amniotic sac does not break, or has notbroken:
Use clamp to puncturePush away from nose and mouth
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
27/56
Home
Delivering the Head
Umbilical cord around neck?Slip over shoulderClamp and cut it
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
28/56
Home
Delivering the Body
Support head andbody
Grasp feetSupport with bothhands
Baby will beslipperyDo not squeezeneck or chest
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
29/56
Home
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
30/56
Home
Post Delivery Care
Initial care of baby Set baby downSame level or lower than birth canalOn side with head slightly lower thanbodyContinue to aspirate
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
31/56
Home
Initial care of the baby
Wrap in blanketWarm prior if possibleLeave only face expose
If not breathing, perform CPR
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
32/56
Home
Cutting the Umbilical cord
Clamp with two clamps
Four fingers width from the babyTwo to six inches apart
Cut between clamps
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
33/56
Home
Apgar score
1 and 5 minutesHealthy baby will score 10Five areas
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
34/56
Home
APGAR
Appearance - pink shortly after birthPulse - greater than 100/minGrimace - crying, or withdrawing in
response to stimuliActivity - resistance or muscle tonewhen attempts are made to
straighten legsRespirations - regular and rapid
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
35/56
Home
Delivery of Placenta
Normal DeliveryWithin a few
minutes of babysbirthUsually less than250 ml blood lossRecord deliverytimeTake to hospital
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
36/56
Home
Delivery of Placenta
Provide prompt transportIf not delivered within 30 minutes250ml of bleeding occurs before
delivery of placentaSignificant bleeding occurs afterdelivery of placenta
Do not pull cord!
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
37/56
Home
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
38/56
Home
Click for Video
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program/Vid_0020.asxhttp://www.pychealth.com/CFD-QA-Program/Vid_0020.asxhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
39/56
Home
Resuscitation of Newborn
Assessing the babyRespirationsPulse
Artificial VentilationUse BVM40- 60 breaths per minute
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
40/56
Home
Resuscitation of Newborn
Chest compressionsHeart rate is < 60 bpm, or between60- 80 bpm and not risingBoth thumbs on middle third of thesternum or one thumb over the
other
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
41/56
Home
Abnormal Deliveries
Prolapsedumbilical cord
Cord comes outbefore babyDo not replace!
Danger: DecreasedO 2 to the baby
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
42/56
Home
Treatment
Place mother with legs and buttockselevatedExert gentle counter pressure with
gloved handWrap moistened sterile towel aroundcord
OxygenKeep warmTransport
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
43/56
Home
Breech Delivery
Presenting part -buttocks or feet
Treatment Position anddrape mother
Allow buttocksand feet todeliverSupport legsand trunk
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
44/56
Home
Treatment
Head usually delivers on its ownIf not within 3 minutes of buttocksand trunk, do not pull!Cup hand over babys face/mouthand transport
Head delivers- procedures thesame
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
45/56
Home
Limb Presentation
Presenting part single arm, leg, orfoot
Cannot successfully deliver in thefield
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
46/56
Home
Treatment
Give mother O 2 Place mother on back, head lowerthan pelvisCover with sterile towelTransport
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
47/56
Home
Multiple Births
1st baby is smallAbdomen still largeContractions about 10 minutes afterfirst baby
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
48/56
Home
Treatment
Cut cord on first babyFollow normal delivery proceduresMay be considered premature
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
49/56
Home
Premature Infants
Premature - born before 8th month orweighing less than 5 1/2 lbs.
Judge weightThinner, smaller, redder than fulltermHead larger
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
50/56
Home
5 important steps in management
Keep warm90-95 degrees F
Keep mouth, nose, and throat clearMake sure cord not bleeding
Apply additional clamps or tiesSlightest bleeding serious
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
51/56
Home
5 important steps in management
Increase O 2 in enviromentMake tent over headAim O 2 at top of tentDo not administer directly
Avoid infection
Use sterile equipmentAvoid unnecessary handling
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
52/56
Home
Gynecologic Emergencies
Trauma to external genetalia Treat as other bleeding and soft
tissue injuriesO 2 Never pack vagina
Transport
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
53/56
Home
Alleged Sexual Assault and Rape
Patient may refuse assistance
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
54/56
Home
Treatment
BSIAirwayNonjudgmental attitude duringSAMPLECrime scene protection
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
55/56
Home
Treatment
Examine genitalia only if profusebleeding
Use same sex providers if possibleDiscourage bathing, voiding, orcleaning wounds
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program8/14/2019 obstretric review.ppt
56/56
H
The End
http://www.pychealth.com/CFD-QA-Programhttp://www.pychealth.com/CFD-QA-Program