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Obstetrics and Gynecological Emergencies
You are having a WHAT!?!?
BABY
Obstetrics and Gynecological Emergencies
• 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
Obstetrics and Gynecological Emergencies
– A baby blanket– Several sanitary napkins– Plastic bag– Standard BSI precautions
Obstetrics and Gynecological Emergencies
• 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
Obstetrics and Gynecological Emergencies
– 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
Obstetrics and Gynecological Emergencies
• Preparing for Delivery– Control the scene– BSI– Position the patient– Remove clothing that can obstruct view of
delivery– Position OB kit or available materials
Obstetrics and Gynecological Emergencies
The Delivery
Obstetrics and Gynecological Emergencies
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
Obstetrics and Gynecological Emergencies
• 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
Obstetrics and Gynecological Emergencies
Complications of the Delivery
Obstetrics and Gynecological Emergencies
• Supine Hypotensive Syndrome– The weight of the baby, placenta and
amniotic fluid can compress the vena cava– Care
• Place mother on lateral left side
Obstetrics and Gynecological Emergencies
• 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
Obstetrics and Gynecological Emergencies
• 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
Obstetrics and Gynecological Emergencies
• Limb Presentation– High flow oxygen– Do Not pull on the baby
Obstetrics and Gynecological Emergencies
• 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
Obstetrics and Gynecological Emergencies
• 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
Obstetrics and Gynecological Emergencies
• 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
Obstetrics and Gynecological Emergencies
• 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
Obstetrics and Gynecological Emergencies
• 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
Obstetrics and Gynecological Emergencies
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)
Obstetrics and Gynecological Emergencies
Treatment for Pregnant Trauma Patient– High flow oxygen– Be ready to suction due due to nausea and
possible vomiting– Activate EMS– Provide emotional support
Obstetrics and Gynecological Emergencies
GYN EMERGENCIES
Obstetrics and Gynecological 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
Obstetrics and Gynecological Emergencies
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
Obstetrics and Gynecological Emergencies
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