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Lesson Objective:
Indicate procedures for emergency
(pre -hospital) childbirth.
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OVERVIEW
Anatomy Review
Beginning of Labor
Predelivery Emergencies
Preparing for Delivery
Delivering the Baby
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OVERVIEW cont.
Postdelivery Care
Resuscitation of the Newborn
Abnormal Deliveries & Complications
Gynecologic Emergencies
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FetusUterus
Placenta
Umbilical Cord
Amniotic Sac
Cervix
Anatomy Review
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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
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Signs of Labor
Beginning of regular contractions
Bloody show
Rupture of the amniotic sac (waterbreaks)
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Predelivery Emergencies
Miscarriage
SeizuresVaginal
Bleeding
Trauma
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Miscarriage
Delivery of fetus & placenta before 20
weeks
Danger - bleeding & infection
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Treatment
Initial assessment
History & physical exam
Ask if she is pregnant
Ask date of last cycle
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Treatment
Apply external vaginal pads
Collect tissues Transport
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Seizures
Eclampsia- related to high blood
pressure
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Treatment
Initial assessment
HX & vitals
Transport on left side
Monitor airway & give O2
Transport
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Vaginal Bleeding
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
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Treatment
BSI
Initial assessment
History and physical exam
Ask patient if she has any pain.
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Treatment
Transport on left side
Sterile pad or sanitary napkin
Save any tissue
Transport
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Trauma
Severe bleeding
Injury to fetus
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Treatment
Initial assessment
O2
Place on left side
Control external bleeding
Transport
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Decision based on three factors:
Is the delivery imminent
Hospital cannot be reached due toa natural disaster, weather, or
traffic conditions
No transportation is available
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Equipment
Surgical scissors-1 pair
Hemostats or cord clamps-3
Umbilical tape/sterile cordSmall rubber bulb syringe
Towels-5
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Equipment
1 dozen 2 x 10 gauze sponges
Rubber gloves
Baby blanket-1Sanitary napkins
Plastic bag
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Delivering The Baby
Position and support
Flat, sturdy surface
Lie with knees drawn up and
spread apart
Elevate buttocks with blankets
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Position and support
Create sterile fieldOne towel under buttocks
One between her legs
One across her abdomen
Partner at head
Reassure/comfort
Assist airway
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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
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Delivering the Head
Umbilical cord around neck?
Slip over shoulder
Clamp and cut it
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Delivering the Body
Support head and
body
Grasp feet Support with both
hands
Baby will be
slippery
Do not squeeze
neck or chest
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Post Delivery Care
Initial care of baby Set baby down
Same level or lower than birth canal
On side with head slightly lower thanbody
Continue to aspirate
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Initial care of the baby
Wrap in blanket
Warm prior if possible
Leave only face expose
If not breathing, perform CPR
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Cutting the Umbilical cord
Clamp with two clamps
Four fingers width from the babyTwo to six inches apart
Cut between clamps
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Apgar score
1 and 5 minutes
Healthy baby will score 10
Five areas
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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
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Delivery of Placenta
Normal Delivery
Within a few
minutes of babysbirth
Usually less than
250 ml blood loss
Record delivery
time
Take to hospital
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Delivery of Placenta
Provide prompt transportIf not delivered within 30 minutes
250ml of bleeding occurs before
delivery of placentaSignificant bleeding occurs after
delivery of placenta
Do not pull cord!
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The End
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