Pregnancy and Childbirth Pathways NCC Quality Assurance Team

So you’re going to deliver a baby... Remember: Once the birthing sequence has begun, there is little anyone can do to safely stop it.

“How many months/weeks...days, hours, minutes, seconds…” 1st Trimester 2nd Trimester 3rd Trimester 0-3 months 4-6 months 7-9 months 0-12 weeks 13-24 weeks 25-40 weeks Why is this important to know? Miscarriage Premature Delivery Imminent Delivery!

Complications of Pregnancy Hyperemesis Gravidarum Pregnancy or Sick Card? Gestational Diabetes Pregnancy, Diabetic Problems or Sick Card? Bleeding Pregnancy or Hemorrhage Card? Abdominal Pain Pregnancy or Abdominal Pain Card?

Complications of Pregnancy “I have Pre-Eclampsia. My B/P is elevated and I’m swollen.” Pregnancy, Heart Problems or Sick Card? Sudden Difficulty Breathing Pregnancy or Breathing Problems? “My wife’s 8 months pregnant! She just tripped and fell on the baby!” Pregnancy, Fall or Traumatic Injuries? “My daughter’s pregnant and I think she’s having a seizure!” Pregnancy or Convulsions?

“Is she bleeding (or passing any tissue?)” What are we looking for? Miscarriage Ectopic Pregnancy Placenta Previa Abruptio Placenta

Miscarriage The post delivery of a fetus or products of conception (tissue) in the 1st or 2nd trimester. Miscarriage is the term for loss of pregnancy at a stage when the fetus is not capable of living outside the uterus. This is generally prior to the 26th week.

Miscarriage

Ectopic Pregnancy Results from the fertilization and fetal development outside the uterus, usually in the Fallopian tube. As the embryo grows, it eventually tears the tube and hemorrhages. The woman can bleed to death within hours without exterior evidence of bleeding. Treat for Shock!

Ectopic Pregnancy Abdominal pain in a female of child-bearing age (12-50) who has fainted (or nearly fainted) is considered an ectopic pregnancy until proven otherwise. - Rule 2, Abdominal Pain Card

Placenta Previa The placenta lies either partially or fully between the fetus and the uterine opening into the birth canal. Potentially life-threatening! Painless bleeding in the last trimester.

Abruptio Placenta Sudden, premature tearing of the placenta away from the uterine wall, usually in the last trimester. Very painful! Life-threatening!

“Can you see any part of the baby now?” Head Visible (Crowning) Breech - Visual presentation of the cord, hands, feet of buttocks first.

Crowning When crowning (top of baby’s head is visible) and/or pushing is present, turn to PAI Childbirth - Delivery Sequence “Check Crowning”(F5) since birth is IMMINENT. - Rule 1, Pregnancy Card

Breech Visual presentation of the cord, hands, feet or buttocks first (breech) is a dire prehospital emergency. Often the only chance for survival of the baby is at the hospital. See also PAI Childbirth - Delivery Sequence “Breech” (F15). - Rule 2, Pregnancy Card

Breech

Breech

Breech

Prolapsed Cord (Breech) Cord presentation occurs when the cord slips down into the vagina or presents externally after the amniotic membranes have ruptured. Dangerous when the baby’s head compresses the cord during delivery in the narrow birth canal, cutting off the baby’s blood and oxygen supply.

Nuchal Cord …the umbilical cord is wrapped around the baby’s neck at delivery.

Labor Physical or mental exertion, especially when difficult or exhausting; work; the physical efforts of childbirth; Primigravida or Multigravida? In general, initial pregnancies progress through labor more slowly than second plus pregnancies.

Imminent Delivery 1st full pregnancy and labor pains <= 2 minutes apart. 2nd plus pregnancy and labor pains <= 5 minutes apart.

Post-Dispatch Instructions Possible, but not appropriate? 1st and 2nd party callers should be kept on the line until help arrives. Define “Imminent.”

Childbirth

Now you have TWO patients! “Is the baby CRYING or BREATHING?” (F7) No; Nuchal Cord. (F(16) No; “Gently slap the bottom of the baby’s feet.” “Is the baby CRYING or BREATHING now?” (F17) “Is there any GREEN fluid in its mouth?” (F18)

Now you have TWO patients! Monitor baby’s ABC’s. Keep baby warm. Don’t forget to monitor MOM! Keep her warm ABC’s Hemorrhaging

Delivery of the Placenta Also known as the afterbirth. PAI Childbirth - Delivery Sequence “Keep Afterbirth” (F10). Important for MD to verify placenta delivered normally and completely. Incomplete or partial delivery can result in severe hemorrhaging and serious infection.

A New Life Make every effort to note the time of delivery. Is it a boy or girl? Childbirth is usually a happy event. However be cautious about assuming this until the caller’s demeanor indicates celebration is in order.