Childbirth and Gynecologic Emergencies Chapter 22 Childbirth and Gynecologic Emergencies

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

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

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

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

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.

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

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

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.

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

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

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.

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

Recognizing Non-Injury-Related Vaginal Bleeding Abdominal cramps

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.

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

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.

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.

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.

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

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.

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

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

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?

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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

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.

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.

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

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

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

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

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.

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

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

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.

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

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

Care for Premature Babies Keep baby warm; increased risk of hypothermia Keep mouth and nose clear of mucus. Monitor breathing. Perform CPR if necessary.

Gynecologic Emergencies Reproductive-system problems that occur in nonpregnant females

Sexual Assault and Rape Rape is fastest growing violent crime in US. Most often victim is a woman. 1 in 3 American women sexually assaulted at some point. Men can also be raped. Rape Attempted or actual sexual intercourse against victim’s will Physical and psychological injury Calm, sympathetic care is essential.

Recognizing Sexual Assault and Rape (1 of 2) Focus on providing care, not obtaining evidence. Preserve evidence. Question about injuries only, not crime. Use SAMPLE survey.

Recognizing Sexual Assault and Rape (2 of 2) Signs: Headaches Sleeplessness, nightmares Nausea, muscle spasms Confusion Depression Anxiety, jumpiness

Care for Sexual Assault and Rape (1 of 2) Don’t ask a lot of questions. Don’t blame survivor. Be supportive. Remind that he/she is safe. Determine immediate care needed. Try to have woman present to care for female victim. Do not expose genitalia unless extreme care is needed.

Care for Sexual Assault and Rape (2 of 2) Try to preserve evidence. Encourage victim not to change clothes, wash, urinate, defecate, douche. Do not leave victim alone. Protect privacy. Provide crisis center information. Get survivor to medical care. Encourage survivor to get medical care if he/she refuses.