Obstetrics/Gynecology

Female Reproductive System

Anatomy/Physiology Terminology  Uterus  Organ in which the fetus grows, located in the mother’s lower abdomen.  Birth Canal  Vagina and lower part of the uterus  Cervix  Lower part of the uterus that opens during labor to allow baby to pass into the birth canal  Vagina  Lower part of the birth canal  Ovaries  Produce ova (eggs) for conception

 Perineum  Area of skin and muscle between a women’s vagina and anus

Female Reproductive Cycle  Menstruation  Stimulated by estrogen and progesterone  Ovaries release ovum  Uterus walls thicken  Fallopian tubes move egg (peristalsis)  Uterine walls expelled (bleeding 3–5 days)  Fertilization  Sperm reaches ovum  Ovum becomes embryo  Embryo implants in uterus  Fetal stage begins

Anatomy/Physiology Terminology  Fetus  Developing unborn baby  Placenta (afterbirth)  Disk-like organ through which baby exchanges waste products and nourishment during pregnancy  Amniotic Sac (bag of waters)  Sac that completely encases baby inside the uterus. Amniotic fluid should be clear.

Fetal Development  Umbilical Cord  Rope-like structure, 20” long that acts as a “pipeline” between baby and placenta  Contains 2 arteries and 1 vein  Labor  Contraction of uterine muscles which push the baby into the birth canal  Presenting Part  Part of the baby which comes through the birth canal first  270 Days  Length of average pregnancy – about 40 weeks

Labor and Delivery  Dilation  Stretching or opening  Effacement  Thinning of the cervix to allow passage of the fetus into the birth canal

 Crowning  The appearance of the baby’s head at the vaginal opening

Labor and Delivery  Primigravida  Woman who is pregnant for the first time  Multigravida  Woman who has been pregnant more than once  Primipara  Woman who has delivered one viable (over 20 weeks) infant  Multipara  Woman who has delivered more than one viable infant

Labor and Delivery  Lightening  Sensation of the fetus moving from high in the abdomen to low in the birth canal.  Braxton Hicks  Irregular pre-labor contractions of the uterus.

Three Stages of Labor  First Stage  The time from the first uterine contraction until the cervix is fully dilated (open). Amniotic sac breaks. The time between contractions is measured from the end of one contraction until the beginning of the next.

 Second Stage  Full dilation (10 centimeters) of the cervix to birth of the baby, decision to transport or not

 Third Stage  Birth of the baby to delivery of placenta. Wait 20 minutes before transport, save all tissues, record mother’s name and time of birth

 Cephalic birth  Head comes through the birth canal first  “normal” birth. This accounts for most of deliveries that an EMT will assist with  Fontanelles “soft spot” – facilitate the birth

Evaluation of Mother  History  When was your last normal menstrual period (LNMP)?  Abdominal pain? (location/quality)  Vaginal bleeding/discharge?  Is there a possibility you might be pregnant?  Missed period?  Nausea/vomiting  Increased urinary frequency  Breast enlargement  Vaginal discharge

3 Signs of Eminent Delivery  Water Broke  Bloody show  Mucus plug  Bowel movement  Crowning

 History  If pregnant:  Para = # of live births  Gravida = # of pregnancies  -3 /+ 7 to estimate due date Subtract 3 from the month of the LNMP Add 7 to the date of the LNMP LNMP - 12/9/98 Due date - 9/16/99

Normal Delivery 1. Place mom on firm surface. Leave at least 12” from the end of the bed (room to lay baby after delivery) 2. Place clean sheet, blanket or newspaper under mother’s buttock

Normal Delivery 3. Drape mom if materials are present 4. When the baby’s head appears, place fingers gently around the head and exert SLIGHT pressure to prevent explosive delivery

Normal Delivery 5. Check for the umbilical cord around the neck after the head appears. 6. Slip cord over baby’s head if wound around neck. If it cannot be slid off the neck, clamp the cord and immediately cut the cord. 7. Continue to support the head but do not pull 8. Be prepared to use a bulb syringe to suction the infant. Suction the mouth first, then the nose.

Normal Delivery 9. Place the other hand under baby’s body as it is born 10. To stimulate the baby to breath you should gently rub its back or tap the soles of its feet.  Vernix  White, cheese-like film that covers the baby to separate it from the amniotic fluid. May be present at birth

11. When providing oxygen to a newborn, the EMT should deliver the oxygen into the top of an aluminum foil tent placed over the baby’s head 12. If necessary, lower baby’s head to facilitate delivery of upper shoulders and guide head upward to deliver lower shoulder 13. Place the baby at or below the level of the mother’s vagina. Hold baby in head down position to facilitate drainage of blood and mucous

14. Clamp the cord 10” from baby and then 7” away from the baby. When the umbilical cord stops throbbing, cut the cord between the two clamps. If bleeding from the umbilical cord continues, apply another clamp as close to the original one as possible.

Normal Delivery 15. Keep the baby warm. Preventing heat loss is a major concern. 16. Observe mom for delivery of the placenta. Do not wait for delivery of afterbirth to transport. It can take more than 30 minutes to deliver. 17. If there is excessive bleeding following normal delivery you should:  Massage the uterus  Place the woman in the shock position  Give oxygen

Normal Delivery 18. When delivered wrap placenta in newspaper or place in a container and take to the hospital with patient so the hospital staff can determine if it has been completely expelled. 19. Transport. If possible the newborn should be transported in an approved safety seat.

Infant Assessment  A – appearance (color)  P – pulse (heart rate)  G – grimace (muscle tone)  A – activity (response to flicking soles of feet)  R – respiratory effort An new born’s normal heart rate =

Infant Assessment  If you cannot detect a brachial pulse in a non- breathing newborn, you should clamp and cut the cord and then begin CPR.  Rate of pulmonary resuscitation in a newborn is 1 breath every 3 seconds.  Ratio of compressions to breaths is 3 to 1  CPR is performed by wrapping your hands around the chest and placing your thumbs upon the sternum.

Abnormal Deliveries 1. Breech  Buttocks or both feet of the baby come through the birth canal first

Abnormal Deliveries With Breech Births: 1. Allow butt/trunk delivery, provide support for body, arms, legs. 2. Head will deliver on own accord. If it does not do so within 3 minutes, form a “V” with your fingers (index and middle) on each side of infants nose and maintain airway 3. DO NOT allow EXPLOSIVE delivery 4. DO NOT pull the baby out

Abnormal Deliveries 2. Prolapsed Umbilical Cord  When the umbilical cord presents first  This is dangerous because it may compress the cord cutting off circulation 1. Elevate hips – shock position 2. Administer oxygen 3. Wrap cord in sterile, moist dressing (or towel) 4. Transport ASAP

Abnormal Deliveries 2. Prolapsed Umbilical Cord (cont.) 5. MAINTAIN GENTLE PRESSURE ON BABY’S HEAD, BUT DO NOT PUSH CORD BACK IN 6. Form “V” with fingers (index & middle) on each side of the umbilical cord and gently press to take pressure off the cord.

Abnormal Deliveries 3. Limb Presentation 1. Transport ASAP!!!! True Emergency 2. Only a doctor can deliver or treat this

Complications of Pregnancy and During Delivery

 Ectopic Pregnancy  Any pregnancy occurring outside the uterus  Placenta Previa  Implantation of placenta over cervical opening  Will not allow for normal delivery.  Cause of excessive pre- birth bleeding

 Gestational Diabetes  Eclampsia (toxemia of pregnancy)  Abnormal body reaction to pregnancy, resulting in convulsions, possible coma

 Supine hypotensive syndrome  This occurs when the mother lies flat on her back and the uterus, fetus, and placenta compress the inferior vena cava.  Deoxygenated blood to the heart is impaired and the blood pressure drops.  Place mother on her left side and treat for shock  Abrupito Placenta  Condition in which the placenta separates from the uterine wall; a cause of pre-birth bleeding

 Ruptured uterus  Tearing sensation in the abdomen caused by previous cesarean section, weakened uterine wall, baby too large for pelvis extended labor.  Severe pain, nausea, shock symptoms, minimal bleeding  Multiple births  If the mothers abdomen remains unusually large after delivery, you should prepare for multiple births  Meconium  A baby’s first bowel movement. Stains amniotic fluid greenish or brownish-yellow in color  Can be toxic to baby if breathed into the lungs  Sign of fetal or maternal distress

Complications 1. Cord around the neck – nuchal cord 2. Unbroken amniotic sac 3. Hypo/Hypertension 4. Pre-delivery bleeding 5. Drug dependency 6. 5 blood soaked pads after delivery is an EMERGENCY

Pre-Delivery Emergencies  Excessive Pre-birth bleeding  Treat for shock  Do Not hold legs together – place sanitary napkin on vaginal opening and transport ASAP  Replace pads as necessary, save pads for blood loss, save the tissues  Pre-Eclampsia (Toxemia) “poisoning of the blood” – swelling of face, hands, feet, high blood pressure, convulsions

Pre-Delivery Emergencies  Ectopic pregnancy  Pregnancy outside the uterus. Life threatening and very painful.  May cause a woman to have:  Acute abdominal pain  Rapid/weak pulse  Slight vaginal bleeding  Go into shock

Pre-Delivery Emergencies  Miscarriage (Spontaneous Abortion) and Abortion  Stopping the pregnancy either by natural means or by medical means, before the 28 th week.  Treat for shock, transport, and save all tissues