Chapter 34:OBGYN Emergenicies When the Stork Delivers to the Snow Bowl

Anatomy and Physiology

The Reproductive Cycle Menstruation cycle is about 28 days Gestation: The time between conception and birth 3 trimesters, 12 weeks each After weeks uterus emerges from the protection of pelvic bones At full term uterus can be found in all 4 quadrants of abdomen Born before 37 weeks- premature

Important Physiological Changes Blood volume rises after 28 weeks Heart rate increases by bpm Slight increase in respiratory rate BP decreases during mid pregnancy, normal by final trimester Can lose 35% blood volume without showing signs of shock Fetus can go into shock

Common OBGYN Emergencies Abdominal pain Dysmenorrhea Cystitis Ovarian cysts Pelvic inflammatory disease Ectopic pregnancy Vaginal Bleeding GI Trauma Sexual Assault

Pregnancy Possible complications Hemorrhage: vaginal bleeding during first trimester may signal a miscarriage or ectopic pregnancy Pregnancy-Induced Hypertension (PIH): develops after 20 th week of gestation, more common in 1 st time pregnancy, twin pregnancies, and women with preexisting diabetes Miscarriage: Primary Sign: Spotting or bleeding accompanied by lower abdominal cramping Supine Hypotensive Syndrome: BP> 140/90: When the uterus enlarges, compressing the vena cava, resulting in abnormally low blood pressure

WHAT DO I DO?!

SO IN ALL OTHER CASES, I’M SUPPOSED TO DELIVER THIS THING??

That’s gross

Pregnancy

continued

Transport to Hospital if… It will take less than 20 min to get there The umbilical cord is visible inside the vagina (prolapsed cord) -If any part of the baby other than the top it the head is visible in the vagina (a breech delivery) -If woman says her DR said she would need a C-section -If this delivery is a woman’s first and the amount of the baby’s head that is visible is smaller than 1 in across

Pregnancy

How to Deliver a Baby and not Dissolve into Tears 1. Use a disposable sterile OB delivery kit 2. Assist the mother, if necessary, in removing her clothing and place in semi-fowler’s position. 3. Time the contractions 4. Once the baby is crowning, allow the mother to push 5. Deliver head and shoulders 6. Should transportation be delayed more than 20 minutes, you will need to cut the umbilical cord 7. Delivery of the placenta ***Always transport mother and baby to the hospital or other ALS point

Newborn Care: APGAR Appearance Pulse Grimace or irritability Activity or muscle tone Respirations

Possible Trauma Ruptured uterus S/S: sharp pain following direct trauma to abdomen, irregular abdomen Abruptio placenta S/S: Vaginal bleeding, abdominal pain, constant uterine contractions, expanding uterine height Premature labor Rupture of membranes: amniotic sac or uterus

Abruptio Placenta continued

Amniotic Sac Rupture

Management Initial management Scene safe ABCDs SAMPLE OPQRST DCAP-BTLS ALS if needed Management following trauma

Guess that Baby Troll!