1. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Chapter 24 Obstetrics and Neonatal Care Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

2. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 1.Define key terms introduced in this chapter. 67-6867-68 2.Describe the functions of the uterus, cervix, placenta, umbilical cord, amniotic sac, and birth canal in pregnancy and childbirth. 10-1810-18 3.Describe the events of each of the three stages of labor. 19-24 19-24 4.Discuss the indications that you should expect to assist with delivery on an emergency call. 25-2825-28 5.Demonstrate patient positioning to manage or prevent supine hypotension syndrome. 3030

3. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 6.Given a scenario, demonstrate preparation for and assistance in newborn delivery. 29, 31-362931-36 7.Select correct Standard Precautions for assisting with childbirth. 3131 8.Given a scenario, demonstrate clearing the newborn’s mouth and nose of meconium. 37-3837-38 9.Given a scenario, demonstrate assessment and care of the newborn. 40-4140-41

4. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 10.Given a scenario, demonstrate management of complications of delivery, including: 39, 42-46, 50-553942-4650-55 a.Umbilical cord around the neck b.Prolapsed umbilical cord c.Abnormal presentations, multiple births d.Infant with inadequate breathing, heart rate below 100 per minute, or persistent central cyanosis e.Excessive maternal bleeding

5. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 11.Recognize the signs and symptoms of pregnancy complications, including preeclampsia, eclampsia, vaginal bleeding, and ectopic pregnancy. 57-6557-65 12.Describe the pregnant patient’s altered physiological response to trauma. 6464 13.Discuss special considerations in the management of premature infants. 5656

6. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer MULTIMEDIA DIRECTORY Slide 24First Stage of Labor Video Slide 36Information about Childbirth Video Slide 42Newborn Resuscitation Video Slide 65Information about Preeclampsia Video

7. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer TOPICS Anatomy of Pregnancy Stages of Labor Assisting in Childbirth Caring for the Newborn Caring for the Mother Complications of Delivery Complications of Pregnancy

8. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer INTRODUCTION Imminent childbirth What to do

9. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Call Dispatch –Called to respond to a farmhouse for a 33-year-old in labor –Contractions are reported to be four to five minutes apart –Your response time is 12 minutes –Patient is sitting in a chair and announces her “water has broken” –You ask questions about her contractions and other pregnancy related questions; you obtain vitals –Ambulance is 10 minutes out

10. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anatomy of Pregnancy Back to Topics

11. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: © Alexander Tsiaras/ Science Source/ Photo Researchers, Inc.

12. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anatomy of Pregnancy Uterus –Houses the fetus –Smooth muscle –Provide for contractions

13. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anatomy of Pregnancy Cervix –Neck of uterus –Mucous plug –Bloody show

14. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anatomy of Pregnancy Placenta –Organ on inner lining of uterus –Provides nourishment and oxygen –Absorbs waste –Produces hormones –Afterbirth

15. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anatomy of Pregnancy Umbilical cord –“Lifeline” –One vein –Two arteries

16. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anatomy of Pregnancy Amniotic sac –Fetus floats –500–1000 mL of fluid –Insulates and protects –“My water broke”

17. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anatomy of Pregnancy Birth canal –Cervix and vagina –8–12 cm –Smooth muscle

18. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Anatomy of Pregnancy Back to Objectives

19. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Stages of Labor Back to Topics

20. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

21. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Stage One: Dilation of the Cervix Contractions begin as aching pain in small of back Pain becomes cramp-like in lower abdomen Mucous plug may appear before or during this stage Amniotic sac may rupture

22. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Stage Two: Expulsion Baby moves through the birth canal and is born

23. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Stage Three: Delivery of the Placenta Placenta separates from uterine wall and is expelled Photo: © Fred McConnaughey/ Photo Researchers, Inc.

24. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer First Stage of Labor Click on the screenshot to view a video with information about the first stage of labor. Back to DirectoryBack to Objectives

25. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Assisting in Childbirth Back to Topics

26. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: © Custom Medical Stock

27. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Labor Approach as with any other call Determine if delivery is imminent –Crowning –Feel for contraction of the uterus –Time duration of contraction –Time interval between contractions Five minutes apart or more?

28. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Labor Make decision to transport –Have you had a baby before? –What is your due date? –Have you received prenatal care? –Are you having more than one baby, or are there any complications? –Has your water broken? When? What color was the fluid? –Do you feel the urge to push? –Do you feel like the baby is ready to be born? Back to Objectives

29. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Labor Position patient Observe for crowning Back to Objectives

30. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Supine Hypotension Syndrome During last few months of pregnancy Uterus applies pressure on vena cava Position patient in sitting position or on her side Back to Objectives

31. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Preparation for Delivery Obstetrical (OB) Kit –Sheets, towels, and receiving blanket –Dozen 4-inch square gauze pads –Sanitary napkins –Suction syringe –Scissors –Clamps or ties –Germicidal wipes –Plastic bag –Sterile gloves and gown Back to Objectives

32. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Preparation for Delivery Help the mother relax Place towels under the buttocks Allow the position of comfort Elevate the mothers hips Create a sterile field “Chin to chest” when bearing down Be prepared to provide care

33. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Assisting in Childbirth Delivery

34. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Assisting in Childbirth Delivery

35. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Assisting in Childbirth Delivery

36. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Information about Childbirth Click on the screenshot to view a video with information about childbirth. Back to DirectoryBack to Objectives

37. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Caring for the Newborn Back to Topics

38. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Back to Objectives

39. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Resuscitation of the Newborn Back to Objectives

40. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Keeping the Newborn Warm Replace wet blankets or towels with dry ones Keep the newborn’s head covered Keep the newborn in a warm environment

41. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Cutting the Umbilical Cord Wait until cord stops pulsating Place clamp or tie six to seven inches from baby Place second clamp or tie three inches away from first Cut Back to Objectives

42. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Newborn Resuscitation Click on the screenshot to view a video about newborn resuscitation. Back to Directory

43. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Caring for the Mother Back to Topics

44. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

45. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Delivering the Placenta Umbilical cord appears longer Uterus will contract Have mother bear down Guide placenta out Never pull on the cord

46. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Controlling Bleeding After Birth Check for bleeding 500 mL is normal Place sanitary napkins Breastfeeding Treat for shock as necessary Uterine massage Back to Objectives

47. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response Patient tells you that her “water broke” 30 minutes ago Has had only one contraction before you arrived This is her first pregnancy, and she is due in two weeks She has preeclampsia, and her blood pressure has been monitored and under control CONTINUED

48. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response Cont. Vital signs are obtained –Pulse: 90 –Respirations: 22 –Blood pressure: 170/100 You place the patient on oxygen SAMPLE history is unremarkable She has another contraction lasting 15 seconds and denies feeling like she has to move her bowels CONTINUED

49. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer The Response Cont. You do not feel the need to check for crowning Second set of vitals is similar to the first You reassure the patient as her husband gets her bag for the hospital. You remain alert for the possibility of seizures.

50. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Complications of Delivery Back to Topics

51. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Possible Complications

52. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Prolapsed Umbilical Cord Cord compressed by the baby’s head Cuts off oxygen supply Emergency care –Place mother on her side –Elevate the mother’s hips and legs –Knees drawn to her chest –Administer high-concentration oxygen –Push baby’s head from the compressed cord –Do not attempt to push the cord into the vagina

53. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Breech Birth Feet or buttocks deliver first Prepare for delivery As the legs deliver, place the baby astride your arm Emergency care if the head does not deliver

54. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Arm or leg presents first Normal delivery may not be possible Transport immediately Limb Presentation

55. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Delivered the same as single births When to suspect twins Emergency care when delivering Multiple Births Back to Objectives

56. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Premature Birth Delivers before 36th week completed Baby is less than 5 ½ lbs Special care –Keep warm –Clear airway –Prevent bleeding –Administer oxygen –Prevent infection Back to Objectives

57. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Complications of Pregnancy Back to Topics

58. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

59. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Patient Assessment: Preeclampsia Signs and symptoms –Hypertension –Swelling of the face and extremities –Headache –Nausea or vomiting –Abnormal weight gain Eclampsia Treatment of seizures

60. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Vaginal Bleeding Of particular concern for pregnant women Causes –Spontaneous abortion –Ectopic pregnancy –Placenta previa –Abruptio placenta

61. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Vaginal Bleeding Spontaneous abortion –Signs and symptoms Heavy vaginal bleeding Lower abdominal pain Passage of tissue –Emergency care Immediate transport Transport tissue with patient

62. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Vaginal Bleeding Ectopic pregnancy –An egg is released and travels to the uterus –Ovum implants outside of uterus (fallopian tube) –Severe emergency –Signs and symptoms Sudden, sharp pain Tender, bloated abdomen Vaginal spotting or bleeding Missed menstrual periods Signs of shock

63. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Vaginal Bleeding Placenta previa –Placenta is too low in the uterus –Placenta enters birth canal first –Signs and symptoms Severe painless bleeding Signs of shock –Emergency care Immediate transport Treat for shock

64. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMR Emergency Care: Vaginal Bleeding Abruptio placenta –Leading cause of fetal death after trauma –Causes –Signs and symptoms –Emergency care Back to Objectives

65. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Information about Preeclampsia Click on the screenshot to view a video with information about preeclampsia. Back to DirectoryBack to Objectives

66. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Transition ALS unit arrives on scene You provide a report, including the diagnosis of preeclampsia You assist with packaging the patient and offer to help with transport Paramedic declines your offer You document your call and prepare for the next one

67. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –Uterus –Cervix –Bloody show –Placenta –Afterbirth –Umbilical cord –Amniotic sac –Birth canal CONTINUED

68. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –Meconium staining –Preeclampsia –Eclampsia –Miscarriage –Fallopian tube –Ovary –Ovum –Fontanel Back to Objectives

69. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER The “bag of waters” refers to the a)embryonic sac. b)amniotic sac. c)umbilical sac. d)placental sac. CONTINUED

70. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER How many weeks does a full-term pregnancy last? a)28 b)32 c)40 d)48 CONTINUED

71. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Artificial ventilation of the newborn should be performed a)when the pulse is less than 100 beats per minute. b)before suctioning, drying, and tactile stimulation. c)when there is mild cyanosis of the extremities. d)When the newborn does not immediately breathe after nasal suctioning. CONTINUED

72. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Ectopic pregnancy should be suspected in which of the following patients? a)A woman of child-bearing age with abdominal pain b)A woman with confirmed pregnancy with severe bleeding and no pain c)A woman with swelling and hypertension during pregnancy d)A woman in her third trimester with abdominal pain

73. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Discussion 1.Describe the events of each of the three stages of labor. 2.Discuss the proper positioning of a patient with supine hypotension syndrome. 3.Discuss the guidelines of delivery of the infant.

74. Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Please visit www.bradybooks.com www.bradybooks.com and click on the mykit links to access content for this text. REINFORCE AND REVIEW