1. OB/GYN Emergencies for the EMT and Paramedic
Presented for the East Cleveland Fire Department
23 SEP 04

2. The Prenatal Period
Fetal development begins immediately after implantation
The date of the expected delivery in known as the “estimated date of confinement” or EDC
Sex determined…end of 3 months
Fetal Heart Tones by 5 months can be detected with your stethoscope

3. Terminology
Gravidity- the number of times a woman has been pregnant (also: primi-,multi-, and nulli-)
Parity- the number of times a woman has deliver a viable fetus (also: primi-, multi-, and nulli-)
EX: A pt who has been pregnant 5 times and has 3 children has a P and G of ??
ANSWER: P=5 G=3

4. Complications of Delivery
Cephalopelvic Disproportion
Abnormal Presentations
Prolapsed Cord
Shoulder Dystocia
Postpartum Hemorrage
Uterine Rupture
Uterine Inversion

5. Cephalopelvic Disproportion
Babies head is larger than the vaginal opening
Occurs in 1 of ~500
Usually delivery will require a cesarean section
Causes fetal distress
IV, O2 Monitor

6. Abnormal Presentation
Approx. 3% of births
Positioning the mother
Support versus pulling
Spontaneous breathing
Which way is the baby facing?
Breech presentations
Baby should be facing posterior and then rotate. But if baby if facing anterior or forward already, passage through the vagina will be delayed or impossible

8. Prolapsed Cord Compression cuts fetal circulation
If seen in vagina, insert fingers to check for pulsation and remove pressure off cord
Position, O2, IV, continue insertion, and moisten exposed cord

9. Shoulder Dystocia When shoulders are larger than its head
Head delivers normal, but…
Rest of body cannot deliver
Have mother modify position
Apply pressure, NOT TRACTION
Occurs with diabetic and/or obese mothers and in postmature pregnancies
Position to place mother: Buttocks off of bed. Thighs elevated and pressure above symphsis pubis
Tends to cause nerve damage, Erb’s Paulsey?
Much litigation concerning delivety techniques…lawyers!

10. Postpartum Hemorrage Defined as loss of 500mL over 24hr period
Occurs in 5% of deliveries
Placenta previa, abruptio placenae, and clotting disorders
O2, IV, and fundal massage

11. Uterine Rupture Actual tearing of uterus
Occurs mostly during labor or at onset
ALSO OCCURS DURING TRAUMA
Scar tissue in uterus from previous cesarians can causethis emergency
Mgmnt: IV, O2, monitor fetal heart tones and treat for shock!

12. Pulmonary Embolism
Usually occurs after pregnancy from blood clot or venous thromboembolism.
Most common cause of maternal death!
Occurs more frequently in cesarean than vaginal delivery
S/S: very sudden SOB, sharp C/P, may show tachycardia, and hypotension
Outcome is poor: support as necessary with IV, O2 and monitor frequently for changes
Be aware of this in the field with new mothers after discharge

13. APGAR APGAR is an acronym for newborn assessment Appearance– Color
Pulse– The heart rate of the newborn
Grimace– also known as irritability
Activity– How active is the neonate
Respirations– Breathing rate (this one is important)

14. Appearance Score of zero is central cyanosis
Score of one is pink body but blue extremities
Score of two is pink all over.

15. Pulse Score of zero= no pulse Score of one= pulse rate < 100
Score of two= pulse rate > 100

16. Grimace Big purple guy who likes milk shakes
Hang’n with Ronald McDonald
Can I get a Big Mac?

17. Grimace (For real) Score of zero= No Response
Score of one= mild irritability
Score of two= vigorous irritability and crying

18. Activity Score of zero= limp Score of one= some flexion with agitation
Score of two= active with good motion in extremities

19. Respirations Score of Zero= absent resps
Score of One= slow and irregular or ineffective
Score of Two= crying, rhythmic and effective

20. When DO you do it!!??!!
APGAR is obtained after the first minute and after five minutes.
It is taken at this time because of two reasons: 1) to document “trend”
2) because someone smarter than us said so

21. Inverted Pyramid
This is a diagram for the priorities of resuscitation, stemming from the most frequently used care to the less often used interventions.

23. So When do I Transport?
Transport priorities depend largely upon your findings from these assessment tools.
It is situational dependant.
Lower APGAR scores indicate the need for higher transport priority.
Remember the golden rule: Air goes in and out, blood goes ‘round and ‘round, and blue is called “not too good”. Anything different is a bad thing!

24. This concludes the presentation
Are there any questions, concerns, gripes, or complaints?