1. Pregnancy and Childbirth
Pathways NCC Quality Assurance Team

2. So you’re going to deliver a baby...
Remember:
Once the birthing sequence has begun, there is little anyone can do to safely stop it.

3. “How many months/weeks...days, hours, minutes, seconds…”
1st Trimester 2nd Trimester 3rd Trimester
0-3 months 4-6 months 7-9 months
0-12 weeks weeks weeks
Why is this important to know?
Miscarriage
Premature Delivery
Imminent Delivery!

4. Complications of Pregnancy
Hyperemesis Gravidarum
Pregnancy or Sick Card?
Gestational Diabetes
Pregnancy, Diabetic Problems or Sick Card?
Bleeding
Pregnancy or Hemorrhage Card?
Abdominal Pain
Pregnancy or Abdominal Pain Card?

5. Complications of Pregnancy
“I have Pre-Eclampsia. My B/P is elevated and I’m swollen.”
Pregnancy, Heart Problems or Sick Card?
Sudden Difficulty Breathing
Pregnancy or Breathing Problems?
“My wife’s 8 months pregnant! She just tripped and fell on the baby!”
Pregnancy, Fall or Traumatic Injuries?
“My daughter’s pregnant and I think she’s having a seizure!”
Pregnancy or Convulsions?

6. “Is she bleeding (or passing any tissue?)”
What are we looking for?
Miscarriage
Ectopic Pregnancy
Placenta Previa
Abruptio Placenta

7. Miscarriage
The post delivery of a fetus or products of conception (tissue) in the 1st or 2nd trimester.
Miscarriage is the term for loss of pregnancy at a stage when the fetus is not capable of living outside the uterus. This is generally prior to the 26th week.

8. Miscarriage

9. Ectopic Pregnancy
Results from the fertilization and fetal development outside the uterus, usually in the Fallopian tube.
As the embryo grows, it eventually tears the tube and hemorrhages.
The woman can bleed to death within hours without exterior evidence of bleeding.
Treat for Shock!

10. Ectopic Pregnancy
Abdominal pain in a female of child-bearing age (12-50) who has fainted (or nearly fainted) is considered an ectopic pregnancy until proven otherwise.
- Rule 2, Abdominal Pain Card

11. Placenta Previa
The placenta lies either partially or fully between the fetus and the uterine opening into the birth canal.
Potentially life-threatening!
Painless bleeding in the last trimester.

12. Abruptio Placenta
Sudden, premature tearing of the placenta away from the uterine wall, usually in the last trimester.
Very painful!
Life-threatening!

13. “Can you see any part of the baby now?”
Head Visible (Crowning)
Breech - Visual presentation of the cord, hands, feet of buttocks first.

14. Crowning
When crowning (top of baby’s head is visible) and/or pushing is present, turn to PAI Childbirth - Delivery Sequence “Check Crowning”(F5) since birth is IMMINENT.
- Rule 1, Pregnancy Card

15. Breech
Visual presentation of the cord, hands, feet or buttocks first (breech) is a dire prehospital emergency. Often the only chance for survival of the baby is at the hospital. See also PAI Childbirth - Delivery Sequence “Breech” (F15).
- Rule 2, Pregnancy Card

16. Breech

17. Breech

18. Breech

19. Prolapsed Cord (Breech)
Cord presentation occurs when the cord slips down into the vagina or presents externally after the amniotic membranes have ruptured.
Dangerous when the baby’s head compresses the cord during delivery in the narrow birth canal, cutting off the baby’s blood and oxygen supply.

20. Nuchal Cord
…the umbilical cord is wrapped around the baby’s neck at delivery.

21. Labor
Physical or mental exertion, especially when difficult or exhausting; work; the physical efforts of childbirth;
Primigravida or Multigravida?
In general, initial pregnancies progress through labor more slowly than second plus pregnancies.

22. Imminent Delivery
1st full pregnancy and labor pains <= 2 minutes apart.
2nd plus pregnancy and labor pains
<= 5 minutes apart.

23. Post-Dispatch Instructions
Possible, but not appropriate?
1st and 2nd party callers should be kept on the line until help arrives.
Define “Imminent.”

24. Childbirth

25. Now you have TWO patients!
“Is the baby CRYING or BREATHING?” (F7)
No; Nuchal Cord. (F(16)
No; “Gently slap the bottom of the baby’s feet.” “Is the baby CRYING or BREATHING now?” (F17)
“Is there any GREEN fluid in its mouth?” (F18)

26. Now you have TWO patients!
Monitor baby’s ABC’s.
Keep baby warm.
Don’t forget to monitor MOM!
Keep her warm
ABC’s
Hemorrhaging

27. Delivery of the Placenta
Also known as the afterbirth.
PAI Childbirth - Delivery Sequence “Keep Afterbirth” (F10).
Important for MD to verify placenta delivered normally and completely.
Incomplete or partial delivery can result in severe hemorrhaging and serious infection.

28. A New Life Make every effort to note the time of delivery.
Is it a boy or girl?
Childbirth is usually a happy event. However be cautious about assuming this until the caller’s demeanor indicates celebration is in order.