OB/GYN
EMERGENCIES
Anatomy & Physiology
Review
Menses
• Onset 12 - 13 years old
• Periodic discharge of blood , mucus and cellular
debris
• Menstrual cycle lasts 28 days
• Menstrual flow lasts 4-6 days (endothelium)
• Menopause occurs between ages 35 - 60
Fertilization & Implantation
At ovulation , an egg is released from the ovary and
begins its journey through the fallopian tubes . While
in the tube the egg is fertilized by the sperm . Once the
egg reaches the uterus implantation will occur .
Fetal Development
•8 weeks , Embryo
•Through out the pregnancy , Fetus
•Upon delivery , Newborn
Maternal Changes During
Pregnancy
•Genital - Uterus, Bladder, Breasts, cervix
•Gastrointestinal - Stomach, Liver,
•Cardiovascular - Heart >, CO >, Circulation
•Respiratory - Tidal volume <, RR >
Baby Position
Specialized Structures of
Pregnancy
•Placenta
•Umbilical Cord
•Amniotic Sac
Placenta
Serves as the organ of exchange between the
mother and the fetus .
•Transfers gases
•Transports nutrients
•Excretion of wastes
Amniotic Sac
Amniotic Sac is a fluid filled cavity that
completely surrounds and protects the
Embryo . Amniotic fluid originates from
Fetal urine , skin and respiratory secretions .
Vaginal Bleeding during
Pregnancy
Placenta Previa
Painless bleeding in late
2nd or in 3rd trimester.
Spontaneous.
Risk of death for both
mother and baby.
Placental Abruption
Bleeding associated with
abdominal or back pain.
Usually associated with a
trauma; fall, MVC,
Complications vary based
on how far along the
pregnancy is and the size
of the abruption
Some other causes for vaginal
bleeding
Etopic pregnancy
Cancer
Miscarrage
STDs
Management
BSI
High Flow O2
Prepare for and treat shock
Emergent transport
Stages of Labor
Stage 1
•Pressure felt in the upper
abdomen/contractions
•Mucus plug expelled
•Amniotic fluid
released/sac ruptures
•cervical dilation/Ending
1st stage
Stage 2
•Complete dilation of the
cervix
•Contractions intensity
increase/frequency
•Urge to move her
bowels
•Crowning
•Fetus delivers
Stage 3
Delivery of the placenta,
usually within 20 mins of the
infant .
Placental delivery is
characterized by the
lengthening of the umbilical
cord and a sudden gush of
blood
Uncomplicated Delivery
Signs of Imminent Delivery
•Urge to move bowels
•Water broken
•Crowning
•Length of contractions
•Braxton Hicks ?
•Distance between contractions
Assessing of Imminent delivery
Has the mother delivered other Children?
Has the mother lost her mucus plug?
Create sterile field around vaginal opening.
Crowning of Infant’s Head
Delivery
Place gloved hand on presenting part to
prevent “explosive” delivery
Delivery Procedures
If amniotic sac has not broken,
puncture sac and pull away from
baby's face.
If umbilical cord is around baby’s
neck, clamp and cut cord.
Delivery of the Head—Prevent explosive
delivery.
Aid in birth of upper shoulder.
Delivery
Gently guide baby’s head down to deliver
upper shoulder
Gently guide baby’s head up to deliver
lower shoulder
Gently assist with delivery of rest of baby;
Do NOT pull
Note time of delivery of baby
Support the trunk.
Support the legs.
Delivery
Control slippery baby during delivery
– Support head, shoulders, feet
– Keep head lower then feet to facilitate
drainage of secretions from mouth
Dry baby
Keep baby warm
Delivery Procedures
Wipe blood and mucus from nose
and mouth.
Suction as needed
Warmth is critical!
Wrap baby in warm towel, head
lower than trunk.
Delivery Procedures
Have partner provide initial care
and monitoring.
Keep infant level with vagina until
cord is cut.
Delivery
Flick baby’s feet, rub back to stimulate
Do NOT shake infant
Do NOT slap buttocks
“Blow by” O2 if:
– Heart rate < 100
– Persistent central cyanosis present
Resuscitate if necessary
Delivery
Clamp, cut cord
– First clamp about 4” from baby
– Second clamp 2” further away from first
– Cut between clamps
– Use umbilical tape to control any bleeding
from cord
Clamp or tie cord; then cut.
Delivery Procedures
Observe for delivery of placenta.
When placenta delivers, place in
plastic bag for transport to
hospital.
Delivery
“Deliver” Placenta
– Place placenta in plastic bag and deliver to
hospital to be examined for completeness
– If placenta does not deliver within 10 minutes,
transport
Delivering the
Placenta
After-Delivery Procedures
Cover vaginal opening with
sterile pad.
Lower mother's knees; help her
to hold them together.
Record time of delivery.
After-Delivery Procedures
Vaginal
Bleeding
A loss of 500 cc is
well tolerated.
If blood loss is
excessive, massage
the uterus.
Treat for shock.
Massage uterus to control bleeding.
APGAR
Postpartum Hemorrhage
•Encourage the mother to breast feed the baby
•Do not pack the vagina with dressings
•Apply dressings to the exterior portion of the vagina to
absorb the blood
•Massage the uterus, place one hand on the lower
abdomen feeling for a grapefruit size ball
Blood lost
Normal blood loss during the third stage of
labor is about 150 ml – 500 ml
Controlling excessive postpartum the
same as normal postpartum bleeding
If excessive bleeding rapid transport is
needed
Use pressure dressing
Do not pack vagina