Three Stages of Labor First stage Dilation of the cervix Second
stage Expulsion of the infant Third stage Delivery of the placenta
First stage Dilation of the cervix Second stage Expulsion of the
infant Third stage Delivery of the placenta
Slide 3
Predelivery Emergencies Preeclampsia Headache, vision
disturbance, edema, anxiety, high blood pressure Eclampsia
Convulsions resulting from hypertension Supine hypotensive syndrome
Low blood pressure from lying supine Preeclampsia Headache, vision
disturbance, edema, anxiety, high blood pressure Eclampsia
Convulsions resulting from hypertension Supine hypotensive syndrome
Low blood pressure from lying supine
Slide 4
Hemorrhage Vaginal bleeding that occurs before labor begins If
present in early pregnancy, it may be a spontaneous abortion or
ectopic pregnancy. Vaginal bleeding that occurs before labor begins
If present in early pregnancy, it may be a spontaneous abortion or
ectopic pregnancy.
Slide 5
Ectopic Pregnancy Pregnancy outside of the uterus Should be
considered for any woman of childbearing age with unilateral lower
abdominal pain and missed menstrual period History of PID, tubal
ligation, or previous ectopic pregnancy Pregnancy outside of the
uterus Should be considered for any woman of childbearing age with
unilateral lower abdominal pain and missed menstrual period History
of PID, tubal ligation, or previous ectopic pregnancy
Slide 6
Placenta Problems Placenta abruptio Premature separation of the
placenta Placenta previa Development of placenta over the cervix
Placenta abruptio Premature separation of the placenta Placenta
previa Development of placenta over the cervix
Slide 7
Gestational Diabetes Develops only during pregnancy. Treat as
regular patient with diabetes. Develops only during pregnancy.
Treat as regular patient with diabetes.
Slide 8
Scene Size Up: Womans balance is altered. Be aware for falls
and the need for spinal stabilization. Use BSI. Usual threats to
your safety still exist. Be calm. Protect the mother and the child.
Womans balance is altered. Be aware for falls and the need for
spinal stabilization. Use BSI. Usual threats to your safety still
exist. Be calm. Protect the mother and the child.
Slide 9
Initial Assessment Is the mother in active labor? Evaluate
trauma or medical problems first. Treat ABCs in line with local
protocols. Is the mother in active labor? Evaluate trauma or
medical problems first. Treat ABCs in line with local
protocols.
Slide 10
Transport Decision If delivery is imminent, prepare for
delivery in warm, private location. If delivery is not imminent,
transport on left side if in last two trimesters of pregnancy. If
the patient was subject to spinal injury, stabilize and prop
backboard with towel roll on right side. If delivery is imminent,
prepare for delivery in warm, private location. If delivery is not
imminent, transport on left side if in last two trimesters of
pregnancy. If the patient was subject to spinal injury, stabilize
and prop backboard with towel roll on right side.
Slide 11
Focused History/ Physical Exam Obtain full SAMPLE history, and
also: Prenatal history Complications during pregnancy Due date
Number of babies (twins) Drugs or alcohol Water broken Green fluid
(meconium) Obtain full SAMPLE history, and also: Prenatal history
Complications during pregnancy Due date Number of babies (twins)
Drugs or alcohol Water broken Green fluid (meconium)
Slide 12
Focused Physical Exam Mainly abdomen and delivery of fetus
Based on her chief complaints and history Pay close attention to
tachycardia, hypotension, or hypertension. Mainly abdomen and
delivery of fetus Based on her chief complaints and history Pay
close attention to tachycardia, hypotension, or hypertension.
Slide 13
Interventions Childbirth is natural, does not require
intervention in most cases. Treating the mother will benefit the
baby. Childbirth is natural, does not require intervention in most
cases. Treating the mother will benefit the baby.
Slide 14
Detailed Physical Exam Only if other treatments are not
required
Slide 15
Ongoing Assessment Continue to reassess the patient for changes
in vital signs. Watch for hypoperfusion. Notify hospital of your
preparations for delivery. Document carefully, especially babys
status. Obstetrics is one of the most litigated specialties in
medicine. Continue to reassess the patient for changes in vital
signs. Watch for hypoperfusion. Notify hospital of your
preparations for delivery. Document carefully, especially babys
status. Obstetrics is one of the most litigated specialties in
medicine.
Slide 16
When to Consider Field Delivery Delivery can be expected within
a few minutes A natural disaster or other catastrophe makes it
impossible to reach a hospital No transportation is available
Delivery can be expected within a few minutes A natural disaster or
other catastrophe makes it impossible to reach a hospital No
transportation is available
Slide 17
Preparing for Delivery Use proper BSI precautions. Be calm and
reassuring while protecting the mothers modesty. Contact medical
control for a decision to deliver on scene or transport. Prepare OB
kit. Use proper BSI precautions. Be calm and reassuring while
protecting the mothers modesty. Contact medical control for a
decision to deliver on scene or transport. Prepare OB kit.
Slide 18
Positioning for Delivery
Slide 19
Delivering the Baby Support the head as it emerges. Once the
head emerges, the shoulders will be visible. Support the head and
upper body as the shoulders deliver. Handle the infant firmly but
gently as the body delivers. Clamp the cord and cut it. Support the
head as it emerges. Once the head emerges, the shoulders will be
visible. Support the head and upper body as the shoulders deliver.
Handle the infant firmly but gently as the body delivers. Clamp the
cord and cut it.
Slide 20
Complications With Normal Vaginal Delivery Unruptured amniotic
sac Puncture the sac and push it away from the baby. Umbilical cord
around the neck Gently slip the cord over the infants head. It may
have to be cut. Unruptured amniotic sac Puncture the sac and push
it away from the baby. Umbilical cord around the neck Gently slip
the cord over the infants head. It may have to be cut.
Slide 21
Un-ruptured Amniotic Sac
Slide 22
Umbilical cord around the neck
Slide 23
Postdelivery Care Immediately wrap the infant in a towel with
the head lower than the body. Suction the mouth and nose again.
Clamp and cut the cord. Ensure the infant is pink and breathing
well. Immediately wrap the infant in a towel with the head lower
than the body. Suction the mouth and nose again. Clamp and cut the
cord. Ensure the infant is pink and breathing well.
Slide 24
Meconium
Slide 25
Delivery of Placenta Placenta is attached to the end of the
umbilical cord. It should deliver within 30 minutes. Once the
placenta delivers, wrap it and take to the hospital so it can be
examined. If the mother continues to bleed, transport promptly to
the hospital. Placenta is attached to the end of the umbilical
cord. It should deliver within 30 minutes. Once the placenta
delivers, wrap it and take to the hospital so it can be examined.
If the mother continues to bleed, transport promptly to the
hospital.
Slide 26
APGAR Scoring AActivity P Pulse G Grimace A Appearance R
Respirations AActivity P Pulse G Grimace A Appearance R
Respirations
Slide 27
Neonatal Resuscitation
Slide 28
Giving Chest Compressions to an Infant Find the proper position
Just below the nipple line Middle third of the sternum Wrap your
hands around the body, with your thumbs resting at that position.
Press your thumbs gently against the sternum, compressing 1/3 the
depth of the chest Ventilate with a BVM device after every third
compression. 90 compressions to 30 ventilations per minute Continue
CPR during transport Find the proper position Just below the nipple
line Middle third of the sternum Wrap your hands around the body,
with your thumbs resting at that position. Press your thumbs gently
against the sternum, compressing 1/3 the depth of the chest
Ventilate with a BVM device after every third compression. 90
compressions to 30 ventilations per minute Continue CPR during
transport
Slide 29
Breech Delivery Presenting part is the buttocks or legs. Breech
delivery is usually slow, giving you time to get to the hospital.
Support the infant as it comes out. Make a V with your gloved
fingers then place them in the vagina to prevent it from
compressing infants airway. Presenting part is the buttocks or
legs. Breech delivery is usually slow, giving you time to get to
the hospital. Support the infant as it comes out. Make a V with
your gloved fingers then place them in the vagina to prevent it
from compressing infants airway.
Slide 30
Breech Presentation
Slide 31
Rare Presentations Limb presentation This is a very rare
occurrence. This is a true emergency that requires immediate
transport. Prolapsed cord Transport immediately. Place fingers into
the mothers vagina and push the cord away from the infants face.
Limb presentation This is a very rare occurrence. This is a true
emergency that requires immediate transport. Prolapsed cord
Transport immediately. Place fingers into the mothers vagina and
push the cord away from the infants face.
Slide 32
Limb Presentation
Slide 33
Prolapsed umbilical cord
Slide 34
Excessive Bleeding Bleeding always occurs with delivery but
should not exceed 500 mL. Massage the mothers uterus to slow
bleeding. Treat for shock. Place pad over vaginal opening.
Transport to hospital. Bleeding always occurs with delivery but
should not exceed 500 mL. Massage the mothers uterus to slow
bleeding. Treat for shock. Place pad over vaginal opening.
Transport to hospital.
Slide 35
Spina Bifida Defect in which the portion of the spinal cord or
meninges may protrude outside the vertebrae or body. Cover area
with moist, sterile compresses to prevent infection. Maintain body
temperature by holding baby against an adult for warmth. Defect in
which the portion of the spinal cord or meninges may protrude
outside the vertebrae or body. Cover area with moist, sterile
compresses to prevent infection. Maintain body temperature by
holding baby against an adult for warmth.
Slide 36
Spina bifida
Slide 37
Abortion (Miscarriage) Delivery of the fetus or placenta before
the 20th week Infection and bleeding are the most important
complications. Treat the mother for shock. Transport to the
hospital. Bring tissue that has passed through the vagina to the
hospital. Delivery of the fetus or placenta before the 20th week
Infection and bleeding are the most important complications. Treat
the mother for shock. Transport to the hospital. Bring tissue that
has passed through the vagina to the hospital.
Slide 38
Abortion or miscarriage
Slide 39
Twins Twins are usually smaller than single infants. Delivery
procedures are the same as that for single infants. There may be
one or two placentas to deliver. Twins are usually smaller than
single infants. Delivery procedures are the same as that for single
infants. There may be one or two placentas to deliver.
Slide 40
Twins
Slide 41
Delivering an Infant of an Addicted Mother Ensure proper BSI
precautions Deliver as normal. Watch out for severe respiratory
depression and low birth weight. Infant may require immediate care.
Ensure proper BSI precautions Deliver as normal. Watch out for
severe respiratory depression and low birth weight. Infant may
require immediate care.
Slide 42
Premature Infants and Procedures Delivery before 8 months or
weight less than 5 lb at birth. Keep the infant warm. Keep the
mouth and nose clear of mucus. Give oxygen. Do not infect the
infant. Notify the hospital. Delivery before 8 months or weight
less than 5 lb at birth. Keep the infant warm. Keep the mouth and
nose clear of mucus. Give oxygen. Do not infect the infant. Notify
the hospital.
Slide 43
Fetal Demise An infant that has died in the uterus before labor
This is a very emotional situation for family and providers. The
infant may be born with skin blisters, skin sloughing, and dark
discoloration. Do not attempt to resuscitate an obviously dead
infant. An infant that has died in the uterus before labor This is
a very emotional situation for family and providers. The infant may
be born with skin blisters, skin sloughing, and dark discoloration.
Do not attempt to resuscitate an obviously dead infant.
Slide 44
Fetal Demise
Slide 45
Delivery Without Sterile Supplies You should always have
goggles and sterile gloves with you. Use clean sheets and towels.
Do not cut or clamp umbilical cord. Keep placenta and infant at
same level You should always have goggles and sterile gloves with
you. Use clean sheets and towels. Do not cut or clamp umbilical
cord. Keep placenta and infant at same level
Slide 46
Premature infant
Slide 47
Gynecologic Emergencies Do not examine genitalia unless there
is obvious bleeding. Leave any foreign bodies in place, after
packing with bandages Treat as any other patient with blood loss.
Do not examine genitalia unless there is obvious bleeding. Leave
any foreign bodies in place, after packing with bandages Treat as
any other patient with blood loss.