Obstetric and Gynecological Emergencies

avatar
Created by
Victoria Guerrero

Cards (91)

  • Anatomy & Physiology of Pregnancy

    • Fetus
    • Uterus
    • Placenta
    • Birth Canal
    • Umbilical cord
    • Amniotic sac
    • Vagina
    • Perineum
    • Crowning
    • Bloody Show
    • Labor
    • Presenting Part
    • Abortion
    • Cervix
  • Full-term pregnancy

    Lasts approximately 280 days from the first day of the last menstrual cycle
  • Uterus

    Muscular organ where the fetus grows for approximately 9 months (40 weeks)
  • Trimesters

    Each three-month period of the approximately nine-month pregnancy
  • Stages of Labor

    1. Stage 1: Dilation
    2. Stage 2: Expulsion
    3. Stage 3: Placental
  • Stage One: Dilation

    1. First Uterine Contraction
    2. Bloody Show
    3. Rupture of the Amniotic Sac
    4. Contractions Increase Frequency and Intensity
    5. Mucus Plug
  • Stage Two: Expulsion

    1. Complete Cervical Dilation and ends with the delivery of the baby
    2. Contractions – closer
    3. Mother has urge to "Push"
    4. Crowning appears
  • Stage Three: Placental Delivery

    1. Begins with the delivery of baby and ends with the delivery of the Placenta
    2. Occurs 5-20 minutes after the delivery of the baby
    3. Uterus becomes smaller
  • SAMPLE history

    Get a SAMPLE history including the OPQRST
  • Ask patient if she is pregnant
  • Ask if the patient is experiencing any pain or discomfort
  • Ask when the patient's last menstrual period was
  • Ask if there has been any unusual vaginal bleeding
  • Ask what the baby's due date is
  • Perform a focused history and physical exam
  • If the patient is experiencing abdominal pain or contractions, perform a focused exam of abdomen and vaginal area
  • Obtain baseline vital signs
  • Active Labor and Normal Delivery

    Determine whether the patient can be transported, or delivery is imminent and will have to occur on scene
  • Active Labor and Delivery

    1. Preparation for a field delivery
    2. Emergency medical care
    3. Position the mother
    4. Create a sterile environment around the vaginal opening
    5. Continually assess for crowning
  • Active Labor and Delivery

    1. Gently place your gloved fingers on the bony part of the infant's skull when it crowns
    2. Tear the amniotic sac if not already ruptured
    3. Determine the position of the umbilical cord
  • Active Labor and Delivery

    1. Remove fluids from the newborn's airway by suctioning
    2. Support the newborn's body with your hands as he is delivered
    3. Grasp the feet as they are born
    4. Clean then suction the newborn's mouth and nose with a bulb syringe
    5. Dry, wrap, warm, and position the newborn
  • Active Labor & Normal Delivery

    1. Assign your partner to monitor and complete the initial care of the newborn
    2. Clamp, tie, and cut the umbilical cord
  • Active Labor & Normal Delivery

    1. Observe for delivery of the placenta
    2. Place one or two sanitary napkins over the vaginal opening
    3. Record the time of delivery
  • Management of a Normal Delivery
    1. Support the baby's head over the perineum with gentle pressure
    2. If the membranes cover the head after it emerges, tear the sac with your fingers or forceps to permit escape of the amniotic fluid
    3. Gently guide the head downward until the shoulder appears
    4. The other shoulder is delivered by gentle upward traction
    5. The infant's face should be upward at this point
    6. Maintain firm grasp on infant
  • Provide ongoing care for both the mother and infant
  • Treat the mother for shock if present
  • If bleeding is excessive consider uterine massage
  • Assure that the airway is clear of all secretion or birth fluids
  • APGAR

    Appearance, Pulse, Grimace, Activity, Respirations
  • APGAR

    Perform the APGAR score 1 and 5 minutes after birth
  • APGAR - Appearance

    • If the skin of the newborn's entire body is blue (cyanotic) or pale, award 0 points
    • If the newborn has blue hands and feet with pink skin at the core of the body (a condition called acrocyanosis), award 1 point
    • If the skin of the extremities as well as the trunk is pink, award 2 points
  • APGAR - Pulse

    • If no pulse is present, award 0 points
    • If the heart rate is under 100 (also a serious finding), award 1 point
    • If the heart rate is over 100, award 2 points
  • APGAR - Grimace (reflex irritability)

    • If the newborn displays no reflexive activity to your stimulation, award 0 points
    • If the newborn displays only some facial grimace, award 1 point
    • If your stimulation causes the newborn to grimace and cough, sneeze, or cry, award 2 points
  • APGAR - Activity

    • If during your assessment, the newborn is limp and displays no extremity movement, award 0 points
    • If the newborn only displays some flexion without active movement, award 1 point
    • If the newborn is actively moving around, award 2 points
  • APGAR - Respiration

    • If the newborn displays good respirations and a strong cry, award 2 points
    • If the newborn displays only a slow or irregular breathing. Distress is indicated by irregular, shallow, gasping, or absent respirations, award 1 point
    • If the newborn displays no respiratory effort, award 0 points
  • APGAR Score

    • 7–10 points - The newborn should be active and vigorous. Provide routine care
    • 4–6 points - The newborn is moderately depressed. Provide stimulation and oxygen
    • 0–3 points - The newborn is severely depressed. You will probably need to provide extensive care including oxygen with bag-valve-mask ventilations and CPR
  • Depressed Newborn

    • Most newborns require no resuscitation beyond temperature maintenance, mild stimulation, and suctioning
    • Of those who do require additional resuscitation, most need oxygen or bag-valve-mask ventilations
    • A minority of the newborns will be so depressed that they also will need chest compressions or resuscitative medications
  • Signs of a severely depressed newborn

    • Respiratory rate over 60 per minute
    • Diminished breath sounds
    • Heart rate under 100 per minute
    • Obvious signs of trauma from the delivery process
    • Poor or absent skeletal muscle tone
    • Respiratory arrest, or severe distress
    • Heavy merconium staining of amniotic fluid
    • Weak pulses
    • Cyanotic body (core and extremities)
    • Poor peripheral perfusion
    • Lack of or poor response to stimulation
    • APGAR score under 4
  • Emergency care of the depressed newborn

    1. Oxygen Blow-by
    2. Ventilation with the BVM
    3. Cardiopulmonary resuscitation
  • Serious Pre-delivery Emergencies

    • Abdominal pain
    • Vaginal bleeding or passage of tissue
    • Weakness or dizziness, or alteration in mental status
    • Seizures
    • Excessive swelling of the face or extremities
    • Abdominal trauma
    • Shock (hypoperfusion)