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Lesson 16


Sometimes occurs outside planned setting Rarely becomes medical emergency Problems early/complications become emergencies


Pregnancy and Labor

Begins with fertilization of ovum Growth/development 40 weeks


Stages of Pregnancy
Divided into three trimesters three months each Single cell divides into many First eight weeks an embryo; then fetus


Stages of Pregnancy
Fetus develops inside amniotic sac Embryo attached to placenta All major organ systems developed by week 8


Stages of Pregnancy
Week 36, fetus fully formed Near end of pregnancy, head of fetus positioned downward in pelvis. Fetus passes through dilated cervix and vagina.

Stages of Labor and Delivery

Show or Bloody Show
When mucous plug from cervix released Can occur up to 10 days before contractions begin

Occurs in 3 stages beginning with contractions


First Stage
Amniotic sac ruptures before or during first stage Uterine contractions begin and eventually push infants head into cervix
1015 minutes apart initially 2-3 minutes apart shortly before birth

May last few hours to a day


Second Stage
Typically lasts 1 2 hours Cervix fully dilated Contractions powerful and painful Infants head presses on floor of pelvis urge to push down Vagina stretches open Head emerges (crowning) Rest of body pushed out

Third Stage
Placenta separates from uterus and delivered
Usually within 30 min of birth

Uterus contracts and seals off blood vessels

Emergency Care During Pregnancy

Women who receive regular care are advised about potential problems to watch for Although rare, problems may require emergency care


Vaginal Bleeding


Vaginal Bleeding
May be caused by cervical growths or erosion, problem with placenta or miscarriage In third trimester may be sign of preterm birth See healthcare provider immediately


Assessing Vaginal Bleeding

Perform standard assessment Take repeated vital signs


Emergency Care Vaginal Bleeding

Perform standard patient care Have female assistant present if possible Position patient lying on left side Dont control bleeding by keeping patients legs together Give patient towel/sanitary napkins


Emergency Care Vaginal Bleeding continued

Dont pack vagina Save expelled material to give to arriving EMS Follow local protocol re: oxygen Treat for shock




Loss of embryo/fetus in first 14 weeks 20% - 25% of pregnancies end in miscarriage May result from a genetic disorder, fetal abnormality, a factor related to womans health, or no known cause Most women dont have problems with later pregnancies


Assessing Miscarriage
Perform standard assessment Take repeated vital signs


Signs and Symptoms of Miscarriage

Vaginal bleeding Abdominal pain or cramping


Emergency Care for Miscarriage

Provide same emergency care as vaginal bleeding in pregnancy Retain expelled materials for EMS personnel Be calm and reassuring


Trauma in Pregnancy


Trauma in Pregnancy
Womans blood volume increases significantly in pregnancy Blood loss may not immediately cause signs of shock Blood flow reduced to fetus Signs of internal blood loss may not be apparent


Emergency Care for Trauma in Pregnancy

Perform standard patient care Assume there is internal bleeding Treat for shock Follow local protocol re: oxygen Dont let patient late in pregnancy lie flat on her back Raise right side higher to reduce pressure on vena cava


Other Problems


Other Problems
See healthcare provider: Abdominal pain Persistent or severe headache Sudden leaking of water Persistent vomiting, chills and fever, convulsions, difficulty breathing Persistently elevated blood pressure Signs or symptoms related to diabetes




Remember it is a natural process Woman may be fearful or distressed Remain calm

Supportive Care During Labor

Ensure plan for transport Help woman rest Provide comfort measures Do not let woman have bath Write down contraction intervals and length Remind woman to control breathing Continue to provide reassurance


Assessing Whether Delivery Is Imminent

Labor usually lasts for several hours In rare occasions, labor progresses quickly May begin weeks before due date Prepare to assist in childbirth


Gather Information from the Woman

Name, age, and due date Physicians name/telephone number Ask if she: Has given birth before Knows whether she may be having twins Has broken her water and to describe it Has experienced any bleeding Has any past or present medical problems Give this information to arriving EMS personnel

Assessing Childbirth Imminence

When did contractions begin? How close together are they? How long does each last? Feels strong urge to push? Check whether infants head is crowning


Preparing for Delivery

Someone must stay with woman Gather the items needed or helpful for delivery Many First Responders carry OB kit


Items Needed for Delivery

Clean blanket/coverlet Several pillows Plastic sheet, or stack of newspapers (to cover bed surface) Clean towels and washcloths Sanitary napkins or pads of clean cloth Medical exam gloves Plastic bags (for afterbirth and clean-up)


Items Needed for Delivery continued

Bowl of hot water (for washingbut not the infant) Empty bowl (in case of vomiting) Clean handkerchief (to wear as facemask) Clean, soft towel, sheet, or blanket (to wrap newborn) Bulb syringe (to suction infants mouth)


Items Needed for Delivery continued

If help may be delayed: Clean strong string, shoelaces, or cloth strips (to tie cord) Sharp scissors or knife (to cut cord)
Sterilize in boiling water for 5 minutes or hold over flame for 30 seconds


Preparation for Childbirth

Prepare birthing bed Roll up sleeves, wash hands thoroughly for 5 minutes, put on medical exam gloves


Prepare for Childbirth continued

Protect your eyes, mouth, and nose from blood/other fluids Do not let woman use bathroom Do not touch vaginal areas except during delivery Call dispatch or healthcare provider for additional instructions When crowning occurs, move woman into birthing position Assist with delivery

Help woman lie on back with knees bent and apart and feet flat.


As infants head appears, have gloved hands ready to receive and support the head


Childbirth Care: Assisting with Delivery continued

3. As the head emerges (usually face down), support the head 4. After the head is out, have the woman stop pushing and breathe in a panting manner

5. Hold with head lower than feet Suction nose and mouth with bulb syringe

Childbirth Care: Assisting with Delivery continued

6. Gently dry and wrap the infant in a towel or blanket to prevent heat loss, keeping the cord loose 7. Follow your local protocol to clamp or tie the umbilical cord or leave it intact for arriving EMS personnel

Childbirth Care: Assisting with Delivery continued

8. Wait for the delivery of the afterbirth, the placenta, and umbilical cord 9. Do not pull on the umbilical cord in an attempt to pull out the placenta


Care of the Mother After Delivery

Support and comfort mother Monitor pulse and breathing Replace any blood-soaked sheets/blankets, dispose of used supplies The mother may drink water now

Bleeding After Delivery

Bleeding normally occurs with childbirth and delivery of placenta Usually stops after placenta delivered Use sanitary pads or clean folded cloths to absorb blood To help stop bleeding, massage the abdomen below navel


Care for Bleeding After Delivery continued

If bleeding persists: Be sure you are kneading with your palms Keep mother still and try to calm her Treat for shock Follow local protocol re: oxygen Encourage breastfeeding


Care for the Newborn


Care of the Newborn

Assess the newborn: Note skin color, movement, and whether crying is strong or weak Normal respiratory rate is more than 40 breaths/minute The normal pulse is more than 100 beats/minute Note any changes over time Provide this information EMS personnel

Care of the Newborn continued

Dry newborn Ensure that infant stays wrapped, including the head, to stay warm Support the newborns head if it must be moved for any reason Continue to check breathing and the airway


Premature Infants
Premature infant at greater risk for complications It is crucial to keep a small newborn warm Resuscitation is more likely to be needed


Non-breathing Newborn
If newborn is not crying, gently flick bottom of feet or gently rub its back If it is still not crying, check for breathing


Non-breathing Newborn
If infant is not breathing: Provide two gentle ventilations mouth to mask Assess breathing and pulse If breathing is absent, slow, or very shallow, provide ventilations

40-60 breaths/minute
Follow local protocol re: oxygen


Non-breathing Newborn
If infant is not breathing Pulse 60 100 beats/minute, continue ventilations If pulse is 60 beats/minute, start chest compressions Rate of 120/minute Use thumb-encircling method with second responder 3 compressions: 1 breath


Non-breathing Newborn continued

Reassess breathing and pulse after 30 seconds
If pulse is 100 and respiration has improved, gradually discontinue ventilations


Childbirth Problems
Most deliveries occur without problems Common problems involve presentation of infant or maternal bleeding

Meconium Staining
Infant may defecate before/ during childbirth, staining amniotic fluid brown/ green with meconium Newborn may inhale fluid with first breath, causing lung infection If mother describes amniotic fluid as having color or if you observe this, tell arriving EMS personnel


Buttocks or feet appear in birth canal Umbilical cord is squeezed and blood flow is compromised If infants head becomes lodged in birth canal and it tries to breathe, it may suffocate

Breech Birth

Support body as it emerges, do not try to pull head out If head does not emerge soon, create breathing space for infant Check infant immediately and give CPR if needed

Breech Birth

Limb Presentation
Rarely, arm or leg may emerge first Emergency requiring immediate medical assistance


Limb Presentation

Put woman in knee-chest position Do not try to pull infant out or push arm or leg back in

Prolapsed Cord
Segment of cord protrudes through birth canal before childbirth Cord will be compressed as infant moves through canal

Emergency Care for Prolapsed Cord

Follow local protocol to position woman either in the knee-chest position or lying on the left side Place dressings soaked in sterile or clean water on cord. Follow local protocol re: oxygen Dont push cord back inside mother If medical personnel have not arrived when infant presents/ begins to emerge, follow local protocol


Emergency Care for Prolapsed Cord Continued

Carefully insert sterile gloved hand into birth canal and gently push presenting part away from cord while allowing birth to continue If not possible, open a breathing space with your fingers as for breech presentation Check infant immediately and be prepared to give CPR


Cord Around Neck

Umbilical cord may be around neck when infant emerges Slip it over head or shoulder


Cord Around Neck

If it is too tight and you cannot release head, it is a life-threatening emergency Tie off cord in two places and cut cord between the two


Care for Premature Infant

Keep premature newborn warm Provide ventilations or CPR if needed Follow local protocol re blow-by oxygen

Stillborn Infant
Infants rarely born dead or die shortly after birth Use all resuscitation measures available Provide comfort for mother