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					Obstetrics and Gynecological
        Emergencies
            *Heidi Erbe
                 Overview
•   Anatomy
•   Stages of labor
•   Emergencies prior to delivery
•   Preparing for delivery
•   Delivering the baby
•   Neonatal evaluation and resuscitation
                     Anatomy
• fetus- unborn infant
• uterus- muscular
  organ where fetus
  grows
• cervix- neck of the
  uterus
• birth canal- vagina
  and cervix
• vagina- lower part of
  the birth canal
• placenta- body tissue
  connecting the wall of the
  uterus and the umbilical
  cord
• umbilical cord- lifeline that
  connects mother and
  infant
• amniotic sac- baglike
  membrane filled with fluid
  and the fetus
         Three Stages of Labor
• Dilation of the cervix
      • Onset- contractions, bloody show, rupture of amniotic
        sac
      • ~16 hours
      • Longer in primigravida and shorter in multigravida
• Expulsion of the baby
      • Onset- cervix is fully dilated
      • Crowning
• Delivery of the placenta
      • Birth of baby to the delivery of placenta
 Emergencies Prior to Delivery
• Pregnancy-induced
  hypertension
 Emergencies Prior to Delivery
• Pregnancy-induced
  hypertension
• Eclampsia
 Emergencies Prior to Delivery
• Pregnancy-induced
  hypertension
• Eclampsia
• Supine hypotensive
  syndrome
 Emergencies Prior to Delivery
• Pregnancy-induced
  hypertension
• Eclampsia
• Supine hypotensive
  syndrome
• Ectopic pregnancy
 Emergencies Prior to Delivery
• Pregnancy-induced
  hypertension
• Eclampsia
• Supine hypotensive
  syndrome
• Ectopic pregnancy
• Placenta abruptio
 Emergencies Prior to Delivery
• Pregnancy-induced
  hypertension
• Eclampsia
• Supine hypotensive
  syndrome
• Ectopic pregnancy
• Placenta abruptio
• Placenta previa
 Emergencies Prior to Delivery
• Pregnancy-induced
  hypertension
• Eclampsia
• Supine hypotensive
  syndrome
• Ectopic pregnancy
• Placenta abruptio
• Placenta previa
• Shock
       Preparing for Delivery
• When?
    • Delivery expected
    • Natural disaster
    • No transportation
          Preparing for Delivery
• When?
     • Delivery expected
     • Natural disaster
     • No transportation
• What to ask…
     •   When due?
     •   First pregnancy?
     •   Fluid or spotting?
     •   Contractions?
     •   Urge to move bowels?
     •   Are you sure that you are
         pregnant and not just
         really fat?
         Preparing for Delivery
• When?                        • Semi-Fowler’s
    • Delivery expected          position
    • Natural disaster
                               • Firm surface padded
    • No transportation
                                 with blankets
• What to ask…
    •   When due?              • Hips elevated
    •   First pregnancy?       • BSI
    •   Fluid or spotting?
    •   Contractions?
    •   Urge to move bowels?
        Delivering the Baby
1. Support the head. Suction fluid from the
   mouth, then the nose.
2. Feel the neck for cord.
3. Guide the head downward.
4. Support the head and upper body.
5. Keep neck in neutral position.
6. Place clamps and cut cord.
7. Placenta will deliver itself.
          Neonatal Evaluation

1.   Calculate Apgar score
2.   Suction and stimulate
3.   Vitals
4.   Assess skin color
5.   Remember two patients
           Apgar Scoring System
Area of Activity          2                      1                    0

Appearance         Entire infant is pink.   Body is pink, but     Entire infant is blue
                                            hands and feet        or pale.
                                            remain blue.

Pulse              More than 100            Fewer than 100        Absent pulse
                   beats/min                beats/min


Grimace or         Infant cries and tries   Infant gives a week   Infant does not cry
                   to move foot away        cry in response to    or react to stimulus.
Irritability       from finger snapped      stimulus.
                   against its sole.

Activity or        Infant resists           Infant makes weak     Infant is completely
                   attempts to              attempts to resist    limp, with no muscle
Muscle Tone        straighten out hips      straightening.        tone.
                   and knees.

Respirations       Rapid respirations       Slow respirations.    Absent respirations.
                   Crotch rot
         Neonatal Resuscitation
1. Vitals should be RR>60,
    HR>100.
2. Assess airway and
    breathing. If RR < 40-
    60, stimulate. If still not,
    BVM.
3. Assess circulation. If
    HR<100 give 02. If still
    <80 give CPR.
4. 3:1 Compressions:
    Ventilations. Use
    thumbs and wrap
    around chest.
Yes guys, you can do it too, but it’s easier to
     leave the cooking to the women.

				
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posted:2/27/2012
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