Obstetrical (OB) Emergencies

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Obstetrical (OB)Emergencies
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Medical Terminology (OB)

• Prenatal existing or occurring before birth.
• Perinatal occurring at or near the time of birth.

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Medical Terminology (OB)

• Postpartum the maternal period after delivery.

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Medical Terminology (OB)

• Gravida of the current and past pregnancies
  combined.
• Parity of live children born.

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Medical Terminology (OB)

• G4P3 might be a pregnant mom who has 3 children.
• These will be broken down even more in the
  detailed records (miscarriages, twins, etc).

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Ectopic Pregnancy

• Occurs when a fertilized ovum implants anywhere
  other than the endometrium of the uterine cavity.

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Ectopic Pregnancy
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Ectopic Pregnancy
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Ectopic Pregnancy

• 90 fallopian tubes.
• 6 abdominal.
• 1 ovarian and cervical.

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Ectopic Pregnancy

• 1 in 200 pregnancies.
• Leading cause of first trimester death.
• 11 of maternal deaths in US.

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Ectopic Pregnancy

• Rupture occurs 2-12 weeks gestation.
• Early detection important!!!

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Ectopic Pregnancy

• Classic triad of symptoms
• Abdominal pain.
• Vaginal bleeding.
• Amenorrhea (or oligomenorrhea).

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Miscarriage

• Technically called a spontaneous abortion (SAB).
• Occurs before 20 weeks gestation.

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Miscarriage

• Occurs in 1 in 10 pregnancies.
• Early miscarriages may not be detected by mother.
• After 20 weeks gestation, called a preterm birth.

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Causes of Miscarriage

• Hormonal problems, infections or health problems
  in the mother.
• Lifestyle (i.e. smoking, drug use, malnutrition,
  excessive caffeine and exposure to radiation or
  toxic substances).
• Implantation of the egg into the uterine lining
  does not occur properly.

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Risk Factors for Miscarriage

• Maternal age.
• Maternal trauma.
• Increase in maternal age.

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Risk Factors for Miscarriage

• Women under the age of 35 years old have about a
  15 chance of miscarriage.
• Women who are 35-45 years old have a 20-35
  chance of miscarriage.
• Women over the age of 45 can have up to a 50
  chance of miscarriage.

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Threatened Miscarriage

• Some degree of early pregnancy uterine bleeding
  accompanied by cramping or lower backache. The
  cervix remains closed.
• This bleeding is often the result of implantation.

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Inevitable or Incomplete Miscarriage

• Abdominal or back pain accompanied by bleeding
  with an open cervix.
• Miscarriage is inevitable when there is a
  dilation or effacement of the cervix and/or there
  is rupture of the membranes.
• Bleeding and cramps may persist if the
  miscarriage is not complete.

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Complete Miscarriage

• Embryo or products of conception (POC) have
  emptied out of the uterus. Bleeding should
  subside quickly, as should any pain or cramping.
• A complete miscarriage can be confirmed by an
  ultrasound or by having a surgical curettage
  performed.

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Missed Miscarriage

• Women can experience a miscarriage without
  knowing it. This is when embryonic death has
  occurred but there is not any expulsion of the
  POC. It is not known why this occurs.
• Signs of this may be a loss of pregnancy symptoms
  and the absence of fetal heart tones found on an
  ultrasound.

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Recurrent Miscarriage (RM)

• Defined as 3 or more consecutive first trimester
  miscarriages.
• Occurs in 1 of couples trying to conceive.

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L D Labor Delivery
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Medical Terminology (OB)
Parturition the process by which the baby is
born.
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Beginning of Labor

• Fetus descends into birth canal.
• Relief of pressure in upper abdomen...

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Beginning of Labor

• ... and increase in pressure in the pelvis. May
  see bloody show.

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First Stage of Labor

• Begins with onset of regular contractions and
  ends with complete dilation of the cervix (10 cm).

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First Stage of Labor

• In most pregnancies, the amniotic sac ruptures
  toward the end of this stage.

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Second Stage of Delivery

• Begins with full dilation and ends with delivery
  of the infant.

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Crowning

• The presenting part of the fetus (usually the
  head) emerges from the vaginal opening.
• Birth is imminent!

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Third Stage of Labor

• Begins with delivery of the infant and ends with
  delivery of the placenta and contraction of the
  uterus.

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Third Stage of Labor

• Uterine contraction can be stimulated by
  massaging the abdomen or having the baby breast
  feed immediately.

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Placenta
Doctor will inspect and palpate placenta to
ensure it is complete and that all of the POC
have been expelled.
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Assisting in an Uncomplicated Delivery

• Never say, I delivered a baby! unless you
  actually delivered the baby (meaning, youre the
  new mom!)
• Your role is to assist and support, to evaluate
  and care for any potential problems, and to
  provide care for the newborn when he/she is
  delivered.

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Assisting in an Uncomplicated Delivery

• Items to have on hand if possible
• Gloves.
• Clamps for umbilical cord (wide ribbon or string
  will work).
• Scissors to cut cord.
• Bulb suction to suction the infants mouth and
  nose.

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Assisting in an Uncomplicated Delivery

• Items to have on hand if possible
• Sanitary napkins to help with bleeding control.
• Towels to dry off baby.
• Baby blanket (or any clean blanket) to keep baby
  warm.
• Plastic bag to contain the placenta after
  delivery.

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Assisting in an Uncomplicated Delivery

• Signs of impending delivery
• Crowning.
• Feeling of need to move bowels.
• Increasing vaginal pressure.
• Increased need to push.

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Assisting in an Uncomplicated Delivery

• Take patients vital signs.
• Get pertinent medical historyany known
  complications, if mom has had prenatal care, if
  pregnancy is multiples, etc.
• Get past pregnancy history.

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Assisting in an Uncomplicated Delivery

• If you suspect birth is imminent, visually
  inspect for crowning.
• Perform this with another emergency care provider
  present to avoid any allegations of inappropriate
  behavior.
• You will NOT check for dilation.

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Assisting in an Uncomplicated Delivery

• After baby is born, clamp (or tie) cord at about
  four fingers width away from the infant and the
  second clamp two finger widths further away.
• Cut the cord between the two clamps or ties.

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Assisting in an Uncomplicated Delivery

• Gently dry the infant (stimulate infant more
  firmly if baby is not responding well).
• Place wet towels to the side.
• Wrap baby in baby blanket and cover head (not
  face!) to keep warm.

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Assisting in an Uncomplicated Delivery

• Allow mom to hold and/or breastfeed baby if she
  is able.
• Placenta should deliver within a few minutes.
  Place in plastic bag.
• Provide mom with sanitary napkins for bleeding.

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Risk Factors for Complications

• Maternal age (young or old).
• Absence of prenatal care.
• Maternal lifestyle (alcohol, tobacco, drug use).
• Maternal illness.

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Risk Factors for Complications

• Problems in previous pregnancies or deliveries.
• Previous cesarean.
• Multigravida (two or more previous pregnancies).

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Symptoms of Preeclampsia

• Elevated Blood Pressure
• Peripheral Edema
• Sudden Weight Gain
• Headaches
• Changes in Vision

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Preeclampsia

• Disease occurs after 20 weeks gestation, often
  near full term (40 wks).
• Can lead to Eclampsia.

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Preeclampsia

• Diagnosed by the classic triad of symptoms
• Hypertension, proteinuria, and edema.

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Preeclampsia

• Should always be considered with

Blood Pressure.
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Eclampsia

• Signs and symptoms of preeclampsia .
• seizures.

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Placental Abruption

• Also called Abruptio Placentae.
• Partial or complete detachment of a normally
  implanted placenta at more than 20 weeks
  gestation.

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Abruptio Placentae
Visible Bleeding
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Abruptio Placentae
No Visible Bleeding
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Abruptio Placentae
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Abruptio Placentae

• Characterized by sudden, third-trimester dark red
  bleeding and pain.
• Tender abdomen and rigid uterus.

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Placenta Previa

• Placental implantation in the lower uterine
  segment encroaching on or covering the cervical
  opening.

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Placenta Previa
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Placenta Previa

• Painless, bright red bleeding without
  contractions.
• It is more common in multiparous mothers.
• The cause is unknown.

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Uterine Rupture

• Spontaneous or traumatic rupture of the uterine
  wall.
• Sudden tearing pain, bleeding, signs of shock.

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Breech Birth

• Three to four percent of pregnancies are breech
  births.
• Complications that increase the chances of a
  breech birth baby include premature childbirth,
  high levels of amniotic fluid and multiple birth
  pregnancies.

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Breech BirthExternal Version

• During an "external version" a doctor attempts to
  move the baby out of breech position while the
  baby is still in the uterus by physically
  manipulating the baby.
• Usually done between weeks thirty and forty of a
  pregnancy.
• Fifty percent chance of success.

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Vaginal Delivery when Breech

• Vaginal childbirth is possible with a breech
  birth.
• Risks to both baby and mother are greater.
• Breech birth complications include damage to the
  umbilical cord during childbirth, a serious event
  that can be fatal to the baby or the mother.
• If complications develop, an emergency cesarean
  section is required.

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Planned C-Section when Breech

• If a breech birth is diagnosed in conjunction
  with other pregnancy complications, or if vaginal
  childbirth is not an option, a planned C-section
  may be arranged.
• A planned C-section gives the mother the option
  of regional anesthetic, so she can be awake for
  her baby's birth.

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Multiples

• About half of twins and nearly all higher-order
  multiples are premature (born before 37 weeks).

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Shoulder Dystocia

• Shoulder dystocia describes difficulty
  delivering a baby's shoulders.
• "Dystocia" means "a difficult childbirth."
• Shoulder dystocia is often caused if the baby is
  especially large (but can happen with a baby of
  any size).

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Prolapsed Cord
Occurs when cord presents before baby.

• Create an airway for the baby by placing fingers
  into vaginal opening in front of babys face and
  make a V.

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Prolapsed Cord

• Place mother in a knee-chest position to reduce
  pressure on the cord.
• Place wet dressings over cord and wrap in towel
  to keep warm.

Prolapsed cord with breech presentation.