External Female Genitalia
Labia
Perineum
Mons pubis
Internal Female Genitalia
Vagina
Ovaries
Fallopian tubes
Uterus
Female Reproductive Cycle Menstruation
Stimulated by estrogen and progesterone
Ovaries release ovum
Uterus walls thicken
Fallopian tubes move egg (peristalsis)
Uterine walls expelled (bleeding 3-5 days)
Female Reproductive Cycle Fertilization
Sperm reaches ovum
Ovum becomes embryo
Embryo implants in uterus
Fetal stage begins
Physiologic Changes
Cardiovascular System
Respiratory System
GI System
Ligaments
Preexisting medical conditions
Supine Hypotensive Syndrome
Placenta, infant, and amniotic fluid total 20-24 lbs.
When supine, mass compresses inferior vena cava
Cardiac output decreases
Dizziness and drop in blood pressure
Assessing the Woman in Labor
Assessment focused on imminent delivery
Name, age, expected due date
First pregnancy?
Seen doctor about pregnancy?
When did labor pains start?
Feel the urge to push?
Examine for crowning
Feel for uterine contractions
Take vital signs
Findings Indicating Possible Need for Resuscitation
No prior prenatal care
Premature delivery
Labor induced by trauma
Multiple births
History of pregnancy problems (especially placenta previa and breech presentation)
Labor induced by drug use (especially narcotics) and alcohol
Meconium staining when water
Imminent Delivery
Control scene
Proper PPE
Place mother on bed, floor, or ambulance stretcher
Remove clothing obstructing vagina
Position assistant and OB kit
A lack of prenatal care, premature labor, multiple gestation, and underlying conditions indicate a likelihood of
neonatal resuscitation.
The presenting part is defined as the part of the infant that is first to appear at the vaginal opening during labor. Usually, the presenting part of the baby is the head. The normal head-first birth is called a
cephalic presentation
If the buttocks or both feet of the baby deliver first, the birth is called a
breech presentation or breech birth
If part of the baby's head or presenting part is visible with each contraction
then birth is imminent
Findings Indicating Possible Need for Resuscitation
No prior prenatal care
Premature delivery
Labor induced by trauma
Multiple births
History of pregnancy problems (especially placenta previa and breech presentation)
Labor induced by drug use (especially narcotics) and alcohol
Meconium staining when water
Imminent Delivery
Control scene
Proper PPE
Place mother on bed, floor, or ambulance stretcher
Remove clothing obstructing vagina
Position assistant and OB kit
Childbirth
requires a high level of personal protective equipment.
Preparing Mother for Delivery
Control the scene so the mother has privacy. (Her birthing coach may remain.) Proper PPE for you and your partner: surgical gloves, gowns, face mask, and eye protection. Place the mother on bed, floor, or ambulance stretcher and elevate her buttocks with
Preparing the OB Kit
Position the kit near the mother; all items must be within easy reach. Although supplies will vary, all kits should include what is shown in the slide.
Off-Duty Delivery Supplies
Clean sheets and towels
Heavy, flat twine or new shoelaces
Towel or plastic bag (for placenta)
Clean, unused rubber gloves and eye protection
The lack of PPE in this situation may expose the EMT to contact with infectious diseases.
use your finger to puncture the membrane
If the amniotic sac has not ruptured by the time the baby's head has delivered
Discuss the steps that you must take as the baby's head appears. Describe preventing an explosive delivery, assessing the umbilical cord, and suctioning.
Examine the fluid for meconium staining, which will be a green-black or mustard yellow color. Once the head delivers, check if the umbilical cord is around the neck. While doing this, ask the mother to pant. If you are unable to slip the cord over the bab
The upper shoulder usually delivers with some delay, followed quickly by the lower shoulder. Support the baby throughout this process.
Gently guide the baby's head downward as the upper shoulder delivers, then gently upward as the lower shoulder delivers.
contraction
labor pains
Braxton-Hicks
Labor Pains that last longer
irregular prelabor contractions of the uterus.
Contractions indicating the first Stage
3 min apart
Neonate
is the term used for a baby from birth to one month old.
infant
is used for a baby in its first year of life
Neonate APGAR score
should be assessed as soon as its born. Pulse should be greater than 100/min. An APGAR score (appearance, pulse, grimace, activity, respiratory effort) is done one minute after birth and then again 5 minutes after birth. The total APGAR score is done on a
APGAR
appearance, pulse, grimace, activity, respiratory effort
Adds up to 10
0
Appearance Blue (or pale) all over
Pulse 0
Grimace No reaction to suctioning or flicking of the feet
No movement Activity
No Respiratory effort
1
Appearance Extremities blue, trunk pink
Pulse <100
Grimace Facial grimace to suctioning or flicking of the feet
Activity Only slight activity (flexing extremities)
Respiratory effort Slow or irregular breathing, weak cry
2
Appearance Extremities Pink all over
Pulse >100
Sneeze, cough, cry to suctioning or flicking of the feet
Activity Moving around normally
Respiratory effort Good breathing, strong cry
Keeping the Baby Warm
Heat retention is high priority
Dry baby
Discard wet blankets
Wrap baby in a dry blanket (infant swaddler or "space blanket")
Cover head
The most important aspect of caring for a neonate is keeping the baby warm.
Cutting the Umbilical Cord
Do not tie, clamp, or cut an umbilical cord on a baby who is not breathing unless the cord is around the baby's neck. Do not cut or clamp a cord that is still pulsating. Apply one clamp or tie about 10 inches from the baby. This leaves enough cord for par
Why is it so important to stimulate the baby?
Babies are passive throughout birth, but should quickly become active (i.e., breathe), usually on their own. Stimulating babies ensures that they will start breathing on their own.
Neonatal Resuscitation Assessing Heart Rate
Less than 100bpm
provide artificial ventilation at 40-60 per minute
Less than 60bpm
start chest compressions
Adequate respirations, heart rate greater than 100bpm, but has central cyanosis
provide supplemental oxygen via blow-by
Assessing Neonatal Heart Rate Less than 100bpm
provide artificial ventilation at 40-60 per minute
Assessing Neonatal Heart Rate Less than 60bpm
start chest compressions
Assessing Neonatal with Adequate respirations and a Heart Rate greater than 100bpm, but has central cyanosis
provide supplemental oxygen via blow-by
If heart rate is below 100 beats per minute
ventilate at a rate of 40-60/minute
If heart rate is below 60 per minute
then begin chest compressions at a rate of 120 per minute
What are the first steps in neonatal resuscitation?
The first steps in resuscitation are drying, warming, positioning to keep the airway clear, suctioning, and tactile stimulation.
What is central cyanosis?
Central cyanosis is blue coloration of the torso.
When is artificial ventilation required, and what is the rate of artificial ventilations?
If the heart rate is below 100 beats per minute, ventilations are provided at 40-60 per minute.
Care After Delivery
Emphasize that the mother may be the more serious patient. Post partum hemorrhage can kill. Use previous discussions about shock to describe the treatment of a hemorrhaging mother. Advise students that uterine massage can be quite painful to the mother. N
Caring for the Mother
Mother at risk for serious bleeding, infection, emboli
Deliver placenta
Control vaginal bleeding
Comfort
After delivery, there are two patients to care for: the infant and the mother. Although it is easy to make the baby the primary focus, there are many
Delivering the Placenta
Afterbirth: placenta with umbilical cord, amniotic sac membranes, and tissues lining uterus
Placental delivery starts with labor pains
May take 30 minutes or longer
Begin transport in 20 minutes (do not wait to deliver placenta)
Avoid putting pressure on
Afterbirth:
placenta with umbilical cord, amniotic sac membranes, and tissues lining uterus
Placental delivery starts with labor pains
May take 30 minutes or longer
Begin transport in 20 minutes (do not wait to deliver placenta)
Controlling Vaginal Bleeding
Controlling vaginal bleeding for the mother is a priority. If the placenta hasn't delivered in 20 minutes, transport mother and neonate. Blood loss is not usually more than 500 cc, but it may be profuse. Have mother lower her legs after placing a sanitary
Providing Comfort to the Mother
Take vital signs frequently
Acts of kindness will be appreciated and remembered
Wipe face and hands with damp washcloth
Replace blood-soaked sheets and blankets
Make sure mother and baby are warm
What are your responsibilities in caring for the mother?
Responsibilities include delivery of the placenta, controlling vaginal bleeding, and making the mother as comfortable as possible. Some EMS systems recommend transport without waiting for delivery of the placenta. You can always stop the ambulance en rout
What is considered to be the usual blood loss?
Blood loss during delivery is considered to be normal in the amount of 500 cc.
Give examples of acts of kindness toward the mother.
Acts of kindness include wiping the mother's face and hands with a damp washcloth and then drying them, clearing away blood-soaked linens, and so on.
Breech presentations occur
when the head is not the first presenting part of the baby during birth. Breech presentations can spontaneously deliver successfully, but the complication rate is high. : Initiate rapid transport. Never attempt to deliver by pulling on legs. Provide high-
Limb Presentation
Place mother in head-down position and give high-concentration oxygen by non-rebreather mask. Initiate rapid transport.
Premature Birth
Keep baby warm
Keep airway clear
Provide ventilations and chest compressions
Watch umbilical cord for bleeding
Oxygen (blow by)
Protect from contamination
Call ahead to emergency department
Meconium
Don't stimulate infant before suctioning
Suction mouth, then nose
Maintain open airway
Provide ventilations and/or chest compressions
Transport as soon as possible
Emergencies in Pregnancy
Excessive prebirth bleeding
Ectopic pregnancy
Seizures in pregnancy
Miscarriage and abortion
Trauma in pregnancy
Stillbirths
Accidental death of pregnant woman
Excessive Prebirth Bleeding
Main sign is unusually profuse bleeding
Abdominal pain may or may not be felt
Assess for signs of shock
High-concentration oxygen and transport
Place sanitary napkin over vagina
It's normal for a pregnant woman to have spotting or a light discharge of a s
Placenta previa and abruptio placentae
are common causes of excessive prebirth bleeding.
Placenta previa is a condition in which the placenta is formed in an abnormal location and does not allow for normal delivery. As the cervix dilates, the placenta tears. The similar abruptio placentae is a
One-sided abdominal pain
in a woman of childbearing years should be assumed to be an ectopic pregnancy.
Low blood pressure is a late sign of ectopic pregnancy.
Seizures in Pregnancy
Existing preeclampsia
Elevated blood pressure
Excessive weight gain
Excessive swelling to face, ankles hands, and feet
Altered mental status or headache
Miscarriage and Abortion
Cramping, abdominal pains
Bleeding: moderate to severe
Discharge of tissue and blood from vagina
Have students work in small groups. Have them rehearse death and dying situations associated with spontaneous abortion.
Trauma in Pregnancy
Pulse 10-15 beats faster than non-pregnant women
Blood loss may be 30%-35% before signs/symptoms appear
Ask patient if she received blows to abdomen
Because of slowed digestion and delayed gastric emptying, there is a greater risk that the patient will vo
Stillbirths
Do not resuscitate if it is obvious the baby died some time before birth
Resuscitate if baby is born in cardiac or respiratory arrest
Prepare to provide life support
Emotional support for family
Keep accurate records of the time of stillbirth and care ren
Accidental Death of Pregnant Woman
Chance to save unborn child
Begin CPR on mother immediately
Continue CPR until emergency cesarean section can be performed or you are relieved in emergency department
Describe a complication. Have students discuss the immediate necessary actions. Discuss
Vaginal Bleeding
Treat as potential life threat
Check for associated abdominal pain
Monitor for hypovolemic shock
Vaginal bleeding that is not a result of direct trauma or a woman's normal menstrual cycle may indicate a serious gynecological emergency.
Trauma to External Genitalia
Observe MOI
Look for signs of severe blood loss and shock
Consider additional internal injuries
Consider assault a likely cause of any trauma to external genitalia.
Caring for these injuries may be difficult due to patient modesty.
Using a programmed pati
Sexual Assault
Treat immediate life threats
Do not disturb potential evidence
Examine genitals only if severe bleeding is present
Discourage bathing, voiding, or cleansing wounds
Fulfill mandated reporting requirements
Care of the sexual assault patient
Care of the sexual assault patient must include medical, legal, and psychological considerations. When treating sexual assault patients, EMTs should be professional, nonjudgmental, and conscious of personal space. EMTs should explain examinations and trea
28 weeks
Miscarriage
When Contractions Stop
the Cervix is dropping and Expanding
not even
First stage
This stage starts with regular contractions and the thinning and gradual dilation of the cervix and ends when the cervix is fully dilated.
Second stage
This stage is the time from when the baby enters the birth canal until he is born.
Third stage
This stage begins after the baby is born and lasts until the afterbirth (placenta, umbilical cord, and some tissues from the amniotic sac and the lining of the uterus) is delivered.
lightening
the sensation of the fetus moving from
high in the abdomen to low in the
birth canal.
three stages of labor.
First stage:
beginning of contractions to full cervical dilation
Second stage:
baby enters birth canal and is born
Third stage:
delivery of the placenta
meconium staining
amniotic fluid that is greenish or brownish-yellow rather than clear as a result of fetal defecation; an indication of possible maternal or fetal distress during labor.
The general procedure for umbilical cord care is as follows:
1. As already noted, keep the infant warm. Turn the heat up in the ambulance or the room you are in. Dry off the baby and wrap him in a baby blanket or infant swaddler, clean towel, or sheet prior to clamping the cord. Do not wash the infant. Sometimes th
Mons Pubis
Tissue covers pubic symphasis
Perineum
between Vagina and anus
Ovulation
ovum released
Labor
The Three stages of delivery of a baby that begin with the contractions of the Uterus and end with the expulsion of the Placenta
Afterbirth
extra tissue released post birth
Supine Hypotensive Syndrome
baby and everything else in mothers stomach lies on Vena Cava restricting blood flow to heart
Amniotic Sac
Bag of Waters
Umbilical Cord
Structure transports blood to fetus from placenta
Placenta
Organs where exchanges made between mother and embryo
Fetus
Baby: Development to birth
Embryo
Baby: Fertilization to development
Labia
Tissue protecting Vagina
Vagina
Birthing Canal
Uterus
Organ where fetus develops
Fallopian Tubes
Tubes connecting ovary to fetus
Cervix
Neck of uterus
Entrance of the Birth Canal
Ovary
Female reproductive organ
Breech Presentation
Baby butt/ legs appear 1st before anything during birth
Crowning
Baby Visible from opening
Neonate
infant less than 1 month old
Meconium Fluid
discolored amniotic fluid indicating baby poop during birth
Lightening
Sensation of baby moving down
Braxton Hick's Contractions
irregular Contractions
Cephalic Presentation
babies head appears 1st during birth
Limb Presentation
Limb protrudes from vagina before anything else
Still Born
Born Dead
Induced Abortion
Miscarriage from deliberate action
Placenta Previa
Placenta formed in abnormal location prohibiting normal delivery
Abruptio Placentae
Placenta separates from uterine wall
Spontaneous Abortion
Miscarriage
Eclampsia
Severe complication of pregnancy that produces seizures and coma.
Prolapsed Umbilical Cord
Cord presents itself 1st between vaginal wall and baby head
Preclampsia
Woman retains amounts of fluid experiencing hypertension
Ectopic Pregnancy
fertilized egg not in the uterus
Abortion
termination of pregnancy
Premature Infant
an infant born 5.5 LBS or less, or before 37 weeks
Multiple Births
multiple babies born at once
Labia
Soft tissues that protect the entrance to the vagina. Highly vascular and prone to significant bleeding with trauma.
Clitoris
Urethral opening andvthe nerve-rich center of sexual stimulation.
Perineum
soft tissue and muscle found between the vaginal opening and the anus. Prone to tearing during childbirth.
Mons Pubis
A layer of soft tissue that covers and protects the pupic symphysis. Area hair grows as a woman reaches puberty.
External Genitalia
The labia, perineum, and mons pubis.
Internal Genitalia
The vagina, ovaries, and the fallopian tubes.
Vagina
The birth canal. Stretches to accommodate passage of the fetus during delivery and connects the uterus to the outside world
Ovaries
Small, round organs that are located on either side of most women's lower abdominal quadrants. Responsible for producing ova (eggs) for conception.
Fallopian Tubes
Narrow tube that connects the ovary to the uterus. Also referred to as oviducts.
Uterus
Muscular, hollow organ located along the midline in most women's lower abdominal quadrants; the womb. Able to stretch and grow as the fetus gets larger.
Cervix
Muscular ring that seperates the uterus and the vagina.
Fundus
The top of the uterus.
Ovulation
The phase of the female reproductive cycle in which an ovum is released from the ovary.
Embryo
The baby from fertilization to 8 weeks of development.
Fetus
The baby from 8 weeks of development to birth.
Placenta
The organ of pregnancy where exchange of oxygen, nutrients, and wastes occurs between a mother and fetus.
Umbilical Cord
The fetal structure containing the blood vessels that carry blood to and from the placenta.
Amniotic Sac
The "bag of waters" that surrounds the developing fetus.
Supine Hypotensive Syndrome
Dizziness and a drop in blood pressure caused when the mother is in a supine position and the weight of the uterus, infant, placenta, and amniotic fluid compress the inferior vena cava, reducing return of blood to the heart and cardiac output.
Labor
The entire process of delivery; beginning fo contractions to full cervical dilation, baby enters birth canal and is born, delivery of the placenta.
First Stage of Labor
Regular contractions and the thinning and gradual dilation of the cervix. Ends when the cervix is fully dilated.
Second Stage of Labor
Time from when the baby enters the birth canal until the baby is born.
Third Stage of Labor
After the baby is born; lasts until the afterbirth is delivered.
The First Stage of Labor Starts with regular contractions of the uterus. This can occur earlier or later than 9 months. it ends with full dilatation of the cervix.
Afterbirth
The placenta, ambilical cord, membranes of the amniotic sac, and some tissues from the lining of the uterus that are delivered after the birth of the baby.
Braxton-Hicks Contractions
Irregular prelabor contractions of the uterus. Typically does not indicate impending delivery.
Lightening
Sensation of the fetus moving from high in the abdomen to low in the birth canal.
Contraction Time (Duration)
Time from the beginning of a contraction to when the uterus relaxes.
Contraction Interval (Frequency)
This is the time from the start of one contraction to the beginning of the next contraction.
Meconium Staining
Amniotic fluid that is greenish or brownish-yellow rather than clear as a result of fetal defecation; an indication of possible maternal or fetal distress during labor.
Imminent Childbirth Indications
Contractions last 30 seconds to 1 minutes and are 2-3 minutes apart, amniotic sac breaks ("water breaking" or "rupture of the membranes")
Crowning
When part of the baby is visible through the vaginal opening.
Cephalic Presentation
When the baby appears head first during birth. This is the normal presentation.
Neonate
A newly born infant or an infant less than 1 month old.
Breech Presentation
When the baby's buttocks or both legs appear first during birth. High risk of birth trauma.
Limb Presentation
When an infant's limb protrudes from the vagina before the appearance of any other body part.
Multiple Birth
When more than one baby is born during a single delivery.
Premature Infant
Any newborn weighing less than 5 1/2 pounds or born before the 37th week of pregnancy.
Placenta Previa
A condition in which the placenta is formed inn an abnormal location (low in the uterus and close to or over the cervical opening) that will not allow for a normal delivery of the fetus; a cause of excessive prebirth bleeding.
Abruptio Placentae
A condition in which the placenta separates from the uterine wall; a cause of prebirth bleeding.
Ectopic Pregnancy
When implantation nof the fertilized egg is not in the body of the uterus, occuring instead in the fallopian tube, cervix, or abdominopelvic cavity.
Eclampsia
A severe complication of pregnancy that produces seizures and a coma.
Preeclampsia
A complication of pregnancy in which the woman retains large amounts of fluid and has hypertension. She may also experience seizures and/or coma during birth, which is very dangerous to the infant.
Abortion
Spontaneous miscarriage or induced termination of pregnancy.
Spontaneous Abortion (Miscarriage)
When the fetus and placenta deliver before the 28th week of pregnancy.
Induced Abortion
Expulsion of a fetus as a result of DELIBERATE actions taken to stop the pregnancy.
Stillborn
A baby that dies in the uterus several hours, days, or even weeks before birth.
APGAR Score
A score that assigns a number value to the neonate's assessment findings; Ranges from 0-2 over 5 categories (Appearance, Pulse, Grimace (Reaction to suctioning or flicking of the feet) , Activity, and Respiratory Effort) totalling 0-10 points.
Basic Neonatal Resuscitation
In order: [Drying, Warming, Positioning, Suction, Tactile Stimulation], Oxygen, Bag-Mask Ventilation, Chest Compressions.
Advance Neonatal Resuscitation
In order: Intubation, Medications
Prolapsed Umbilical Cord
When the umbilical cord presents first and is squeezed between the vaginal wall and the baby's head.
Lateral Recumbant Position
Lying on the side; also known as the recovery position. All pregnant women should be transported in this position on their LEFT side to relieve pressure from the abdominal organs and the vena cava.
The 9 months of pregnancy are divided into
3-months Trimesters
During the 2nd Trimester
the Uterus grows very rapidly while the womans blood volume, cardiac output, and heart rate increase.
The Normal Birth Position
is head first position and is called a Cephalic Birth
Breech
is buttocks of or Feet First Birth
The first stage of labor
Starts with regular contractions of the Uterus. This can occur earlier or later than 9 months. It ends with full dilatation of the Cervix.
The Third Stage of Labor
Begins after the birth of the neonate/baby.
The Third Stage of Labor
is Complete when the afterbirth is expelled.
The Third Stage Expulsion
should occur within 20 minutes from the birth of the baby.
Dilation
the process by which the cervix gradually widens and thins out
May indicate fetal or maternal distress
If fluid from the Amniotic sac normally breaks and the fluid leaks out is greenish or brownish-yellow in color
When the fetus moves downward and the cervix dilates
the Amniotic sac normally breaks and fluid leaks out.
The greenish or Brownish-yellow fluid Expelled from the amniotic sac
is called meconium staining
trauma in the pregnant woman
She may lose up to 35 percent of her blood volume before exhibiting signs of shock.
The greatest danger to the pregnant woman and her fetus involved in trauma is which of the following?
Hemorrhagic shock
You are assessing a newborn patient 1 minute after delivery. You notice the patient has blue extremities with a pink trunk, a pulse of 120, and strong crying with good movement of all extremities. What is the newborn's APGAR score?
9