fetus
a baby as he develops in the womb.
Developing baby.
uterus
the muscular abdominal organ where the fetus develops , The womb. The uterus contracts in ever shortening intervals and push the baby through.
cervix
the neck of the uterus at the entrance to the birth canal. Must dilate to 10 cm or 4 inches to allow the babys head to pass.
vagina
the birth canal where delivery takes place.
placenta
the organ of pregnancy where exchange of oxygen, nutrients, and wastes occurs between a mother and fetus. Attached to the wall of the uterus. An organ of pregnancy and expelled after the baby is born.
Drugs, nicotine, Carbon dioxide and alcohol pass through
the mother's bloodstream and carried across the placenta to the fetus.
Umbilical cord
Mother's blood does not flow through the baby. The baby's blood vessels in the umbilical cord to the placenta where the blood picks up nourishment from mother and then returns through the umbilical cord to the fetus's body. 1 inch wide and 22 inches long
amniotic sac
a thin membranous bag of water. This sac contains almost 1 QUART of liquid called amniotic fluid. It allows the fetus to float, acts as a cushion, and helps maintain constant body tempurature. It breaks during labor and provides a natural lubricant during
Trimesters------3 month periods of pregnancy
called Trimesters
1st- little uterine growth , 1 to 3 months
2nd- rapid uterine growth, reaching the navel by the 5th month and up to the epigastrium by the seventh month. 4 to 6 months
3rd- increased blood volume, increased cardiac output, increased hear
crowning
presenting part, when the baby first bulges from the vaginal opening. The part of the infant that is first to appear at the vaginal opening, normally the babys head
cephalic presentation
head presenting first. Normal presentation.
breech presentation
buttocks or feet presenting first.
labor in three stages
is the intire process of delivery. The 3 stages are 1st, 2nd, 3rd
1st- regular contractions and thinning and gradual dilation of the cervix and ends when the cervix is fully dilated.
2nd- is the time from when the baby enters the birth canal until he is b
first stage of labor
dilation period. Dilates to the size of a wide neck jar, prior to that the neck must me shortened and thinned. This is called effacement.
effacement
when the long neck of the cervix shortenes and thins.
days before labor
mild contractions and slight dilation may begin as the cervix begins to thin. Labor contractions begin anywhere from 30 minutes apart and get closer to 3 minutes or less and usually become more regular.
meconium staining
amniotic fluid that is greenish or brownish-yellow rather than clear as a result of fetal defacation, an indication of possible maternal or fetal distress during labor. Infant should not be stimulated if not suctioned first.
amniotic sac breaks
as the fetus moves down and cervix dilate, fluid is usually clear but may be a watery, bloody discharge of mucus, not bleeding, that plugged the cervix. This is associated with the first stage of labor. This bloody show does not have to be wiped away
second stage
after full dilation of the cervix, labor pains become more severe, more frequent, and a new feeling of having to move a bowel. This is due to the baby putting pressure in the rectum, delivery is near. EMT will need to decide whether to stay and deliver or
third stage of labor
after the baby is born. Contractions will resume and continue until the placenta is delivered. The contractions and labor pains may be as painful and severe as they were in the second stage. The third stage usually lasts 10-20 minutes.
EMT's do not deliver babies........
mother's do
The role of the EMT
primary role is to determine whether the delivery will occur on scene and if so to assist the mother as she delivers her child.
at the scene, contractions 2 min. apart then
medical direction for permission to transport or go to hospital.
supine hypotensive syndrome
3rd trimester in SUPINE Position ---the weight of the uterus coupled with the infants weight placenta and amniotic fluid aproximates 20-24 pounds. The heavy mass tends to compress the inferior vena cava, blood vessel, reducting return of blood to the hear
drop in blood pressure
from supine hypotensive syndrome should not be treated just like shock, transport on left side with a pillow behind her back for support/
preparing mother for delivery when delivery is imminent
provide privacy
surgical gloves, gown, cap, face mask and eye protection.
place mother on bed or floor or ambulance stretcher, elevated butt, knees up and spread apart
Need 2 feet of work space to deliver the baby
Remove any clothing that is abstructing v
time of delivery patient may be .....
scared, have intense feelings, and could be uncooperative, encourage patient to relax and not strain during contractions, time them from the start of one to the start of the next, feeling of bowel movement as baby moves into birth canal, do not allow to g
when delivery has started.....
do not touch vaginal unless necessary and always have your partner there for legal reasons, place one hand below the babies head as it delivers, be careful of soft spots, light pressure on the tissue with your hand and a sterile towel may prevent tearing.
when head is delivered,
unwrap umbilical cord if necessary, tell mother NOT to push while you inspect the baby, the umbillical cord MUST BE CUT if it can't be removed from around the babies neck. Clamp with 2 clamps, cut between the clamps and deliver the baby. SUCTION MOUTH FIR
entire baby is delivered
lay baby on side, head slightly lower than body, suction mouth then the nose, keep at the same level as the vagina until the umbilical cord stops pulsating, wrap baby in a warm dry blanket, NOTE THE EXACT TIME OF BIRTH.
assessing ther new born APGAR
A- appearance
P-ulse
G- grimace when suctioned or flicking feet
A- activity or movement
R- respiratory effect (slow, irregular, weak cry or breathing with strong cry.
Values of 0, 1 or 2
Determined one minute after birth and again at 5 minutes.
Artificial ventilations
40-60 per minute reassess after 30 seconds
heart rate
if less than 100 beats per minute, artificial ventilations
if less than 60 beats per minute, chest compressions
120 compressions per minute
90 compressions 30 breaths
if breathing is greater than 100 but cyanosis of the face and or torso, provide blow by
cutting the cord
the baby must be breathing ON HIS OWN before you cut the cord. Palpate and feel for pulsating to be stopped before clamping and cutting. DO NOT CUT OR CLAMP A CORD THAT IS STILL PULSATING.
vernix
protective coating on the infant, leave it until he reaches the midical facility.
clamped cord
leave on the baby and be careful not to cause trauma to the cord, it will be needed for IV's in emergency situations. Cord vessels should callapse on their own.
The placenta end of the cord should be layed over the mothers legs to avoid contamination from
to avoid infant hypotheria
properly dry baby and discard used towels, wrap baby in dry towels, pre warmed if possible and be sure to cover babies head, warm the ambulance, have mother or assistant hold baby while placenta delivers.
off duty
use shoe laces, may delay this step if infant will recieve care withing 30 minutes. soak a pair of scissors in alcohol for several minutes. If not keep baby, cord and placenta as a whole, with placenta wrapped in separate towel, place it at the same level
delivery of the placenta
is usually in a few minutes after birth. A brief return of contractions, the cord lengthens when it detaches from the uterus. Transport to the hospital can be delayed up to 20 minutes if not complications while waiting for the placenta to be delivered. It
what to write on a piece of tape after delivery
mothers last name and time of delivery, fold it so adhesive does not touch the baby's skin and place it around the babys wrist.
save all afterbirth and tissues
try to catch placenta in bag or container and label it placenta with time of placenta delivery and time of delivery.
controlling bleeding after placenta is delivered
bleeding up to 500 cc is usually normal. it may be profuse. sanitary napkin over vaginal, lower legs and keep closed and elevate her feet. Message uterus lightly in circular motion, it should contract and become firm and the size of a grapefruit. Bleeding
`perineum
may tear, sanitary napkin and some pressure for bleed control.
Take vitals regularly
throughout entire birthing process.
clean up
Wipe down face and hands then dry, replace sheets and blankets and make sure both are warm. Clean up what you can without delaying transport.
definitive treatment beyond the emt's level
breech presentation, prolapsed umbilical cord, and limb presentation. HIGH CONCENTRATION OXYGEN AND RAPID TRANSPORT
Breech presentation
most common abnormal deliver, butt first, or both legs first, risk of birth trauma is high, increased risk of prolapsed cord and meconium staining. Can deliver successfully but complication rate is high.
Rapid transport
High Concentration Oxygen
Mother in
prolapsed umbilical cord
when the umbillical cord presents first, most common in breech births, pinched and oxygen supply to the baby may be totally interrupted. With butt raised, NRB, place several fingers of your gloved hand into the mothers vagina so that you can gently push u
Limb presentation
CANNOT BE DELIVERED IN A PREHOSPITAL CONDITION usually involves prolapsed cord as well.
Multiple births
NOT A COMPLICATION. Call for assistance. Identify babys as one and two or A and B.
Clamp or tie the cord of the first baby before the secnd baby is born. The second baby may be born before the first placenta or if only one shared placenta.
Premature infant
any infant born beighing less than 5 1/5 lbs. or born before the 37th week. Use humidified oxygen if possible. Transport in a warm ambulance 90-100 degrees. Call ahead to emergency department.
placenta previa
occuring late in pregnancy ,
a condition in which the placenta is formed in an abnormal location like low in the uterus and close to or over the cervical opening, that will not allow for a normal delivery of the fetus and caused excessive prebirth bleedin
abruptio placentae
occuring late in pregnancy,
a condition in which the placenta separates from the uterine wall, a cause of pre birth bleeding.
signs of excessive prebirth bleeding
profuse bleeding, may have abdominal pain, signs of shock, obtain baseline vital signs. A rapid heartbeat may indicate significant blood loss.
treatment for excessive prebirth bleeding
treat with high concentration oxygen and rapid transportation, sanitary napkin, NOTE TIME OF NAPKIN PLACEMENT, replace pads a they become soaked and SAVE ALL PADS FOR USE IN EVALUATING BLOOD LOSS. Save all tissue that has passed.
oviduct
fallopian tube
ectopic pregnancy
egg implants in the tubular oviduct which ruptures as the fetus grows, causes internal bleeding.
Signs seen early in pregnancy, and patient may be unaware they are even pregnant, SHOCK, abdominal pain.
ANY WOMAN OF CHILDBEARING AGE WITH ABDOMINAL PAIN HAS
Treatment for ectopic pregnancy
immediate transport, shock position and treatment, high concentration oxygen by nonrebreather mask. Do not give anything by mouth.
Seizures in pregnancy
called Eclampsia tend to occur late in pregnancy. Usually associated with high blood pressure and preeclampsia (SWELLING OF THE EXTREMITIES). Increases the risk of abruptio placentae, excessive weight gain, extreme swelling of face, hands, ankles, and fee
Eclampsia
a severe complication of pregnancy that produces seizures and coma.
Preeclampsia
a complication of pregnancy where the woman retains large amounts of fluid and has hypertension. She may also experience seizures and /or coma during bith which is very dangerous to the infant.
Seizures in pregnancy
maintain open airway
high concentration oxygen by nonrebreather mask
transport on left side
handle patient gently, rough handling may induce more seiaures
keep her warm
have suction ready
have delivery kit ready
abortion
spontaneous (miscarrieage)
induced termination of pregnancy.
spontaneous abortion
misscarriage, when the fetus and placenta deliver before the 18th week of pregnancy..
induced abortion
expulsion of a fetus as a result of deliberate actions taken to stop the pregnancy.
assessment of miscarriage and abortion
cramping, bleeding from moderate to severe, noticable discharge of tissue and blood. If more than 24 weeks prepare delivery pack.
care of miscarriage and abortion
baseline vitals, shock, provide oxygen, sanitary napkin, transport, replace and save all blood soaked pads, save all tissue that are expelled, do not pull out anything, provide emotional support.
trauma in pregnancy
especially during the last two trimesters. The greatest danger is hemorrhage and shock. Most common trauma is automobile collisions also falls and beatings account for many. The uterus is a great shock absorber and most minor trauma does not harm the fetu
assessment of trauma in pregnancy
pulse 10-15 beats per minute faster than the nonpregnant female.
still births
born dead several hours, days or even weeks before birth. The mother can view the stillborn if desired. All resuscitative efforts should be continued until transfer to the hospital. Keep accurate records of the time of stillbirth and the care rendered for
death of a pregnant woman
CPR must be continued until an emergency cesarean section can be performed. CPR must be move 1 to 2 inches higher on the sternum to make up for shifting of the heart due to the large fetus. 5-10 minutes delay chances are fair, 25 minutes almost zero chanc
vaginal bleeding
gynecological emergencies
vaginal bleeding and abdominal pain serious complication is hypovolemic shick due to blood loss.
treatment for vaginal bleeding
standard precautions, adequate airway, shock, administer oxygen, transport.
trauma to externa genitalia
profuse bleeding, blood loss and shock.
Treatment---sanitary pad, do not remove undergarments, shock, oxygen, professional attitude, privacy
sexual assualt
medical and psychological considerations, law enforcement, tremendous stress, wide range of emotions,, same sex EMT.
care to sexual assault patient care
open airway, do not disturb potential criminal evidence, examine genitals for severe bleeding, discourage bathing, voiding, or cleansing any wounds, fullfill reporting requirements.