1 / 72

Emergency Delivery

Emergency Delivery. Presence Regional EMS November 2013 CE. Objectives. Describe the normal changes that occur in a woman’s body during pregnancy Outline the steps of assessment of the pregnant patient Differentiate between the 3 stages of labor Describe the indications of imminent delivery.

quentin-hahn
Télécharger la présentation

Emergency Delivery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Emergency Delivery Presence Regional EMS November 2013 CE

  2. Objectives • Describe the normal changes that occur in a woman’s body during pregnancy • Outline the steps of assessment of the pregnant patient • Differentiate between the 3 stages of labor • Describe the indications of imminent delivery

  3. Objectives (cont.) • Explain the steps of a normal delivery • Outline the steps for care of the newborn • Recognize complicated deliveries including malpresentation, maternal hemorrhage, meconium staining and multiple gestations.

  4. Introduction • Most infants are delivered in a hospital. • Occasionally, the birth process moves faster than the mother expects. • You must then decide whether to: • Stay on the scene and deliver the infant • Transport the patient to the hospital

  5. Normal Changes in Pregnancy • Many normal changes occur in the body that are not all directly related to the reproductive system. • Respiratory changes • Cardiovascular changes • Musculoskeletal changes

  6. Normal Changes in Pregnancy • Rapid uterine growth occurs in the second trimester. • As the uterus grows, it pushes up on the diaphragm and displaces it. • Respiratory capacity changes, due to brocho-dilation with increased respiratory rates and decreasing minute volumes.

  7. Fetal Development

  8. Normal Changes in Pregnancy • Blood volume gradually increases to: • Meet the increased needs of the fetus • Allow for adequate perfusion of the uterus • Prepare for the blood loss during childbirth • Number of red blood cells will increase • The patient is able to clot faster. • The patient’s heart rate increases up to 20%.

  9. Increased Blood Volume

  10. Increased Cardiac Output

  11. Decreased Stroke Volume

  12. Vasodilation • To accommodate the increased blood volume the pregnant woman’s blood vessels dilate • Keeps blood pressure lower • Gives the “rosy glow” of pregnancy

  13. Vital Signs • Do not mistake normal vital signs of pregnancy for signs of shock. • Normal pulse: 10–15 beats faster • Blood pressure: 10–15 mmHg lower • 30–35% blood loss before significant blood pressure change

  14. Patient Assessment • Childbirth is seldom an unexpected event, but there are occasions when it becomes an emergency. • Dispatch protocols usually include the dispatcher asking simple questions to determine whether birth is imminent.

  15. Patient Assessment • Scene Size-Up • Your safety is a priority. • Take standard precautions. • Gloves and eye protection are a minimum if delivery is already begun or is complete. • If time allows, a mask and gown should also be used. • Consider calling for additional resources. • Form a general impression. • The general impression should tell you whether the patient is in active labor or if you have time to assess and address other possible life threats

  16. Patient Assessment • Evaluate • Level of consciousness • Airway • Breathing • Circulation • Transport decision • If delivery is imminent, prepare to deliver at the scene. • If delivery is not imminent, prepare the patient for transport.

  17. History Taking • Obtain a thorough obstetric history: • Her expected due date • Any complications that she is aware of • If she has been receiving prenatal care • Her thorough medical history

  18. Physical Exam • Assess the major body systems. • Assess for fetal movement. • For a pregnant patient in labor, focus on contractions and possible delivery. • If you suspect that delivery is imminent, check for crowning.

  19. Vital Signs • Include pulse; respirations; skin color, temperature, and condition; and BP • Pay attention to tachycardia and hypotension or hypertension. • Hypertension, even mildly elevated BP, may indicate more serious problems.

  20. Stages of Labor • First Stage – dilation • Begins with first uterine contraction and ends when the cervix is completely dilated. • “Bloody” show. • Rupture of amniotic sac. • Contractions increase in frequency and intensity. • May last longer for woman having first child.

  21. Stages of Labor • Second Stage – Expulsion • Begins with complete cervical dilation and ends with delivery of the baby. • Contractions are close together and last longer. • Mother has urge to “push.” • Perineum may tear. • Crowning.

  22. Stages of Labor • Third stage – placental • Begins once the baby is delivered and ends when the placenta is expelled. • Placenta typically delivered 5 to 20 minutes after the baby. • Gush of blood. • Uterus becomes smaller. • Umbilical cord lengthens. • Maternal urge to push.

  23. Preparing for Delivery • Consider delivering the infant at the scene when: • Delivery can be expected within a few minutes • A natural disaster, inclement weather, or other environmental factor makes it impossible to reach the hospital

  24. Preparing for Delivery • To determine if delivery is imminent, ask the patient: • How long have you been pregnant? • When are you due? • Is this your first baby? • Are you having contractions? • How far apart? • How long do they last?

  25. Preparing for Delivery • To determine if delivery is imminent, ask the patient (cont.): • Do you feel as though you will have a bowel movement? • Have you had spotting or bleeding? • Has your water broken? • Were any of your previous children delivered by cesarean section?

  26. Preparing for Delivery • Delivery can probably be expected within a few minutes, if the following signs and symptoms are present: • Crowning has occurred. • Contractions are 2 minutes apart or closer, and they are intense and last from 60 to 90 seconds. • The patient feels the infant’s head moving down the birth canal (sensation of the urge to defecate). • The patient has a strong urge to push. • The patient’s abdomen is very hard.

  27. Preparing for Delivery • To help determine potential complications, ask: • Have you had problems in a previous pregnancy? • Do you use drugs, drink alcohol, or take any medications? • Is there a chance of multiple birth? • Does your doctor expect complications?

  28. Preparing for Delivery • If the patient has delivered before, she may be able to tell you whether she is about to deliver. • If she has an extremely firm abdomen or feels the need to push, the infant’s head is probably pressing on the rectum. • Visually inspect the vagina to check for crowning.

  29. Preparing for Delivery • Use proper BSI. • Act calm and reassuring. • Prepare OB kit. • Push away or remove mother’s clothing while preserving modesty. • Place the mother in a semi-Fowler’s position. • Pad under and around the mother’s hips (raise hips approximately 4” with padding)

  30. Delivering the Baby • Support the head as it emerges, using caution not to push on soft area of scalp. • Once the head emerges, determine if the umbilical cord is around the infant’s neck (nuchal cord). • If it is, use two fingers to slip the cord over the infant’s shoulder. If you cannot move the cord, place two clamps 2 to 3 inches apart and cut between the clamps. Remove the cord from around the neck. • Suction airway with bulb suction, always suction mouth first then nose.

  31. Suction the Airway

  32. Delivering the Baby • Support the head and upper body as the shoulders deliver. • Handle the infant firmly but gently as the body is delivered. • Suction airway again.

  33. WARNING • Guide the baby in the delivery • Never pull!!!

  34. Shoulder Delivery

  35. Shoulder Delivery

  36. Post Delivery Care • Dry off the infant and wrap in a blanket or towel. • Place the infant on one side, with the head slightly lower than the rest of the body. • Wrap the infant so only the face is exposed. • Keep the blanket or towel warm.

  37. Post Delivery Care • Clamp and cut the umbilical cord • Place clamps 2-3 inches apart, first one approximately 7 inches from baby. • Wait until pulsation stops, then cut with sterile scissors. • Monitor end for bleeding, if bleeding occurs place another clamp proximal to the initial clamp.

  38. Clamp and Cut the Cord

  39. Post Delivery Care • Delivery of the placenta • Placenta is attached to the end of the umbilical cord. • It should deliver within 30 minutes. • Never pull on the umbilical cord. • Once it delivers, wrap the placenta and take to the hospital so it can be examined. • If the mother continues to bleed, transport promptly to the hospital, and massage the uterus to stimulate contractions.

  40. Delivery of Placenta

  41. Post Delivery Care • Record the time of birth in your patient care report. • The following are emergency situations: • More than 30 minutes elapse, and the placenta has not delivered • There is more than 500 mL of bleeding before delivery of the placenta. • There is significant bleeding after the delivery of the placenta.

  42. Neonatal Evaluation and Resuscitation • Perform APGAR Score at 1 minute and 5 minutes after birth • Newborns should begin breathing spontaneously within 15-30 seconds after birth • Heart rate should be ≥ 120 beats / minute

  43. APGAR Score

  44. Neonatal Evaluation and Resuscitation • Many infants require some form of stimulation, including: • Positioning the airway, drying, warming, suctioning, or tactile stimulation • Use the inverted pyramid concept

  45. Neonatal Resuscitation

  46. Neonatal Evaluation and Resuscitation • To maximize the effects of these measures, follow these tips: • Position the infant on the back with the head down and the neck slightly extended. • Suction the mouth and then the nose. • In addition to drying the head, back, and body with dry towels, rub the back and flick or slap the soles of the feet.

  47. Neonatal Evaluation and Resuscitation • Evaluate skin color: • If skin is pink or pink with peripheral cyanosis, monitor. • If skin is cyanotic throughout, administer supplemental OXYGEN by blow-by technique.

  48. Neonatal Evaluation and Resuscitation • Evaluate respirations • If respirations are adequate but cyanosis is present, administer supplemental oxygen by blow by technique. • If neonate is apneic or respirations are inadequate, ventilate with BVM and 100% oxygen at 40-60 breaths/minute. • Reassess every 30 seconds.

  49. Neonatal Evaluation and Resuscitation • Evaluate the heart rate at the base of the umbilical cord or the brachial artery. • If the heart rate is > 100, initiate transport keeping infant warm and re-assess frequently • If the heart rate is 60-100, begin assisted respirations with a bag mask device and 100% oxygen • Reassess every 30 seconds until heart rate and respirations are normal

More Related