Emergency Medical Responder First on Scene TENTH EDITION

Emergency Medical Responder First on Scene TENTH EDITION CHAPTER 23 Care During Pregnancy and Childbirth Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 1. Define the following terms: a. b. c. d. e. f. g. Amniotic fluid Amniotic sac Birth canal Bloody show Breech birth Cervix Crowning continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 1. Define the following terms: h. Eclampsia i. Ectopic pregnancy j. Fallopian tube k. Fontanel l. Full term m. Imminent delivery n. Labor o. Meconium Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron continued on next slide Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 1. Define the following terms: p. Miscarriage q. Newborn r. Nuchal cord s. Ovary t. Ovum u. Placenta v. Placenta previa w. Pre-eclampsia Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron continued on next slide Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 1. Define the following terms: x. Prenatal care y. Prolapsed cord z. Spotting aa. Supine hypotensive syndrome bb. Trimester cc. Umbilical cord dd. Uterus ee. Vagina Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron continued on next slide Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 2. Describe the function of the following anatomy related to childbirth: amniotic sac, birth canal, cervix, placenta, umbilical cord, and uterus. 3. Describe three stages of labor and when each begins and ends. 4. Describe the signs of an imminent delivery. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 5. Explain the steps for preparing for a field delivery. 6. Explain the steps for assisting with a field delivery. 7. Explain the purpose of each of the items in a typical field obstetrics (OB) kit. 8. Explain the priorities of care for the newborn following a field delivery. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 9. Explain the priorities of care for the mother following a field delivery. 10. Explain the common causes of vaginal bleeding during the first trimester. 11. Explain the common causes of vaginal bleeding during the third trimester. 12. Explain the appropriate care for a pregnant patient with vaginal bleeding. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 13. Describe the signs and symptoms of supine hypotensive syndrome. 14. Explain the appropriate care for a patient with signs and symptoms of supine hypotensive syndrome. 15. Describe the signs and symptoms of preeclampsia. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 16. Explain the appropriate care for a patient with signs and symptoms of preeclampsia. 17. Explain the common complications related to a field delivery and how to properly care for each. 18. Demonstrate the ability to identify the signs of an imminent delivery. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 19. Demonstrate the steps for preparing for and assisting with a field delivery. 20. Demonstrate the proper care of the infant following a field delivery. 21. Demonstrate the proper care of the mother following a field delivery. 22. Demonstrate the ability to identify a complicated delivery. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Objectives 23. Demonstrate the proper assessment and care for a complicated field delivery. 24. Value the importance of proper body substance isolation (BSI) precautions when assisting with a field delivery. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Media Directory Slide Slide 17 28 29 30 50 51 53 59 Female Reproductive Anatomy Animation First Stage of Labor Video Second Stage of Labor Video Transition Stage of Labor Video Delivery with Vacuum Extraction Video Delivery with C-Section Video Apgar Scoring Video Placenta Delivery Video Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Topics Understanding Childbirth Delivery Complications and Emergencies Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

UNDERSTANDING CHILDBIRTH Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth cy oduced by the mother that holds baby during Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Female Reproductive System Animation Click on the screenshot to view an animation illustrating the anatomy of the female reproductive system. Back to Directory Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Anatomy of Pregnancy § Full term • Pregnancy achieved complete gestation of between 38 and 40 weeks § Trimester • Three months of pregnancy continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Anatomy of Pregnancy § Labor • Process body goes through to deliver fetus § Cervix • Opening of uterus Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 1 Anatomy of pregnancy. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Anatomy of Pregnancy § Bloody show • Normal discharge of bloody mucus prior to delivery § Vagina • Birth canal § Crowning • Showing of baby's head at opening of vagina continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Anatomy of Pregnancy § Imminent delivery • Delivery that is likely to occur within a few minutes § Amniotic sac • Fluid-filled sac that surrounds developing fetus continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Anatomy of Pregnancy § Rupture of membranes • Sac breaks during labor. • Fluid flows out of vagina. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Anatomy of Pregnancy § Placenta • Organ of pregnancy that serves as filter between mother and developing fetus § Umbilical cord • Structure that connects baby to placenta Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Stages of Labor § First stage • Begins with onset of regular contractions and ends when cervix is fully dilated allowing baby to enter birth canal § Second stage • Begins when baby enters birth canal and ends when born continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Stages of Labor § Third stage • Begins when baby is born and ends when placenta (afterbirth) delivered Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 2 Stages of labor. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

First Stage of Labor Video Click on the screenshot to view a video on the topic of the first stage of labor. Back to Directory Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Second Stage of Labor Video Click on the screenshot to view a video on the topic of the second stage of labor. Back to Directory Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Transition Stage of Labor Video Click on the screenshot to view a video on the topic of the transition stage of labor. Back to Directory Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Stages of Labor § Contraction time • Span of time from beginning of contraction until it relaxes § Interval time • Span of time from start of one contraction to beginning of next contraction continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Stages of Labor § Braxton Hicks contractions • False labor • Not as regular and rhythmic as true labor contractions Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 3 Measure the contraction intervals by counting from the beginning of one contraction to the beginning of the next contraction. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Supplies and Materials § § § Personal protective equipment Towels, sheets, blankets Gauze pads Rubber bulb syringe Clamps and ties continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Understanding Childbirth • Supplies and Materials § § Sterile scissors or single-edged razor Sanitary pads or bulky dressings Basin and plastic bags Red, plastic biohazard bags Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 4 Contents of a commercial obstetric (OB) kit. All items are disposable. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Think About It • You respond to the home of a young couple expecting their first child. They had planned to deliver at home, but grew nervous when the pain of labor became too strong. • What questions will you include in your assessment? • How will you proceed? Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

DELIVERY Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 5 Algorithm for assisting a mother in a normal delivery. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Preparing for Delivery Wear PPE. EMS activated Encourage patient to remain lying down. Place clean sheets or towels under buttocks. § Obtain medical history of pregnancy. § § continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Preparing for Delivery § If mother is having contractions two minutes apart or less, delivery is imminent. § Find out if she has taken a childbirth preparation class. § Control scene so mother has privacy. § Position mother on back with knees bent, feet flat, legs spread wide apart. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Preparing for Delivery § § Feel abdomen for contractions. Prepare mother for examination. Check for crowning. DO NOT attempt any type of internal or vaginal exam. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 6 Algorithm for an imminent delivery. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Normal Delivery § Crowning evident as head emerges from vagina. § Use both hands to support head as it delivers. § Check neck for umbilical cord. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Normal Delivery § Guide baby's head downward to facilitate delivery of top shoulder. § Use both hands to support baby following delivery. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

23. 1. 1 Crowning is evident as the head emerges from the vagina. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

23. 1. 2 Use both hands to support the head as it delivers, and check the neck for presence of the umbilical (nuchal) cord. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

23. 1. 3 Guide the baby’s head downward to facilitate delivery of the top shoulder. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

23. 1. 4 Use both hands to support the baby following delivery. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery with Vacuum Extraction Video Click on the screenshot to view a video on the topic of childbirth delivery and vacuum extraction. Back to Directory Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery with C-Section Video Click on the screenshot to view a video on the topic of childbirth delivery by c-section. Back to Directory Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Normal Delivery Dry baby and cover to conserve heat. Clamp cord in preparation for cutting. Cut cord between the clamps. Assess APGAR score at 1 minute and 5 minutes. § Expect delivery of placenta 20 to 30 minutes following delivery of baby. § § Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Apgar Scoring Video Click on the screenshot to view a video on the topic of Apgar scoring after childbirth. Back to Directory Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

23. 1. 5 Carefully dry the baby, and cover him to conserve heat. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

23. 1. 6 Assess breathing and pulse rate for the newborn. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

23. 1. 7 Once the cord has stopped pulsating, clamp it in preparation for cutting. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

23. 1. 8 Cut the cord between the clamps. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

23. 1. 9 Expect delivery of the placenta within 20 to 30 minutes following the delivery of the baby. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Placenta Delivery Video Click on the screenshot to view a video on the topic of delivering the placenta. Back to Directory Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Caring for the Baby § § § Clear baby's airway. Make certain baby is breathing. Perform quick assessment. Clamp or tie off cord if protocols allow. Keep baby warm. Place paper bracelet loosely around baby's wrist. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 7 Algorithm for assessment of the newborn. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 8 and nose. Use a sterile pad or clean handkerchief to wipe blood and mucus from around the baby’s mouth Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 9 It may be necessary to stimulate the newly born baby to breathe. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Caring for the Nonbreathing Newborn § Provide rescue breaths. § Do not use bag-mask device or airway adjuncts designed for older children or adults. § Be careful not to hyperextend head and neck of baby. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Table 23. 1 Care for the Nonbreathing Newborn Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 10 Resuscitate the newly born baby with a bag-mask resuscitator that is an appropriate size. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Caring for the Non-breathing Newborn § Blow-by oxygen • Holding mask or cup several inches from baby's face. • Do not blow a stream of oxygen directly into baby's face. § Withholding oxygen may be more damaging than delivering too much. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 12 Use an oxygen face mask or similar object attached to oxygen, and hold it near the baby’s face to supply blow-by oxygen. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Umbilical Cord § Use sterile clamps or umbilical ties. § Apply one tie or clamp to cord about six inches from baby's abdomen. § Place second tie or clamp about two inches farther from baby. § Cut between two ties or clamps. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 13 Cutting the umbilical cord. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Delivery • Caring for the Mother § Deliver placenta and birth tissues. § Control vaginal bleeding by gently but firmly massaging from the pubis bone at the front of the pelvis upward only toward the navel. § Make her as comfortable as possible. § Provide reassurance. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Think About It • You respond to a home and find a 32 year-old female seated on the side of her bed. Her husband states that she awoke with intense labor pains and "her water broke. " This is her third child and her contractions are two minutes apart. • How will you proceed? Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

COMPLICATIONS AND EMERGENCIES Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Complications § § § Abnormal bleeding Miscarriage Breech delivery Premature delivery Multiple births Stillbirths Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Risk of Complications § Younger than 18 years old or older than 35 § First pregnancy or more than five pregnancies § Swollen face, feet, abdomen from water retention § High or low blood pressure § Diabetes continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Risk of Complications § § § § Illicit drug use during pregnancy History of seizures Predelivery bleeding Infections Alcohol dependency Injuries from trauma Premature rupture of membranes Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Pre-delivery Emergencies § Miscarriage • Spontaneous natural loss of embryo or fetus before the twenty-eighth week. § Spotting • Normal discharge of blood during pregnancy continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Pre-delivery Emergencies § Ectopic pregnancy • When fertilized egg implants somewhere other than uterus Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 15 Position the patient to control excessive prebirth bleeding. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Emergency Care of Pre-birth Bleeding § § § Make sure the ambulance is on the way. Take BSI precautions. Place patient on her left side. Provide for shock. Monitor the airway. Administer oxygen per local protocol. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Emergency Care of Pre-birth Bleeding § Place a sanitary pad or bulky dressing over vaginal open. • Replace as needed. § Save all blood soaked pads and any fetal tissue in a biohazard bag for transport. § Monitor and reassure the patient while you wait for EMT or ALS personnel. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 16 Algorithm for complications of childbirth. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Complications During Delivery § Meconium staining • Product of baby's first bowel movement • Inhalation of this fluid on first attempt to breathe may lead to aspiration pneumonia. § Breech birth • Buttocks or feet deliver first. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 17 Create and maintain an airway for the baby during a breech birth. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Complications During Delivery § Limb presentation • Presentation of arm or single leg § Prolapsed cord • Delivery of umbilical cord prior to delivery of baby • Compression of the cord obstructs oxygen flow. • Place wet dressings over the cord. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Figure 23. 18 Place the mother in the knee-chest position, which will help keep pressure off the umbilical cord in a limb-presentation birth. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Complications During Delivery § Multiple births • Not necessarily abnormal • Frequently involve premature delivery § Premature births • Any baby weighing less than 5. 5 pounds at birth or born before thirty-seventh week continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Complications During Delivery § Stillborn • Fetus that is delivered dead Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Other Emergencies § Supine hypotensive syndrome • Abnormally low blood pressure that results when mother is supine and fetus puts pressure on vena cava § Preeclampsia • Potentially life-threatening condition that affects mother during third trimester • Characterized by high blood pressure and fluid retention continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Other Emergencies § Eclampsia • Life-threatening condition characterized by seizures, coma, eventually death of both mother and baby continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Other Emergencies § Trauma • Vital signs of a pregnant woman are different from woman who is not pregnant. • Heart rate normally increased by about 15 beats per minute • Blood pressure normally 10 to 15 mm. Hg lower continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Other Emergencies § A pregnant woman can lose almost 40 percent of her blood volume before shows any signs of shock. § Blunt-force injuries • Common in falls, vehicle crashes, abuse, assaults continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Other Emergencies § Penetrating injuries • Result of gunshot wounds and stabbings or punctures from debris of auto wreckage continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Other Emergencies § Vaginal bleeding • • • Blunt force and penetrating trauma Intercourse Sexual assault Reproductive organ problems Abnormal pregnancy Placental tears and uterine rupture continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Other Emergencies § Placenta previa • Placenta grows and develops over cervix. § Placenta abruptio • Can occur in trauma situation when force of trauma abruptly tears placenta partially or completely away from wall of uterus. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Complications and Emergencies • Other Emergencies § Sexual assault or rape is a psychologically and physically traumatic experience. § Fetus is also victim in the assault. § Injuries that the fetus receives may be direct from blows to abdomen, or indirect as result of injuries to mother. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Think About It • You respond to an apartment to find a 17 -year-old female presenting with intense contractions and a prolapsed umbilical cord. You update EMS, but the ambulance is delayed due to a snowstorm. • What steps must you take while awaiting transport? Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

SUMMARY Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Summary • Normal gestation period for a human fetus is 40 weeks, or approximately nine months. • Infant considered premature if delivered prior to thirty-seventh week of gestation continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Summary • Labor is a normal process the body uses to deliver a baby. • Average labor is 16 hours. § Can be much shorter or much longer • Labor has three stages. § First begins with onset of labor and ends with full dilation of cervix. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Summary • Labor has three stages. § Second stage begins with dilation of cervix and ends with delivery of baby. § Third stage begins after delivery of baby and ends with delivery of placenta. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Summary • Signs of imminent delivery § Contractions are two to three minutes apart. § Mother has urge to push. § Crowning at vaginal opening • When signs of imminent delivery are obvious, prepare for delivery at the scene. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Summary • Upon delivery of head, check for umbilical cord around neck. • If present, gently slip it over baby's head. • Suction mouth first then nose prior to delivery of baby. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Summary • After delivery, stimulate baby by drying with clean dry cloth. • Baby should begin breathing on own. § If breathing or pulse is inadequate, provide appropriate care immediately. continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Summary • Immediately call for ALS back up for any delivery that appears abnormal or complicated, such as breech presentation or prolapsed cord. • Place mother in knee-chest position and provide high-flow oxygen if available. • Follow local protocols. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

REVIEW QUESTIONS Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Review Questions 1. Describe the function of the following: a. b. c. d. Amniotic sac Birth canal and cervix Placenta and uterus Umbilical cord 2. What is the purpose of each of the items in a typical field obstetrics (OB) kit? continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Review Questions 3. What are three stages of labor and when do each begin and end? 4. What are the signs of an imminent delivery? 5. What are the steps for preparing and assisting with a field delivery? 6. What are the priorities of care for the newborn following a field delivery? continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Review Questions 7. What are the priorities of care for the mother following a field delivery? 8. What are the common complications related to a field delivery and how would you properly care for each? 9. What are the common causes of vaginal bleeding during the first trimester? continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Review Questions 10. What are the common causes of vaginal bleeding during the third trimester? 11. What is the appropriate care for a pregnant patient with vaginal bleeding? 12. What are the signs and symptoms of supine hypotensive syndrome? continued on next slide Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Review Questions 13. What is the appropriate care for a patient with signs and symptoms of supine hypotensive syndrome? 14. What are the signs and symptoms of preeclampsia? 15. What is the appropriate care for a patient with signs and symptoms of preeclampsia? Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved

Please visit www. bradybooks. com and follow the Resource Central links to access content for this text. Emergency Medical Responder: First on Scene, 10/e Christopher J. Le Baudour | J. David Bergeron Copyright © 2016, 2011, 2009 by Pearson Education, Inc. All Rights Reserved