O. B., Oh, My! Obstetric Emergencies for Prehospital

Providers

O. B., Oh, My! Obstetric Emergencies for

Prehospital Providers

Daniel W. Linkins, BHS, NRP, NCEE EMS Program Director & Dept. Chair John Tyler Community College

Stages of Prenatal Development

The Preembryonic Period (Weeks 0-3) The Embryonic Period (Weeks 4-7) The Fetal Period (Week 8-delivery)

Duration of Pregnancy

Approximately 38 wks. from the date of ovulation.

Typically divided into 3-month trimesters

Hormone-Related Conditions Associated with Pregnancy

Nausea & Vomiting early in Pregnancy Hyperemesis Gravidarum Gestational Diabetes

Spontaneous Abortion Miscarriage

Ectopic Pregnancies

Pregnancy Subsequent to Failure of Artificial Contraception

Failure of the pill Failure of intrauterine device

Abnormal Attachment of Umbilical Cord and Placenta

Velamentous Insertion of Umbilical Cord Placenta Previa Abruptio Placentae

Twins & Multiple Pregnancies

Twins comprise 1% of pregnancies Triplets comprise .01% (1/10,000) Quadruplets, quintuplets, and sextuplets are

very rare, and are generally caused by fertility treatments

Twins & Multiple Pregnancies

Twins & Multiple Pregnancies

Trauma in Pregnancy

Supine Hypotensive Syndrome

Usually occurs during third trimester Also known as vena caval syndrome Occurs when gravid uterus compresses the inferior

vena cava Generally only after patient has been supine for

extended period of time. May complain of dizziness Management includes placing patient in lateral

recumbent position, or elevating her right hip. If immobilized, tilt backboard 15-20 degrees to the left.

Bleeding in Pregnancy

Medical Conditions During Pregnancy

Appendicitis Cholecystitis Dissecting Aortic Aneurysm

Preeclampsia & Eclampsia: Toxemia of Pregnancy

Chronic Hypertension

Transient Hypertension

Hemolytic Disease of Newborn

Braxton-Hicks Contractions

The Puerperium

The time period around the birth of the newborn

Labor

The process of delivery, during which the fetus, placenta, and amniotic sac are passed through the birth canal.

3 Stages Dilatation stage Expulsion State Placental Stage

Management of a patient in labor

Factors to consider when determining whether to transport or deliver: Number of pregnancies Frequency of contractions Urge to push Presence of crowning Fetal presentation

Field Delivery

Neonatal Care

Routine Care and APGAR Scoring Maintain warmth!!! Protect airway Drying and suctioning should stimulate breathing Assess frequently:

Respirations should be 30-60 per minute HR should be 100-180 beats per minute

APGAR Scoring Created by Dr. Virginia Apgar Should be performed at 1min and 5min. After delivery

Neonatal Resuscitation

Complications from Substance Abuse

Low Birth Weight Preterm labor/delivery Fetal Alcohol Syndrome Neonatal Abstinence Syndrome

1-3 days after birth Symptoms include mottled skin, diarrhea, excessive

crying, fever, hyperactive reflexes, low weight gain, diaphresis, vomiting, tremors

Abnormal Deliveries Field Deliverable

Pre-term Labor Breech Birth Multiple Births Precipitous delivery Meconium Staining Shoulder Distocia

Not Field-Deliverable

Prolapsed Cord Limb Presentation Cephalopelvic Disproportion

Post Delivery Care of the Mother

Dealing with Hemorrhage Uterine Rupture Complications with substance abuse Uterine Inversion Pulmonary Embolism

Morving and Transporting the OB or Post-delivery Patient

Ambulating patients Transport concerns

References Byer/Shainberg/Galliano. Dimensions of Human Sexuality. 5e. 1999.

The McGraw-Hill Companies, Inc. Crowley, Leonard V. Introduction to Human Disease. 8e. P. 437-472.

2010. Sudbury, MA. Jones and Bartlett Publishers. http://nursingcrib.com/case-study/placenta-accreta-increta-

pancreta Amnion: six weeks. Art. Encyclopdia Britannica Online. Web. 22

Feb. 2011. .

http://dbpedia.org/page/Vanishing_twin http://maternity-newborn-nursing.blogspot.com/2008/12/supine-

hypotensive-syndrome.html http://www.neonatology.org/classics/hess1922/hess.17.html

http://nursingcrib.com/case-study/placenta-accreta-increta-pancretahttp://nursingcrib.com/case-study/placenta-accreta-increta-pancretahttp://www.britannica.com/EBchecked/media/2923/Development-of-the-human-embryohttp://www.britannica.com/EBchecked/media/2923/Development-of-the-human-embryohttp://dbpedia.org/page/Vanishing_twinhttp://maternity-newborn-nursing.blogspot.com/2008/12/supine-hypotensive-syndrome.htmlhttp://maternity-newborn-nursing.blogspot.com/2008/12/supine-hypotensive-syndrome.html

O. B., Oh, My!Obstetric Emergencies for Prehospital ProvidersO. B., Oh, My!Obstetric Emergencies for Prehospital ProvidersStages of Prenatal DevelopmentDuration of PregnancyHormone-Related Conditions Associated with PregnancySpontaneous Abortion MiscarriageEctopic PregnanciesPregnancy Subsequent to Failure of Artificial ContraceptionAbnormal Attachment of Umbilical Cord and PlacentaTwins & Multiple PregnanciesTwins & Multiple PregnanciesTwins & Multiple PregnanciesTrauma in PregnancySupine Hypotensive SyndromeBleeding in PregnancyMedical Conditions During PregnancyPreeclampsia & Eclampsia: Toxemia of PregnancyChronic HypertensionTransient HypertensionHemolytic Disease of NewbornBraxton-Hicks ContractionsThe PuerperiumLaborManagement of a patient in laborField DeliveryNeonatal CareNeonatal ResuscitationComplications from Substance AbuseAbnormal DeliveriesPost Delivery Care of the MotherMorving and Transporting the OB or Post-delivery PatientReferences