Chapter 22

Childbirth and Gynecologic Emergencies

Childbirth and Gynecologic Emergencies of Pregnancy

• Birth canal: vagina, lower part of uterus• Cervix: opening at lower end of uterus• Placenta: organ through which mother and

fetus exchange nourishment and waste

• Umbilical cord: extension of placenta• Amniotic sac: bag of water surrounding

fetus• Crowning: fetus’s head bulges out of

vaginal opening

Childbirth and Gynecologic Emergencies of Pregnancy

• Bloody show: mucus and blood discharged during labor

• Labor: process of childbirth• Miscarriage: delivery of fetus before it can

live independently of mother

Childbirth and Gynecologic Emergencies of Pregnancy

Predelivery Emergencies

• Miscarriage− Usually occurs in first trimester− Most occur because fetus was not developing

properly.

Miscarriage: What to Look For

• Cramping in lower abdomen• Aching in lower back• Vaginal bleeding

− Could be sudden and heavy• Passage of tissue from vagina

Miscarriage: What to do

• Reassure the woman.• Help into comfortable position.• Have her place sanitary pad over the

outside of the vagina.• Transport expelled tissue to hospital.• Seek medical care or call 9-1-1.

Vaginal Bleeding During Pregnancy

• Vaginal bleeding in the third trimester constitutes an emergency.

• Things to check for:− Extent of bleeding− Pulse rate− Female first aid provider

Vaginal Bleeding During Pregnancy: What to Look For

• Mild spotting• Heavy bleeding• Signs of shock

Vaginal Bleeding During Pregnancy: What to Do

• Place woman on left side.• Have her place sanitary pad over the

outside of the vagina.• Call 9-1-1.• Treat for shock.

Vaginal Bleeding Caused by Injury: What to Look For

• Injuries of external genitalia• Severe pain• Bleeding in vaginal area• Massive vaginal bleeding

Vaginal Bleeding Caused by Injury: What to Do

• Place direct pressure over dressing.• Apply ice.• Do not place dressings inside vagina.• Place person on left side.• If sexual assault, explain need for

evidence preservation.• Seek medical care.

Non–Injury-Related Vaginal Bleeding

• Most likely to be menstrual• Can indicate more serious conditions

− Childbirth− Miscarriage− Infection

Non–Injury-Related Vaginal Bleeding: What to Look For

• Abdominal cramps• Blood in vaginal area

Non–Injury-Related Vaginal Bleeding: What to Do

• Reassure person.• Help her into comfortable position with

legs bent.• Have woman place sanitary pad over the

outside of vagina.• Seek medical care.

Imminent Delivery

• Only transport if:− No urge to push or crowning− First pregnancy

• Have woman wear both lap and shoulder seat belts.

• If necessary, have her lie on left side.

Imminent Delivery

• No time to transport if:− Crowning or urge to push− Not a first pregnancy

• Call 9-1-1.• Prepare a private, clean area.

Emergency Delivery

• Wear exam gloves.• Do not touch vaginal area.• Do not allow the mother to use the toilet.• Do not hold woman’s legs together.

Emergency Delivery

• If head does not present first:− It is a complicated delivery.− Tell woman to stop pushing.− Call 9-1-1.

Stages of Labor

• First stage− Starts at first contraction− Lasts several hours− Cervix stretches.− Contractions increase in

frequency and intensity.− Amniotic sac bursts at end of stage.

© Jones & Bartlett Learning.

Stages of Labor

• Second stage− 30 minutes to 2 hours− Cervix is fully dilated.− Baby’s head passes through pelvis and rest of

body follows

© Jones & Bartlett Learning.

Stages of Labor

• Third stage− Afterbirth− 15 minutes or more− Placenta is expelled

© Jones & Bartlett Learning.

Imminent Delivery: What to Look For

• Woman has had a baby before• Contractions less than 2 minutes apart• Amniotic sac ruptured• Mother feels like she must move her

bowels

Imminent Delivery: What to Do

• Wash hands and wear exam gloves.• Have mother lie in acceptable position.• Remind woman to take:

− Short, quick breaths during contractions− Deep breaths between contractions

• Place absorbent, clean materials under buttocks.

Imminent Delivery: What to Do

• When head appears:− Place palm over head; apply slight pressure.− Have woman stop pushing.− Do not push on fontanelles.

• If amniotic sac does not break, tear with fingers and push away from baby’s head and mouth.

Imminent Delivery: What to Do

• Check for umbilical cord wrapped around neck.

• Support head.• Suction mouth and

nostrils.© University of Maryland Shock Trauma Center/MIEMSS.

Imminent Delivery: What to Do

• Support body as baby emerges.

• Do not pull on head or touch armpits.

• Keep baby level with vagina.

© University of Maryland Shock Trauma Center/MIEMSS.

© University of Maryland Shock Trauma Center/MIEMSS.

Imminent Delivery: What to Do

• Wipe blood and mucus from mouth and nose.

• Dry infant and stimulate breathing.− If baby does not

breathe in 30 seconds, begin CPR. © University of Maryland Shock Trauma Center/MIEMSS.

Imminent Delivery: What to Do

• Wrap infant, place on side, keep level with vagina.

• Tie the umbilical cord.• Cutting the cord

− No need to cut if transporting to hospital.

Imminent Delivery: What to Do

• Watch for placenta.− Wrap in towel with

three quarters of umbilical cord.

• Place sterile pad over vaginal opening.

• Gently massage abdomen.

© University of Maryland Shock Trauma Center/MIEMSS.

Delivery Aftercare

• Monitor mother’s breathing and pulse.• Replace sheets and blankets.• If blood loss continues, massage uterus.• Encourage mother to breastfeed.

Initial Care of the Newborn

• Monitor breathing and pulse.• Keep infant warm, dry, comfortable.• If newborn is motionless:

− Tap bottom of foot or shoulder.− Perform CPR if unresponsive, not breathing,

or gasping.

Prolapsed Cord: What to Look For

• Umbilical cord seen before head

© Jones & Bartlett Learning.

Prolapsed Cord: What to Do

• Raise mother’s buttocks.• Insert gloved fingers into vagina on either

side of cord.− Do not push cord into vagina.

• Call 9-1-1.

Breech Birth Presentation: What to Look For

• Baby’s buttocks emerge first.

© Jones & Bartlett Learning.

Breech Birth Presentation: What to Do

• Place hand in vagina.• Form a V with fingers on either side of

baby’s nose.• Push vaginal wall away from face.• Call 9-1-1.• Have woman continue to push.

Limb Presentation

• What to look for− Arm, leg, or foot

emerges first.• What to do

− Position woman with head down and pelvis elevated.

− Call 9-1-1 immediately.© Jones & Bartlett Learning.

Meconium: What to Look For

• Baby’s first feces in amniotic fluid• May cause distress and respiratory

problems if breathed into lungs• Green or brown-yellow amniotic fluid,

almost odorless

Meconium: What to Do

• Keep infant in moderately head-down position.

• Suction mouth and nostrils.• Keep baby’s airway open.• Call 9-1-1.

Premature Birth: What to Look For

• Birth before 37th week of gestation• Smaller and thinner infant• Proportionately larger head• Cheesy, white coating on skin is minimal

or absent

Premature Birth: What to Do

• Keep warm.• Keep mouth and nose clear of mucus.• Monitor breathing.• Perform CPR if necessary.

Gynecologic Emergencies

• Reproductive system problems that occur in nonpregnant women

Sexual Assault and Rape

• Rape− Criminal act of forcing another person to

submit to sexual intercourse− Physical injury and psychological trauma are

common.

Sexual Assault and Rape: What to Look For

• Headaches• Sleeplessness, nightmares• Nausea, muscle spasms• Confusion• Depression• Anxiety, jumpiness

Sexual Assault and Rape: What to Do

• Do not ask a lot of questions.• Do not blame; be supportive.• Determine which injuries require care.• Do not expose genitalia unless injury

requires immediate care.• Try to preserve evidence.

Sexual Assault and Rape: What to Do

• If person refuses aid:− Have a friend stay with the person.− Protect the person’s privacy.− Provide contact of local rape crisis center.

• Get person to medical care.