Obstetrics and Gynecology Emergencies
Course
Practicum in
Health ScienceEMT
Rationale
Though most childbirth is uncomplicated, EMS is often called to attend various
situations that involve complications and unforeseen events with pregnant
women and female patients.
Unit
Obstetrics and
Gynecology
Emergencies
Objectives
Upon completion of this lesson, the student will be able to:
 Adapt the basics of patient assessment and care for special
populations
 Differentiate between the major organs of the female reproductive
system
 Recognize disorders of pregnancy
 Describe a normal and complicated birth process
 Describe the care of normal newborn
 Recall the resuscitation needs of newborn
 Respond to gynecological emergencies
Essential
Question
How do you
evaluate and
prepare a mom
for delivery?
TEKS
§130.205(c)
(1)(A)(B)(C)(D)
(E)(F)(G)
(2)(A(B(C)
(3)(A)
(5)(A)
(6)(A)(D)
(7)(A)(C)
(8)(A)(B)(C)(D)
Prior Student
Learning
Anatomy &
Physiology,
Medical Patient
Assessment.
Estimated time
5 days
Engage
Tell students that most child births occur in the controlled environment of the
hospital. If EMS has been called something has occurred that was not
foreseen or predicted. Understanding the female anatomy, the process of
childbirth, various complications that can occur during child birth and neonatal
resuscitation will prepare you to bring a life into the world which is often in vast
contrast with what EMTs typically experience.
Discuss the following:
What are the steps to be taken to assist with a normal field delivery?
Key Points
I. Female reproductive anatomy and physiology, (see Reproductive
System Lesson Plan)
A. A woman’s external genitalia consist of three major structures: the
labia, the perineum, and the mons pubis.
B. The vagina is the birth canal made up of smooth muscle. It connects
the uterus to the outside world.
C. Ovaries are small round organs located on either side of most women’s
lower abdominal quadrants. Fallopian tubes are also called oviducts.
They connect to the uterus.
D. The monthly reproductive cycle produces predictable changes to the
reproductive organs in anticipation of fetal implantation and
development. If fertilization does not occur, the reproductive cycle ends
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with menses.
E. The embryonic stage occurs roughly from the point of fertilization
through the first 8 weeks of pregnancy. From this point until delivery,
the developing baby is referred to as the fetus, which will develop over
the next 32 weeks (a typical pregnancy lasts about 40 weeks).
II. Physiologic Changes during Pregnancy
A. A growing fetus creates massive changes to the reproductive system.
Most important, the uterus gets larger. Pregnancy increases oxygen
demand, increases maternal blood volume, puts pressure on the GI
system, and causes ligaments to stretch.
B. Supine hypotensive syndrome causes late-term pregnant females’
blood pressure to drop when they lie flat. EMTs can prevent this by
positioning them in a lateral recumbent position.
C. The development of the fetus has immediate physical effects on
neighboring body systems as well as making other systems in the body
work harder to sustain the growing fetus.
III. Labor and Delivery
Note to Teacher: Use multimedia graphics to illustrate the progression of
labor. Explain why the changes occur. Discuss how structures must
change to allow for delivery of the fetus. Discuss the stages of labor, using
real-life examples. Discuss how these stages might be recognizable from
assessment findings.
A. First stage of labor starts with regular contractions and thinning and
gradual dilation of the cervix. It ends with the cervix fully dilated. This
occurs over several days or weeks and leads to Braxton-Hicks
contractions, which are usually irregular and not sustained. In actual
labor, the uterus will contract regularly and the cervix will dilate. As
this happens the fetus’s head moves downward. Contractions are
timed from the start of one contraction to the beginning of the next.
B. The second stage is when the EMT must make the decision to stay
on scene or to transport. It begins with full dilation of the cervix.
During this time contraction becomes more frequent and labor pains
more severe. As the baby’s head moves down, the mother will feel
the urge to push and move her bowels. This stage ends when the
baby is born.
C. Third stage begins after the baby is born. The placenta detaches
itself from the wall of the uterus and is expelled. The third stage
usually lasts 10–20 minutes and ends as the placenta is delivered.
D. Far from involving just the reproductive system, childbirth involves
the woman’s whole body. Not only is all her strength called for, but
her body undergoes massive change in a very short time.
E. The questions used in this assessment are additions to the
traditional patient assessment. Remind students not to forget the
primary and secondary assessments. There are no absolutes with
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birth. Remind students that findings only generally predict outcomes.
EMTs always should be prepared for surprises. Practice makes
perfect.
F. Assessment of the woman in labor is designed to predict imminent
delivery and to recognize likely resuscitation of the neonate.
G. Assessment can also help indicate the level of resources necessary
to deliver the baby.
H.
Assessing a woman in labor includes all of the elements of
traditional patient assessment including ABC’s as well as vital signs
and SAMPLE history. There are also a few elements specific to
pregnancy. The average time of labor for a woman having her first
baby is normally 16–17 hours.
I. Prenatal care is important in regard to being aware of medical
complications and multiple births.
J. The urge to push and crowning indicate imminent delivery. Transport
typically should be deferred to ready for a delivery on scene.
K. You should also ask the patient if she feels the need to move her
bowels.
L. Do not allow the mother to go to the bathroom even if she says she
has to. It is best to transport an expecting mother unless you expect
imminent delivery based on your evaluation.
M. The presenting part is defined as the part of the infant that is first to
appear at the vaginal opening during labor. Usually, the presenting
part of the baby is the head.
N. The normal head-first birth is called a cephalic presentation. If the
buttocks or both feet of the baby deliver first, the birth is called a
breech presentation or breech birth. If part of the baby’s head or
presenting part is visible with each contraction, then birth is
imminent.
O. A lack of prenatal care, premature labor, multiple gestation, and
underlying conditions indicate a likelihood of neonatal resuscitation.
P. The most important outcome of anticipating neonatal resuscitation is
getting help.
Q. Meconium staining is a sign of fetal distress.
R. Childbirth requires a high level of personal protective equipment.
S. Emotional support for the mother is important during childbirth.
T. Control the scene so the mother has privacy. (Her birthing coach
may remain.)
U. Proper PPE for you and your partner: surgical gloves, gowns, face
mask, and eye protection.
V. Place the mother on bed, floor, or ambulance stretcher and elevate
her buttocks with blanket or pillow.
W. You will need about 2 feet of workspace below the patient’s buttocks
to initially care for the newborn.
X. Remove any restrictive clothing.
Y. Drape the patient with sterile sheets or sterile towels.
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Z. Keep someone at the mother’s head to provide support, monitor vital
signs, and be alert for vomiting.
AA. Position your gloved hand over the mother’s vaginal opening when
the baby’s head starts to appear.
BB. Place one hand below the baby’s head as it delivers, remembering
the baby’s head has soft spots.
CC. A slight, well-distributed pressure may help prevent an explosive
delivery.
DD. Do not pull on the baby!
EE. If the amniotic sac has not ruptured by the time the baby’s head has
delivered, use your finger to puncture the membrane.
FF. Examine the fluid for meconium staining, which will be a green-black
or mustard yellow color.
GG.
Once the head delivers, check if the umbilical cord is around the
neck. While doing this, ask the mother to pant.
HH. If you are unable to slip the cord over the baby’s head, you will have
to cut it. Clamp the cord and be extremely careful as you cut
between the clamps.
II. As soon as the baby’s head is visible, support the head with one
hand. Wipe the mouth and nose with a gauze pad. Then suction the
mouth and nose with a bulb syringe. (Follow your local protocol.)
Compress the syringe prior to inserting it into the baby’s mouth and
insert 1–1½ inches.
JJ. The upper shoulder usually delivers with some delay, followed
quickly by the lower shoulder. Support the baby throughout this
process. Gently guide the baby’s head downward as the upper
shoulder delivers, then gently upward as the lower shoulder delivers.
KK. As the lower extremities are delivered, grasp them to have a good
hold on the baby.
LL. Once delivered, lay the baby on his side with head slightly lower
than the body to facilitate drainage of fluids from the mouth and
nose.
MM.
Keep the baby at the same level as the mother’s vagina until the
umbilical cord stops pulsating.
NN. Dry the infant and wrap in a warm, dry blanket. Note the exact time
of birth.
OO.
Write the mother’s last name and the time of birth on a piece of
tape, and attach tape to baby’s wrist. (Fold tape so adhesive does
not touch baby’s skin.)
IV. Neonate
Note to teacher: Invite an OB or neonatal intensive care unit (NICU) doctor
or nurse to review the steps of neonatal care.
A. Neonatal resuscitation is an infrequently used skill that requires
immediate action. Emphasize the need to learn and memorize the
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basic, immediate steps. Practice!
B. Neonate is the term used for a baby from birth to one month old. The
term infant is used for a baby in its first year of life.
C. A neonate should be assessed as soon as it’s born.
D. Pulse should be greater than 100/min. An Apgar score (appearance,
pulse, grimace, activity, respiratory effort) is done one minute after birth
and then again 5 minutes after birth.
E. The total Apgar score is done on a scale of 0–10.
F. The most important aspect of caring for a neonate is keeping the baby
warm.
G. Heat loss not only drops the neonate’s body temperature, but also
drops glucose levels.
H. Do not tie, clamp, or cut an umbilical cord on a baby who is not
breathing unless the cord is around the baby’s neck. Do not cut or
clamp a cord that is still pulsating. Apply one clamp or tie about 10
inches from the baby. This leaves enough cord for paramedics and
hospital staff to start IV lines.
I. Babies are passive throughout birth, but should quickly become active
(i.e., breathe), usually on their own. Stimulating babies ensures that
they will start breathing on their own.
J. Neonatal resuscitation begins with stimulating the baby. If no breathing
occurs, begin positive pressure ventilations.
K. Few neonates require CPR or ALS interventions.
L. The first steps in resuscitation are drying, warming, positioning to keep
the airway clear, suctioning, and tactile stimulation. Central cyanosis is
blue coloration of the torso. If the heart rate is below 100 beats per
minute, ventilations are provided at 40–60 per minute.
V. Care After Delivery
A. Emphasize that the mother may be the more serious patient. Postpartum hemorrhage can kill. Use previous discussions about shock to
describe the treatment of a hemorrhaging mother. Advise students that
uterine massage can be quite painful to the mother. Nonetheless, it is
necessary in the event of excessive hemorrhage.
B. After delivery, there are two patients to care for: the infant and the
mother. Although it is easy to make the baby the primary focus, there
are many risks of childbirth for the mother.
C. Typically it is not necessary to delay transport as the placenta is
delivered. EMTs should retain the delivered placenta for examination
at the hospital.
D. Avoid putting pressure on the abdomen over the uterus to hasten
delivery. If mother and baby are doing well, and there are no
respiratory problems or significant uncontrolled bleeding,
transportation to the hospital can be delayed up to 20 minutes while
awaiting delivery of the placenta.
E. The attending physician will want to examine the placenta and other
Copyright © Texas Education Agency, 2014. All rights reserved.
tissues for completeness, since any afterbirth tissues remaining in the
uterus pose a serious threat of infection and prolonged bleeding. Try
to catch the afterbirth in a container. Label this material “placenta” and
include the name of the mother and the time the tissues were
expelled.
F. Excessive post-partum bleeding can lead to shock. Assess and treat
accordingly.
G. Controlling vaginal bleeding for the mother is a priority.
H. If the placenta hasn’t delivered in 20 minutes, transport mother and
neonate. Blood loss is not usually more than 500 cc, but it may be
profuse. Have mother lower her legs after placing a sanitary napkin
over the vagina. Have her squeeze legs together. Elevate her feet.
Massaging the fundus of the uterus (felt as a grapefruit-sized object)
will be painful to the mother, but it controls bleeding. Nursing the baby
also helps control bleeding.
I. Talking to the mother and paying attention to her new baby are part of
total patient care. A good rule to follow is to treat the patient as you
would wish a member of your family to be treated.
J. Dispose of all items that have been in contact with blood or body fluids
in a biohazard container.
VI. Childbirth Complications
Note to Teacher: Use graphics to illustrate umbilical prolapse, placenta
previa/abruptio placentae, and breech presentations.
A. Emphasize that the steps necessary to treat a prolapsed cord or a
difficult breech delivery need to be undertaken immediately.
B. Relate this to your previous discussions about neonatal CPR. How
many ventilations of a newborn are lost with just a minute’s delay?
Consider inviting a midwife, OB physician, or OB nurse to discuss
treating complications of delivery.
C. Breech presentations occur when the head is not the first presenting
part of the baby during birth. Breech presentations can spontaneously
deliver successfully, but the complication rate is high.
D. Initiate rapid transport. Never attempt to deliver by pulling on legs.
Provide high-concentration oxygen. Place mother in head-down
position with pelvis elevated. Insert gloved hand and form V on either
side of the baby’s nose to lift away from the vaginal wall.
E. When presented with a limb presentation Place mother in head-down
position and give high-concentration oxygen by non-rebreather mask.
Initiate rapid transport.
F. With a prolapsed cord the oxygen supply to the baby may be totally
interrupted due to the cord being pinched. Elevate the mother’s hips
and give her high-concentration oxygen. Keep the cord warm by
wrapping it in a moist, sterile towel, and check for pulsation. Do not
attempt to push the cord back inside. Insert gloved fingers into the
mother’s vagina to keep pressure off the cord by pushing up on the
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baby’s head and buttocks. Transport to hospital, continuing pressure
on the baby’s head.
G. By definition, a premature infant is one who weighs less than 51/2
pounds at birth, or one who is born before the 37th week of
pregnancy.
H. Placenta previa and abruptio placentae are common causes of
excessive pre-birth bleeding.
I. Placenta previa is a condition in which the placenta is formed in an
abnormal location and does not allow for normal delivery. As the cervix
dilates, the placenta tears. The similar abruptio placentae is a
condition in which the placenta separates from the uterine wall. This
can be partial or complete.
J. Low blood pressure is a late sign of ectopic pregnancy.
K. Keep accurate records of the time of stillbirth and care rendered for
fetal death certificate. Resuscitative efforts should be withheld from
stillborn babies who have been obviously dead for some time.
VII. Gynecological Emergencies
A. Vaginal bleeding is another form of internal bleeding and can have the
same level of risk. Sexual assault is a difficult situation for EMTs.
Recruit expert help for your presentation.
B. Many domestic violence/sexual assault advocacy groups have
professional educators who are willing to lend a hand. Invite a law
enforcement officer or sexual assault nurse to class to discuss
evidence collection and crime scene preservation.
C. Vaginal bleeding that is not a result of direct trauma or a woman’s
normal menstrual cycle may indicate a serious gynecological
emergency.
D. Asking the patient how many pads she has used to block bleeding
may be helpful in assessing blood loss.
E. Consider assault a likely cause of any trauma to external genitalia.
F. Caring for these injuries may be difficult due to patient modesty.
G. Describe the treatment steps for external genitalia trauma.
H. Care of the sexual assault patient must include medical, legal, and
psychological considerations.
I. When treating sexual assault patients, EMTs should be professional,
nonjudgmental, and conscious of personal space.
J. EMTs should explain examinations and treatments beforehand and
should be sensitive to fears and embarrassment.
K. It may be necessary for you to stage your unit near the scene until it is
rendered safe by police.
Activity
I. Label the major structures of the female reproductive system on a blank
diagram.
II. Have students work in groups. Assign each group a specific organ or
Copyright © Texas Education Agency, 2014. All rights reserved.
structure associated with female reproduction. Have groups present to the
class and discuss function.
III. Have students work in small groups. Assign each group a system and ask
that group to research and present on the changes that take place during
pregnancy.
IV. Have students work in small groups. Have each group position one of its
members so as to avoid supine hypotension syndrome. Consider a seated
patient, a supine patient, and a patient on a backboard.
V. Have students work in small groups. Assign each group a stage of labor.
Ask the group to research and present on the physiology of that stage.
VI. Have students write out a script of questions that they would add to their
traditional assessment that might help them identify imminent delivery or
neonatal resuscitation.
VII.
Have students work in small groups. Assign a finding that indicates a
likelihood of resuscitation. Ask that group to research and present to the
class on why that finding might indicate resuscitation.
VIII. Assemble an obstetrics kit. Have students compile the components and
discuss the use of each component.
IX. Using a manikin, demonstrate the steps involved in suctioning a newborn.
Have students repeat.
X. Have students work in small groups, using a manikin to practice the
immediate care of a newborn. Provide different scenarios that require
increased levels of intervention.
XI. Have students work in small groups. Assign each group a specific
complication of delivery. Have the group research and report on
pathophysiology and immediate treatment priorities.
XII.
Assign small groups different weeks of fetal development. Have groups
research and present. Focus on fetal development at that week and the
potential challenges posed if the baby were to be delivered at that stage of
development. Discuss.
XIII. Have students work in small groups. Have them rehearse death and
dying situations associated with spontaneous abortion.
XIV. Practical Application
A. Using a programmed patient or a manikin, prepare for a delivery.
Don appropriate personal protective equipment; prepare equipment
and organize the delivery field.
B. You are called to respond to a mother who has delivered an
extremely premature baby. You arrive and find that the baby was
delivered at 15 weeks. It is extremely small and is not breathing. Do
you begin resuscitation? What is the age of viability for a newborn?
C. You are an EMT dispatched to OB patient. You arrive on scene to
Copyright © Texas Education Agency, 2014. All rights reserved.
find a patient in labor. You are expected to perform patient
assessment and manage the patient(s) appropriately.
This includes (not to be given to student)

Perform scene size

Perform patient assessment and determine priorities

Manage field delivery

Manage resuscitation of the newborn

Communicate effectively with fellow EMTs, deliver pre-hospital radio
report and transfer of pt. care report to ED.

Complete pcr-documentation appropriately
Assessment
Successful completion of activities
Materials
Invite an obstetrician or labor and delivery nurse to class
Invite a law enforcement officer or sexual assault nurse to class
OB kit for demonstration purposes
Brady Emergency Care 12th Edition
J&B Learning Emergency Care and Transportation of the Sick and Injured 10th
Edition.
Accommodations for Learning Differences
One on one instruction, Group learning, Collaborative Group
• Enrichment -- Have students meet with students in the Parenting
Education Program. Visit L&D floor at hospital and arrange for OB/Gyn
Doctor/Nurse to talk with class. Have student develop list of questions
to ask.
• Reinforcement -- Vocabulary: cervix, uterus, placenta, fallopian tube,
labia, mons pubis, ovary, oviduct, urethra, perineum, vagina, abortion,
abruption placenta, afterbirth, amniotic sac, Braxton-hicks contractions,
breech presentation, cephalic presentation, labor, contractions,
crowning, eclampsia, ectopic pregnancy, embryo, fetus, induced
abortion, lightening, limb presentation, meconium staining, miscarriage,
multiple birth, neonate, ovulation, placenta previa, preeclampsia,
premature.
National and State Education Standards
National Health Science Cluster Standards
1.2 Diseases and Disorders
1.21 Describe common diseases and disorders of each body system
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(prevention, pathology, diagnosis, and treatment).
1.22 Recognize emerging diseases and disorders.
1.23 Investigate biomedical therapies as they relate to the prevention,
pathology, and treatment of disease.
2.1 Concepts of Effective Communication
2.11 Interpret verbal and nonverbal communication.
2.12 Recognize barriers to communication.
2.13 Report subjective and objective information.
2.14 Recognize the elements of communication using a sender-receiver
model.
2.15 Apply speaking and active listening skills.
2.2 Medical Terminology
2.21 Use roots, prefixes, and suffixes to communicate information.
2.22 Use medical abbreviations to communicate information.
2.3 Written Communication Skills
2.31 Recognize elements of written and electronic communication (spelling,
grammar, and formatting)
3.14 Explain the impact of emerging issues such as technology, epidemiology,
bioethics, and socioeconomics on healthcare delivery systems.
6.32 Demonstrate respectful and empathetic treatment of ALL patients/clients
(customer service).
Texas College and Career Readiness Standards
English Language Arts
III.A.2 Adjust presentation (delivery, vocabulary, length) to particular
audiences and purposes.
III.B.1 Participate actively and effectively in one-on-one oral communication
situations.
III.B.2 Participate actively and effectively in group discussions.
III.B.3 Plan and deliver focused and coherent presentations that convey clear
and distinct perspectives and demonstrate solid reasoning.
IV.A.2 Interpret a speaker’s message; identify the position taken and the
evidence in support of that position.
IV.A.3 Use a variety of strategies to enhance listening comprehension.
IV.B. 1 Listen critically and respond appropriately to presentations.
IV.B.2 Listen actively and effectively on one-on-one communication situations.
Science
I.D.3 Demonstrate appropriate use of a wide variety of apparatuses,
equipment, techniques, and procedures for collecting quantitative and
qualitative data.
I.E.2 Use essential vocabulary of the discipline being studied.
Cross-Disciplinary
I.C.1 Analyze a situation to identify a problem to be solved.
I.C.2 Develop and apply multiple strategies to solve a problem.
I.C.3 Collect evidence and data systematically and directly relate to solving a
problem.
Copyright © Texas Education Agency, 2014. All rights reserved.
I.D.1 Work independently
I.D.2 Work Collaboratively
TEKS
§130.205.(c)(1)(A)interpret data from various sources in formulating
conclusions;
§130.205.(c)(1)(B)compile information from a variety of sources to create a
technical report;
§130.205.(c)(1)(C)plan, prepare, and deliver a presentation;
§130.205.(c)(1)(D)examine the environmental factors that affect homeostasis;
§130.205.(c)(1)(E)relate anatomical structure to physiological functions;
§130.205.(c)(1)(F)distinguish atypical anatomy and physiology in the human
body systems;
§130.205.(c)(1)(G)implement scientific methods in preparing clinical case
studies; and
§130.205.(c)(1)(H)compare and contrast health issues in the global society.
§130.205.(c)(2)(A)accurately describe and report information, according to
facility policy, observations, and procedures;
§130.205.(c)(2)(B)demonstrate therapeutic communication skills to provide
quality care; and
§130.205.(c)(2)(C)employ therapeutic measures to minimize communication
barriers.
§130.205.(c)(3)(A)demonstrate proficiency in medical terminology and skills
related to the health care of an individual;
§130.205.(c)(5)(A)participate in team teaching and conflict management such
as peer mediation, problem solving, and negotiation skills;
§130.205.(c)(6)(A)integrate regulatory standards such as standard
precautions and safe patient handling;
§130.205.(c)(6)(D)apply principles of infection control and body mechanics in
all aspects of the health science industry.
§130.205.(c)(7)(A)interpret knowledge and skills that are transferable among
health science professions;
§130.205.(c)(7)(C)analyze emerging technologies in the health science
industry.
§130.205.(c)(8)(A)describe pre-procedural preparations;
§130.205.(c)(8)(B)observe therapeutic or diagnostic procedures;
§130.205.(c)(8)(C)identify care indicators of health status; and
§130.205. (c)(8)(D) record health status according to facility protocol.
Nation EMT BASIC STANDARD CURRICULUM
www.nhtsa.gov/people/injury/ems/pub/emtbnsc.pdf
Identify and explain the use of the contents of an obstetrics kit. EMT Basic
National Standard Curriculum 4-9.2
Identify pre-delivery emergencies. EMT Basic National Standard Curriculum 49.3
State indications of an imminent delivery. EMT Basic National Standard
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Curriculum 4-9.4
Demonstrate the procedures for the following abnormal deliveries: vaginal
bleeding, breech birth, prolapsed cord, limb presentation. EMT Basic National
Standard Curriculum 4-9.27
Demonstrate completing a pre-hospital care report for patients with
obstetrical/gynecological emergencies. EMT Basic National Standard
Curriculum 4-9.29
Copyright © Texas Education Agency, 2014. All rights reserved.
OB/GynEmergenciesChart
Complication Causes Supine hypotensive syndrome Caused by the baby compressing the inferior vena cava when the woman is supine Baby does not move to a head down position Breech presentation Prolapsed umbilical cord Limb presentation Premature birth Signs and Symptoms Treatments Dizziness, Drop in Blood Pressure Place mother in the left side. Buttocks or both legs present first Initiate rapid transport. Never attempt to deliver by pulling on legs. Provide high‐concentration oxygen. Place mother in head‐down position with pelvis elevated. Insert gloved hand and form V on either side of the baby’s nose to lift away from the vaginal wall With a prolapsed cord Elevate the mother’s hips When the umbilical cord and give her high‐
the oxygen supply to presents first and is concentration oxygen. the baby may be squeezed between the Keep the cord warm by totally interrupted vaginal wall and the due to the cord being wrapping it in a moist, baby’s head pinched sterile towel, and check for pulsation. Do not attempt to push the cord back inside. Insert gloved fingers into the mother’s vagina to keep pressure off the cord by pushing up on the baby’s head and buttocks. Transport to hospital, continuing pressure on the baby’s head. Presentation of arm or Place mother in head‐
When an infant’s limb down position and give protrudes from the vagina leg from that vaginal high‐concentration opening before any other body oxygen by non‐rebreather part mask. Initiate rapid transport. Watch for respiratory CPR, warming, neonatal Any newborn weighing resuscitation, transport to failure, pulseless, less than 51⁄2 pounds or a NICU. apnea born before the 37th week Copyright © Texas Education Agency, 2014. All rights reserved.
Meconium Usually caused by fetal distress Placenta previa When the placenta is formed in an abnormal location that will not allow a normal delivery of the fetus A condition in which the placenta separates from the uterine wall, causing excessive pre‐birth bleeding When implantation of the fertilized egg is not in the body of the uterus Abruptio placentae Ectopic pregnancy Eclampsia Abortion A severe complication of pregnancy that produces seizures and coma Spontaneous or induced termination of pregnancy Stillborn When the baby is born dead Pre‐eclampsia Complication of pregnancy where the woman retains large amounts of fluids and has hypertension Amniotic fluid that is greenish or brownish‐
yellow rather than clear Spotting dark red blood, painful Prepare suctioning, contact ALS, prepare for neonatal resuscitation Bright red blood. Shock Immediate transport, ALS, high‐concentration oxygen Vaginal Bleeding, abdominal pain, bruising around umbilicus Seizures and coma, high blood pressure Immediate transport, treat for shock, ALS, high‐
concentration oxygen Vaginal bleeding with tissue, cramping, shock Baby born pulseless and apneic, obvious death Hypertension, pedal edema Immediate transport, ALS, high‐concentration oxygen ALS, immediate transport, airway management ALS, treat for shock, transport Keep accurate records of the time of stillbirth and care rendered for fetal death certificate. Resuscitative efforts should be withheld from stillborn babies who have been obviously dead for some time. ALS, transport, watch for seizure, keep patient calm Copyright © Texas Education Agency, 2014. All rights reserved.
Discussion
1. Describe the location and function of the following female reproductive organs: ovaries,
fallopian tubes, uterus, and vagina.
2. After a woman reaches puberty, approximately every 28 days her uterus goes through
changes to prepare for implantation of the fertilized egg. Peristalsis is a wave of muscular
contraction. Fertilization typically occurs in the fallopian tube. Without fertilization, the
thickened inner walls of the vagina slough off and are expelled through the vagina.
3. Describe the reproductive changes that occur during the female reproductive cycle.
4. Compare and contrast normal abdominal anatomy to the anatomy of a full-term pregnancy.
5. Discuss the changes that occur. Invite a pregnant female to class.
6. Describe external changes and illustrate changes in vital signs.
7. Other changes occur elsewhere in the woman’s body.
8. In later stages of the pregnancy, the fetus can put pressure on the woman’s diaphragm,
decreasing the volume of air in the lungs.
9. Pressure on the stomach and intestine can slow digestion. Nausea and vomiting are
common in pregnancy.
10. Describe the major changes that occur during pregnancy. Specifically comment on the
following: reproductive system, cardiovascular system, musculoskeletal system, respiratory
system.
11. Discuss the pathway that the fetus takes to reach the outside world.
12. Describe how the fetus obtains oxygen and nutrients while inside the uterus.
13. What role does the placenta play?
14. Discuss vena cava compression syndrome. The body begins to compensate when it senses
a drop in blood pressure by contracting the uterine arteries, redirecting blood to the major
organs.
15. How might the changes of pregnancy make a woman more vulnerable to trauma?
16. Describe the first stage of labor. Discuss the changes that occur.
17. Describe the second stage of labor. Discuss the changes that occur.
18. Describe the third stage of labor. Discuss the changes that occur.
19. Consider problems that might interfere with the progression of these three stages. How
might these stages be interrupted?
20. In addition to asking when labor pains start, ask how often the patient has the pain. Ask her if
her water has broken.
21. Describe the assessment steps necessary to identify imminent delivery. What are the most
important findings?
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22. Describe the signs and symptoms of a woman in labor. Ask the class if transport is indicated
or if a home delivery is likely. Discuss the decision-making process.
23. What equipment is necessary in normal childbirth? How might you proceed if standard
equipment were not available?
24. What questions might you ask to help predict neonatal resuscitation? What answers would
indicate resuscitation?
25. Describe what additional resources might be necessary in the event of a home delivery or
neonatal resuscitation.
26. Describe the necessary components of an obstetrics kit.
27. Discuss the steps that you must take as the baby’s head appears. Describe preventing an
explosive delivery, assessing the umbilical cord, and suctioning.
28. How might cultural considerations affect the steps you take to assist with delivery? Are there
cultures in which standard practice might not be acceptable?
29. Describe the assessment findings that would indicate the need for artificial ventilations and
CPR.
30. Describe the immediate steps necessary to care for a newborn. Include the steps necessary
to cut the umbilical cord.
31. Describe the steps required to ventilate a newborn appropriately.
32. Describe the delivery of the placenta. How would you know that this stage of labor has
begun?
33. Describe how you might differentiate the normal bleeding that is associated with delivery
from excessive bleeding. Discuss the steps used to treat excessive bleeding after delivery.
34. You deliver the placenta, but it looks like only a piece of the placenta. The mother is still
bleeding heavily. What are the potential problems if part of the placenta remains inside the
uterus?
35. Discuss emotional care. If there are mothers in the class, ask them to discuss how they
would like to have been treated following childbirth.
36. Discuss fetal development to better explain the challenges of prematurity. Focus on lung
development and thermal regulation.
37. Describe the steps necessary to provide an airway to a complicated breech delivery. Why is
immediate action so important?
38. Describe a prolapsed umbilical cord. Why is this dangerous to the fetus? Describe the
immediate actions necessary to treat this complication.
39. Describe the assessment findings that might indicate multiple births.
40. Discuss the hazards of prematurity. What risks are present with premature infants that are
not present with term babies?
41. Describe the pathophysiology of placenta previa and abruptio placentae.
42. Describe how these disorders might injure the mother and baby.
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43. Discuss the causes of trauma during pregnancy. What portion of the trauma can be
accounted for by domestic violence?
44. Describe the assessment findings that would indicate life-threatening vaginal bleeding.
45. Describe the priorities in caring for a sexual assault victim.
46. Discuss the nonmedical priorities of caring for a sexual assault victim. Consider using a
professional advocate/educator to lead this discussion.
47. You are called for a sexual assault victim who is refusing evaluation and care. What steps
should you take to deal with this situation? Might it be appropriate not to transport this
patient?
Copyright © Texas Education Agency, 2014. All rights reserved.