Transcript OB/GYN EMERGENCIES

By: Darryl Jamison
Macon County EMS Training
Coordinator
• Describe fetal-maternal blood flow and the role
of the placenta.
• Identify the details of the history that should be
obtained from an obstetrical patient.
• Discuss the effects of pregnancy on pre-existing
conditions such as diabetes, HTN, and cardiac
problems.
• Define the following terms:
– Spontaneous abortion; criminal abortion;
therapeutic abortion
• Describe the pathophysiology and
management of the following conditions:
– Ectopic pregnancy
– Abruptio placenta
– Placenta previa
Objectives cont.
• Distinguish between pregnancy-induced
hypertension, preeclampsia, eclampsia.
• Describe management of prolapsed cord.
• Describe management of breech presentation
• Describe management of multiple-birth
presentation
• Describe the pathophysiology and management
of the following conditions:
– Postpartum hemorrhage
– Uterine inversion
– Uterine rupture
Fetal-Maternal Blood flow
• Blood flows from the placenta in through
the umbilical vein which connects to the
inferior vena cava then to the heart
• Routed around the lungs through the
ductus arteriosus, into the aorta and then
throughout the baby.
• Deoxygenated blood is filtered by the
liver and then transported to the mother
Role of the placenta
• Provides for exchange of respiratory
gases.
• Transport of the nutrients
• Excretion of wastes
• Transfer of heat
• The placenta becomes an active
endocrine gland, producing several
important hormones
History
• Should include:
– Gravidity—number of
pregnancies
– Para—number of viable
fetus delivered
– Length of gestation
– Estimated date of
confinement
– Previous complications
with pregnancies
– When did pain start
– Sudden or slow in onset
– Duration, location,
radiation
– Is it regular
– Spotting
– Proper prenatal care
– If active labor, question
push or bowel movement
Diabetes
– Patients have to be placed on insulin—
medication will pass to the fetus
– Effects on baby—tend to be larger in size
– Tend to have trouble maintaining body
temp. And subject to hypoglycemia
Hypertension
• Generally speaking bp is lower in
pregnancy than non-pregnancy
• Preexisting hypertension is exacerbated
• Persistent HTN adversely affects
placental size
• Leading to compromise of fetus and
placing mother at risk for CVA or renal
failure
Cardiac
• During pregnancy, cardiac output
increases up to 30%
• Can lead to CHF from preexisting
Spontaneous Abortion
•
•
•
•
Commonly called a miscarriage
Occurs of its own accord
Occur before the 12th week of pregnancy
Many occur within 2 weeks after
conception, being mistaken for menstrual
cycle
Criminal Abortion
• Attempt to destroy fetus by one whom is
not licensed to do so
• Amateurs
• Without aseptic techniques
• Leads to other complications
Therapeutic Abortion
• The pregnancy posed a threat to
maternal well-being
• Judged to medically indicated
Ectopic Pregnancy
• Pathophysiology
– Implantation of fertilized
ovum outside of the
uterus.
– Approximately 1:200
– Most common site—
fallopian tube
– Truly a medical
emergency
– Causes extensive bleeding
into the abdominal cavity
and pelvis
– Predisposing
factors—
• Previous pelvic
infections
• Pelvic adhesions—
previous abdominal
surgery
• Tubal ligations
• IUD
Assessment of ectopic
pregnancy
– At risk for rapid development of shock
– Take VS frequently
– Abdominal—significant lower quadrant
tenderness
– Avoid as much as possiblerupture of
ectopic
– Bleeding can range from spotting  profuse
Management
– Difficult to diagnose
– If suspected should care for as any shocky
patient
– Emergent transport
Abruptio Placenta
• Third trimester bleeding
• Premature separation of
the placenta from the
uterine wall.
• Partial or complete
• Complete often results in
death of fetus
• Predisposing factors
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–
–
–
–
Preeclampsia
Maternal HTN
Multiparity
Abdominal trauma
Extremely short umbilical
cord
– Vaginal blood loss is
minimal due to blood
collecting behind placenta
Assessment
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–
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Have constant, severe abdominal pain
Feels like something is “tearing”
Abdomen is very tender
Bleeding will be dark in color
PMH—abruptio placenta
Management
• COMI
• Large bore IV’s
• Rapid transport
Placenta Previa
– Attachment of the placenta that partially or
completely covers the internal cervix
– Begins to bleed as the cervix thins out,
spreading the placenta until it tears
– Precipitated by sexual intercourse or digital
vaginal examination
Assessment
– Usually multigravida
– Third trimester
– Most common—
painless, bright red
bleeding
– Uterus is soft
– Management—
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•
•
COMI
High flow O2
Large bore IV’s
Rapid transport
PIH
• Bp of 140/90
• Early stage of disease process
• Bp is normally low so 130/80 maybe high
Preeclampsia
• Characterized by:
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–
–
–
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HTN
Abnormal weight gain
Edema
Headache
Protein in urine
Epigastric pain
Visual disturbances
Eclampsia
• Characterized by the same as pre but
includes seizures
Supine Hypotensive Syndrome
• Occurs in the third
trimester
• Marked decrease in
blood flow to the heart
due to increase mass in
abdominal cavity
• Compresses on the
inferior vena cava thus
decreasing the blood
flow back to the heart
• Assessment—be
aware of signs of
shock and verify
previous problems
with same
• Management—place
in LLR, treat for
shock if other signs
of shock are present.