分娩紧急协助

1、What to ask?From an Emergency Responders point of view This presentation is set up as if you were on scene, assisting with a delivery. You will go over the questions to ask, things to look for, possible complications and assisting with a delivery. Hopefully this will help you picture the scene and b

2、etter understand why you are asking certain questions and give more effective instructions. Your EMDPRS will be updated soon, with some new information and pre-arrival instructions.IntroductionChildbirth is a normal, natural part of life.Your part of the process involves helping, guiding, and suppor

3、ting the infant as it is born.After the birth, you should ensure the infant is breathing adequately and being kept warm.Two indicators of an impending birth:Frequency of the contractionsCrowningAs you prepare to assist the mother in the delivery, keep two things in mind:Calm the woman: Delivery is a

4、 natural process.Calm yourself: You are there to help or coach.WARNING!This lecture has some graphic pictures of childbirth and emergency delivery. There will also be an option to click on a link to view an actual childbirth video. Viewer discretion advised.Anatomy of Pregnancy The external opening

5、is called the birth canal (vagina).The developing infant (fetus) is encased in an amniotic sac for support and floats in amniotic fluid. The placenta is the organ of exchange between mother and child. The umbilical cord connects the baby to placenta. Opening of the Uterus is the Cervix.Fetal Anatomy

6、Placenta develops early in pregnancy & performs important functions Exchanges respiratory gases Transports nutrients from mother to fetus Excretes waste Transfers heat Active endocrine gland produces several important hormones Attached by umbilical cordAmniotic sac develops early in pregnancy Co

7、nsists of membranes that surround & protect developing fetus Amniotic fluid cushions fetus & provides stable environment Umbilical cord attaches fetus to placenta Contains one vein & two arteries Vessels in umbilical cord similar to pulmonary circulation Arteries carry deoxygenated blood

8、 Veins carry oxygenated blood Newborn cord is about two feet long Stages of Labor First stage of labor: the pregnant womans body prepares for birth Characterized by these conditions: Initial contractions occur. The bag of waters breaks. The bloody show occurs. (loss of protective mucous plug from ce

9、rvix) The infants head does not appear during contractions. This is the longest stage but is shorter for each pregnancy.Stages of LaborSecond stage of labor: the birth of the infantContractions are close together, 2-3 minutes apart. Mother will have the urge to push.You will see the infants head cro

10、wning during contractions.There is no time for transport, you will need to assist with delivery.Stages of Labor Third stage of labor: delivery of the placenta (afterbirth) Mom will start to have contractions again and will usually delivery the placenta within 20-30 minutes. Your focus should be cari

11、ng for mom and newborn.Is There Time to Reach the Hospital? Is this the womans first pregnancy? A woman experiencing her first labor will usually have more time to reach the hospital. Has the woman experienced a bloody show? Loss of mucous plug. Has the bag of waters broken? The bag of waters usuall

12、y breaks toward the end of the first stage of labor.Is There Time to Reach the Hospital? How frequent are the contractions? Contractions less than 2 minutes apart usually indicate that delivery will occur very soon. Contractions are timed from the start of one to the start of the next. Does the woma

13、n feel an urge to move her bowels? When the infants head is in the birth canal, it presses against the rectum. Do not allow her to go to the toilet.Is There Time to Reach the Hospital? Is the infants head crowning? Head is visible in the birth canal Is transportation available? Is the ambulance resp

14、onding? How far is it to the hospital? Will bad weather, a natural disaster, or traffic prevent prompt arrival of transportation? What additional information do you want to know?Preparing for Delivery You will not be able to maintain sterile conditions. Attempt to be as clean as possible. Wash your

15、hands thoroughly. If you do not have a sterile delivery kit, use household items to prepare for delivery. Use shoestrings or strips of cloth to tie the cord. Have plenty of clean towels ready. There will be lots of fluids, so protect yourself.Preparing for Delivery Place the patient on a firm surfac

16、e that is padded with blankets, folded sheets, or towels. Elevate the womans hips 2 to 4 with pillows and blankets. Place the woman on her back with knees bent and feet flat on the surface beneath her. Remove clothing below the waist.Assisting With Delivery In a normal birth: The infant will turn to

17、 its side by itself after the head emerges. The rest of the body will be delivered spontaneously. The infant will be wet and slippery. Keep the infants head at about the level of the womans vagina. Encourage the mother to breath deeply between contractions and push with contractions.Assisting With D

18、eliveryAssisting With Delivery Support head with gentle pressure Check and see if cord is wrapped around babys neck attempt to loosen (more on that later) Apply gentle downward pressure on shoulder & head After anterior shoulder has delivered, apply gentle upward pressure. Once shoulders are out

19、 the rest of body will follow quickly. Suction or wipe out mouth & nostrils (in that order) when head appears Once delivered, stimulate infant if it does not breathe (info to follow) Put two clamps on umbilical cord & cut 6 inches from navel between clamps, after the cord stops pulsatingChil

20、dbirth videoFollow this link to a childbirth video, starting with crowning and ending with stimulation of the infant and awaiting the afterbirth. This baby had Nuchal Cord.http:/ Amniotic sacDuring first stage of labor amniotic sac usually breaks, expelling amniotic fluid If sac is still covering in

21、fants head when head appears, use a finger to pierce sacVery tough membraneNote color & character of amniotic fluid Fluid can be clear or straw-colored (which is normal) Tainted, discolored, thick or “pea soup-like” (which indicates meconium staining or a bad intra-uterine infection) Baby could

22、be in distressNuchal Cord Once head delivers, have mother to stop pushing so you can check to see if the cord is wrapped around infants neck If cord looks like it is wrapped tightly, you will need to loosen it Gently slip cord over babys head by placing two fingers under cord at back of neck Bring c

23、ord over shoulders & head Cord is durable, but it can tear if handled roughly so dont use excessive force Too tight to loosen, clamp cord in two places two inches apart and cut cord between clampsContinued Delivery Instructions After the baby is out, remember to keep baby level with birth canal

24、until the cord is clamped and cut Position infant on its side for drainage Re-suction or wipe out the babys mouth & nostrils Dry & wrap baby in a warm blanket cover its head If baby is not breathing, try to stimulate it bygently but vigorously rubbing the infants back with you fingertips or

25、flick the soles of its feet If no response begin CPR Stimulate babyCPR - Two-Thumb Encircling Hands Technique CPR technique for the infant that is not breathing, after stimulationPlace infant on a firm, flat surfaceFind compression site which is just below nipple line on middle or lower third of ste

26、rnumWrap your hands around upper abdomen with your thumbs on compression siteUse your thumbs to deliver gentle pressure against sternum, pressing to inch into chest at rate of 100 per minute30:2 compressions to breathsAftercare of the Mother and Newborn Continue to observe the mother and infant and

27、keep both warm. Bleeding should stop after placenta delivers. Observe mother for excessive bleeding and treat for shock If baby is doing well and mother wants to breastfeed, this will help slow bleeding down by contracting uterusComplicated Deliveries(a very small percentage)Cord presentationLimb pr

28、esentationBreech (buttocks or feet)Shoulder Dystocia (stuck at shoulders)Premature or StillbornMultiplesDrug or alcohol abuseUnderlying medical problems with mother or childCan your questioning help identify possible problems and better prepare responders?Complicated DeliveriesMost can not be delive

29、red safely in the field.Elevate mothers hips to relieve pressure on birth canal and advise her not to push. Have her focus on her breathing and wait for responders.Pregnancy ComplicationsAny bleeding during pregnancy could be the sign of a serious problemEctopic Pregnancy (outside uterus)Miscarriage

30、Placenta problemsUterus ruptureMore Problems Some women develop diabetes during pregnancy (Gestational Diabetes) Diabetics can have problems maintaining their blood sugar levels during pregnancy Supine hypotensive syndrome occurs when increased weight of uterus compresses inferior vena cava while a

31、patient is on her back Position mother on her left side to avoid thisPre-EclampsiaVariety of signs and symptoms including: Hypertension Abnormal weight gain Edema Headache Protein in the urine Epigastric pain If untreated, preeclampsia can progress to eclampsia EclampsiaEclampsia, also called toxemi

32、a, most serious manifestation of hypertensive disorders of pregnancy Characterized by grand mal seizures Often preceded by visual disturbances such as flashing lights or spots before the eyes Eclampsia patients often experience swelling of hands & feet & markedly elevated blood pressure If e

33、clampsia develops, death of mother & fetus frequently results Treat by lying mother on her side, maintaining airway and monitor until help arrivesSummary Childbirth is a natural process with a small percentage of complications. Follow your scripted protocol for imminent births.WARNING!This lectu

34、re has some graphic pictures of childbirth and emergency delivery. There will also be an option to click on a link to view an actual childbirth video. Viewer discretion advised.Is There Time to Reach the Hospital? How frequent are the contractions? Contractions less than 2 minutes apart usually indicate that delivery will occur very soon. Contractions are timed from the start of one to the start of the next