OB/GYN GUIDELINES

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crowning occurs; patient feels the urge to bear down or feels she needs to have a bowel movement.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nPre-delivery: Treat the child by treating the mother.\u003cbr\u003e\nPost-delivery: Maintain warmth and adequate respirations for the baby.\u003cbr\u003e\na.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\nb.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\nc.\tIf delivery is not imminent transport left lateral recumbent.\u003cbr\u003e\na.\tNormal childbirth is not an emergency and usually does not warrant emergent transport.\u003cbr\u003e\nd.\tObtain medical and obstetrical history including:\u003cbr\u003e\na.\tDue date (EDC)\u003cbr\u003e\nb.\tWhen did contractions start, how close, bleeding, and does she feel the need to push.\u003cbr\u003e\nc.\tPrevious or present illness, cardiac problems, diabetes, etc.\u003cbr\u003e\nd.\tNumber of pregnancies, live births, and miscarriages (gravida, para, and abortions).\u003cbr\u003e\ne.\tPatient's age\u003cbr\u003e\nf.\tLast menstrual period (LMP)\u003cbr\u003e\ng.\tComplications of prior pregnancies, deliveries, prior C-section.\u003cbr\u003e\nh.\tSummary of prenatal care\u003cbr\u003e\ni.\tUse of drugs (prescribed and recreational)\u003cbr\u003e\n\u003cbr\u003e\n2.\tIf birth is imminent and the following conditions present, contact medical control for delivery instructions:\u003cbr\u003e\na.\tMultiple births\u003cbr\u003e\nb.\tExcessive bleeding\u003cbr\u003e\nc.\tBreech presentation\u003cbr\u003e\nd.\tMeconium\u003cbr\u003e\n\u003cbr\u003e\n3.\tConsider rapid transport and ALS intercept for the following (see Emergency Childbirth Complications):\u003cbr\u003e\na.\tLimb presentations\u003cbr\u003e\nb.\tTransverse presentation\u003cbr\u003e\nc.\tUnlikely to deliver vaginally","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2126497/10042792"},{"listId":10042799,"catId":2126497,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"CHILDBIRTH BREECH DELIVERY","summary":"","detail":"BREECH DELIVERY\u003cbr\u003e\n\u003cbr\u003e\n1.\tPregnant patient in active labor with arm, foot, or buttocks presenting first\u003cbr\u003e\na.\tAttempt to establish contact with MCEP or OB for delivery instructions\u003cbr\u003e\nb.\tThe appearance of feet through the vulva does not require immediate delivery. Allow the feet, legs, and buttocks to advance through the vagina before intervening.\u003cbr\u003e\nc.\tIf imminent delivery\u003cbr\u003e\ni.\tBegin transport to hospital with NICU capability and notify hospital asap.\u003cbr\u003e\nii.\tEncourage mother to push hard\u003cbr\u003e\niii.\tSupport infant’s body until the upper back appears.\u003cbr\u003e\niv.\tGrasp the iliac wings and apply gentle downward traction\u003cbr\u003e\nv.\tGuide the infant's body in the direction of least resistance and rotate infant “back up” and deliver scapulae\u003cbr\u003e\nvi.\tRotate 90 and deliver shoulder/arm\u003cbr\u003e\nvii.\tRotate 180 and deliver opposite shoulder/arm\u003cbr\u003e\nviii.\tGently rotate baby so face is down\u003cbr\u003e\nix.\tIf unable to deliver place fingers on humerus and applying gentle traction with two fingers, the arms can be delivered.\u003cbr\u003e\nx.\tGentle abdominal compression of the mother's uterus will engage the infant's head. Swing the infant's head upwards until the body is in a vertical position.\u003cbr\u003e\nxi.\tWhen the head delivers, suction and wrap the baby.\u003cbr\u003e\n\u003cbr\u003e\nb.\tIf non-imminent delivery\u003cbr\u003e\ni.\tAy apply gentle pressure to presenting part to prevent or slow delivery","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2126497/10042799"},{"listId":10042798,"catId":2126497,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"CHILDBIRTH COMPLICATIONS","summary":"","detail":"CHILDBIRTH COMPLICATIONS\u003cbr\u003e\n\u003cbr\u003e\nCOMPLICATIONS– ALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\n1.\tMeconium\u003cbr\u003e\na.\tSuction the baby's mouth and pharynx extensively before the first breath, preferably on the perineum, prior to delivery. Use a bulb syringe or DeLee suction\u003cbr\u003e\nb.\t\u003cbr\u003e\n2.\tNuchal cord (cord is wrapped around the baby's neck)\u003cbr\u003e\na.\tGently pull and slip over the head or shoulders.\u003cbr\u003e\nb.\tPlace 2 fingers between cord and infant’s neck\u003cbr\u003e\nc.\tIf it will not slip over either, clamp cord twice, and cut between clamps and proceed with delivery.\u003cbr\u003e\n\u003cbr\u003e\n3.\tProlapsed cord\u003cbr\u003e\na.\tPlace patient in knee-chest position and place 2 fingers in the vagina to support presenting part away from cord until it pulsates.\u003cbr\u003e\nb.\tPlace a moist sterile dressing over cord\u003cbr\u003e\nc.\tAdminister oxygen to mother\u003cbr\u003e\nd.\tTransport immediately\u003cbr\u003e\n\u003cbr\u003e\n4.\tShoulder dystocia\u003cbr\u003e\na.\tBaby’s shoulder impacts the anterior symphysis pubis and will not deliver. Turtle sign present\u003cbr\u003e\nb.\tPosition the mother on her left side in a dorsal-knee-chest position to increase the diameter of the pelvis.\u003cbr\u003e\nc.\tAttempt to guide the infant's head downward to allow the anterior shoulder to slip under the symphysis pubis. Avoid excessive force or manipulation.\u003cbr\u003e\nd.\tGently rotate the fetal shoulder girdle into the wider oblique pelvic diameter. The posterior shoulder should deliver without resistance.\u003cbr\u003e\ne.\tMay need to apply posterior pressure just above symphysis pubis to allow shoulder to slip below bony prominence.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n5.\tVaginal bleeding\u003cbr\u003e\na.\tIf just delivered perform fundal message\u003cbr\u003e\ni.\tEncourage baby to breast feed\u003cbr\u003e\nii.\tTransport to hospital \u003cbr\u003e\nb.\tIf not delivered\u003cbr\u003e\ni.\tTransport in left lateral recumbent position\u003cbr\u003e\nii.\tIf \u003c 20 weeks or unsure if pregnant suspect miscarriage\u003cbr\u003e\nAEMT\u003cbr\u003e\na.\tEstablish IV access and provide NS bolus\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\na.\tIf the placenta has delivered, and heavy vaginal bleeding continues, administer OXYTOCIN 20 USP units in 500ml Isotonic Solution infuse over 1 hour. This is 83 drops per minute on a 10 drop/ml. IV line.\u003cbr\u003e\nb.\tConsider TXA for uncontrolled, non-compressible, postpartum bleeding.\u003cbr\u003e\n\u003cbr\u003e\nAdult Initial Bolus (16 years and older)\u003cbr\u003e\nMix 2 grams in 250 cc bag. Infuse IV/IO over 10 minutes.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2126497/10042798"},{"listId":10042795,"catId":2126497,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"CHILDBIRTH-IMINENT DELIVERY","summary":"","detail":"CHILDBIRTH (IMMINENT DELIVERY)\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n1.\tIf the birth is imminent in the pre-hospital setting:\u003cbr\u003e\na.\tReassure mother - encourage to not bear down between contractions, but to “pant”.\u003cbr\u003e\nb.\tPlace slight pressure over the head with hand to prevent rapid delivery, but do not attempt to delay delivery.\u003cbr\u003e\nc.\tOnce head delivers, instruct mother to stop pushing.\u003cbr\u003e\nd.\tSupport body as delivery proceeds. Baby will be extremely slippery. DO NOT pull on baby.\u003cbr\u003e\ne.\tSuction airway with bulb suction.\u003cbr\u003e\nf.\tDry and wrap in blanket, cover head. Stimulate the baby to breathe/cry. If baby does not breathe spontaneously, continue stimulation efforts, apply oxygen and prepare to ventilate with BVM. \u003cbr\u003e\ng.\tIf bleeding occurs post-delivery, provide fundal massage to mother’s abdomen/uterus.\u003cbr\u003e\nh.\tDo not wait on scene for placenta delivery. Do not pull on the umbilical cord (deliver birth products to ED).\u003cbr\u003e\ni.\tPlace sterile pad over vaginal opening.\u003cbr\u003e\nj.\tCover mother with clean and dry bedding.\u003cbr\u003e\nk.\tRecord time of the birth.\u003cbr\u003e\nl.\t Do not let the neonate become hypothermic.\u003cbr\u003e\n\u003cbr\u003e\n2.\tTransport mother and baby to the nearest hospital. Bring all blood-soaked pads and passed tissue to hospital.\u003cbr\u003e\n\u003cbr\u003e\n3.\tMonitor the mother and baby’s vital signs and APGAR at 1, 5 and 10 minutes after delivery.\u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tIf the mother continues to bleed, initiate an IV of LR and infuse at a flow rate to maintain adequate end organ perfusion.\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tIn all field deliveries administer OXYTOCIN (Pitocin) 10 mg. IM immediately after birth. (10mg./ml. concentration).\u003cbr\u003e\n2.\tConsider TXA administration for severe post-partum bleeding.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2126497/10042795"},{"listId":10042797,"catId":2126497,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"NEWBORN CARE","summary":"","detail":"NEW BORN CARE\u003cbr\u003e\n\u003cbr\u003e\nAll levels\u003cbr\u003e\n\u003cbr\u003e\n1.\tBegin vigorously drying baby.\u003cbr\u003e\n\u003cbr\u003e\n2.\tUsing clamps or hemostats, clamp the cord, 6-10 inches from baby, 2 - 3 inches apart, then cut between clamps.\u003cbr\u003e\n\u003cbr\u003e\n3.\tImmediately after birth if poor tone, slow/absent breathing, and not crying\u003cbr\u003e\na.\tWarm baby, suction airway with bulb suction, continue to dry and stimulate.\u003cbr\u003e\n\u003cbr\u003e\n4.\tTake baby’s pulse at the cord if pulsating. Ascultation more accurate. Heart rate is key to evaluation and decision making.\u003cbr\u003e\na.\tIf \u003e100 bpm, observe and continue drying, warming and stimulating. Place on mother’s abdomen and encourage mother to nurse the baby. \u003cbr\u003e\nb.\tConsider blow by oxygen. If oxygenation necessary PPV or CPAP more effective. Position infant properly for effective ventilation. Proper airway and respiration can correct low heart rate. “Fix breathing, everything else should follow”. The big challenge for a newborn is converting to lung breathing from fetal oxygenation.\u003cbr\u003e\n\u003cbr\u003e\n5.\t30 seconds after birth\u003cbr\u003e\na.\tif HR \u003c 100, gasping, or apnea begin BVM at 40-60/min\u003cbr\u003e\n\u003cbr\u003e\n6.\t60 seconds after birth\u003cbr\u003e\na.\tif HR \u003c100 but \u003e 60, continue BVM\u003cbr\u003e\nb.\tif HR \u003c 60 begin CPR, continue BVM\u003cbr\u003e\n\u003cbr\u003e\n7.\t90 seconds after birth\u003cbr\u003e\na.\tif HR \u003c100 but \u003e 60 continue BVM\u003cbr\u003e\nb.\tif HR \u003c 60 continue CPR and BVM\u003cbr\u003e\n\u003cbr\u003e\n8.\tDo not let the neonate become hypothermic.\u003cbr\u003e\n\u003cbr\u003e\n9.\tOnce baby is vigorous and crying with good tone and HR \u003e100 bpm\u003cbr\u003e\na.\tWarp in warm blanket if mother is unstable.\u003cbr\u003e\nb.\tOxygenate if baby still has central cyanosis, not necessarily for acrocyanosis\u003cbr\u003e\nc.\tPlace on mother’s abdomen and allow to breast feed if condition permits\u003cbr\u003e\nd.\tContinue evaluation of baby and mother\u003cbr\u003e\ne.\tTransport to hospital with OB or NICU capability based on patient condition\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\nIf newborn is in distress:\u003cbr\u003e\n1.\tEstablish IV/IO access\u003cbr\u003e\n2.\tGlucose check\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tIf despite all measures (CPR and ventilations) infant remains in poor condition and heart rate stays below 60 administer EPINEPHRINE (1:10,000 or 0.1 mg./ml). Give 0.01 mg./kg. (0.1 ml./kg.) IV/IO every 3-5 minutes if heart rate remains below 60.\u003cbr\u003e\n2.\tAdminister 20 ml./kg. IV/IO bolus.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nAPGAR\t\tSCORE\u003cbr\u003e\n\u003cbr\u003e\nSign\t0\t1\t2\t1\u003cbr\u003e\nmin\t5\u003cbr\u003e\nmin\u003cbr\u003e\nSkin Color\tBlue, pale\tBody pink, extremities blue\tCompletely pink\t\t\u003cbr\u003e\nHeart Rate\tAbsent\t\u003c 100\t\u003e100\t\t\u003cbr\u003e\nIrritability\tNo Resp\tGrimaces\tCries\t\t\u003cbr\u003e\nMuscle Tone\tLimp\tSome flexion of extremities\tActive motion\t\t\u003cbr\u003e\nResp. Effort\tAbsent\tSlow \u0026 irregular\tStrong cry\t\t\u003cbr\u003e\n\t\t\tTOTAL SCORE\t\t\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nPre-Term and Premature newborn considerations\u003cbr\u003e\n\u003cbr\u003e\n3.\tHypothermia is a real risk and every effort should be made to keep the infant warm during the evaluation, treatment, and resuscitation phases. Be aggressive in warming. If plastic sheet or “space blanket” available place on newborn prior to blanket.\u003cbr\u003e\n4.\tDon’t delay treatment to obtain an APGAR Score if necessary.\u003cbr\u003e\n5.\tPulse oximeter levels will always start low and improve over the first few minutes.\u003cbr\u003e\n6.\tThe pattern should be: Dry/Warm/Stimulate-Ventilate-Evaluate-Resuscitate.\u003cbr\u003e\n7.\tIV/IO access may be challenging. Should be only attempted if Resuscitation called for.\u003cbr\u003e\n8.\tObtain BGL and treat hypoglycemia if present.\u003cbr\u003e\n9.\tPulse oximetry values between 85 and 95 preferable by ten minutes.\u003cbr\u003e\n10.\t90% of infants require little more than drying and warming. 10 % require ventilatory assistance, and 1% require resuscitation.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2126497/10042797"},{"listId":10042800,"catId":2126497,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"PRE-ECLAMPSIA/ECLAMPSIA","summary":"","detail":"PRE-ECCLAMPSIA\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nPregnant patient complicated by hypertension and characterized by proteinuria, extremity edema, headache, visual disturbances, RUQ abdominal pain and may progress to ecclamptic seizures.\u003cbr\u003e\n\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n1.\tAssess ABC’s and address as appropriate\u003cbr\u003e\n2.\tBlood pressure \u003e140/90 or 20 mmHg rise systolic or 10 mmHg diastolic over baseline\u003cbr\u003e\n3.\tKeep patient in a left lateral decubitus position and keep away from intense stimulus (i.e. bright lights, loud noises, etc.). Headache, visual problems, abdominal pain or BP \u003e 160/100 indicate more severe disease.\u003cbr\u003e\n4.\tAdminister OXYGEN titrated to patient condition. \u003cbr\u003e\n5.\tAnticipate seizures. \u003cbr\u003e\n6.\tUnless delivery is imminent, transport immediately.\u003cbr\u003e\n7.\tEclamptic seizures can occur up to 2 months post-partum\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tEstablish IV/IO\u003cbr\u003e\n2.\tConsider ALS intercept\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tIf patient is symptomatic and SBP \u003e170 mmHg or DBP \u003e110 mmHg consider MAGNESIUM SULFATE 4 gm. IV/IO over 20 minutes.\u003cbr\u003e\n2.\tIf seizure occurs \u003cbr\u003e\na.\tMAGNESIUM SULFATE 4 gms slow IV/IO\u003cbr\u003e\nb.\tMIDAZOLAM 0.2 mg./kg. up to 10 mg. IM is safe and effective route for seizures. 2-4 mg slow IV/IO/IN. Repeat as needed.\u003cbr\u003e\n3.\tFor Magnesium Sulfate toxicity, administer CALCIUM PREPERATION [5-10 ml] slow IV/IO. Do not exceed 2ml/min.\u003cbr\u003e\n4.\tIf patient has a seizure disorder initiate treatment with benzodiazepine initially. If eclamptic seizure suspected treat with magnesium.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2126497/10042800"}],"data":false,"categoryData":{"catName":"OB/GYN GUIDELINES","catId":2126497,"catIcon":""},"parentCategoryData":{"catId":2114007,"catName":"GUIDELINES"}}}},"page":"/[...slug]","query":{"slug":["2126497"]},"buildId":"1234567890","isFallback":false,"dynamicIds":[1204],"customServer":true,"gip":true,"scriptLoader":[]}