The vagina is also called the birth canal. It is a muscular tube that serves as a passageway between the uterus and the outside of the body.
The placenta is a specialized organ through which the fetus exchanges nourishment and waste products during pregnancy. It attaches to the mother at the inner wall of the uterus and to the fetus by the umbilical cord. The placenta begins to develop about 2 weeks after fertilization occurs.
The umbilical cord is the lifeline that connects the placenta to the fetus. It contains two arteries and one vein. The umbilical vein carries oxygen-rich blood to the fetus. The umbilical cord attaches to the umbilicus (navel) of the fetus.
The amniotic sac is a membranous bag that surrounds the fetus inside the uterus. It contains fluid (amniotic fluid), which helps protect the fetus from injury. The amniotic fluid provides an environment that is at a constant temperature. It also allows the fetus to move and functions much as a shock absorber does.
The first trimester is the first three months of pregnancy.
The mother stops menstruating (missed period). She urinates more frequently and may sleep more than usual. Nausea and vomiting (usually called "morning sickness") are usually at its worst during the second month.
The fetus develops rapidly. Fetal cells differentiate into tissues and organs. The arms, legs, heart, lungs, and brain begin to form. At the end of the first trimester, the fetus is about 3 inches long and weighs about 1/2 ounce.
The second trimester is months 4-6 of the pregnancy.
The uterus expands to make room for the fetus. The mother's abdomen enlarges and her center of gravity often changes. The mother begins to feel the fetus move at about the fourth or fifth month. Her circulatory system continues to expand, which lowers her blood pressure.
The fetus's fingers, toes, eyelashes, and eyebrows are formed. At about the fifth month, the heartbeat of the fetus can be heard with a stethoscope. By the end of this trimester, the heart, lungs, and kidneys have formed. The fetus weighs about 1 3/4 pounds and is about 13 inches long.
The third trimester is months 7-9 of the pregnancy.
The mother may experience a backache due to muscle strain. Stretch marks may appear. The mother urinates frequently because the weight of the uterus presses on the bladder. She may be short of breath as her uterus expands beneath the diaphragm.
The fetus continues to grow rapidly, gaining about 1/2 pound a week and reaching a length of about 20 inches. Fetal movement occurs often and is stronger. Normally, the head of the fetus settles into the pelvis in preparation for delivery.
An abortion is a termination of pregnancy before the fetus is able to live on its own outside the uterus.
A therapeutic abortion is an abortion performed for medical reasons, often because the pregnancy poses a threat to the mother's health.
An elective abortion is an abortion performed at the request of the mother.
A spontaneous abortion, also called a miscarriage, is a loss of a fetus due to natural causes. It usually occurs before the 20th week of pregnancy. In most miscarriages, the fetus dies because of a genetic abnormality that is usually unrelated to the mother. During a miscarriage, the mother experiences lower back pain or cramping abdominal pain, vaginal bleeding, and the passage of tissue or clotlike material from the vagina.
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus. The most common site where this occurs is inside a fallopian tube. In an ectopic pregnancy, the growing fetus bursts through the tissue in which it has implanted. Severe bleeding can occur due to ruptured blood vessels.
Preeclampsia is a disorder of pregnancy that causes blood vessels to spasm and constrict. Blood vessel constriction results in high blood pressure. It also decreases blood flow to the mother's organs, including the placenta. Less blood flow to the placenta usually means that less oxygenated blood and fewer nutrients reach the baby. Preeclampsia usually occurs during the third trimester of pregnancy.
If untreated, preeclampsia may progress to eclampsia. Eclampsia is the seizure phase of preeclampsia. In treating eclampsia, you should have suction readily available. Provide oxygen if it is available and you have been trained to use it. Keep the patient calm and position her on her left side. Avoid any stimulus that might trigger a seizure, such as bright lights and siren noise.
Placenta previa occurs when the placenta attaches low in the wall of the uterus instead of at its top or sides. In this position, the placenta may cover all or part of the cervix (the entrance to the birth canal). Placenta previa can cause sudden, painless, bright red vaginal bleeding.
Abruptio placenta occurs when a normally implanted placenta separates prematurely from the wall of the uterus (endometrium) during the last trimester of pregnancy. If the placenta begins to peel away from the wall of the uterus, bleeding occurs from the blood vessels that transfer nutrients to the fetus from the mother. The placenta may separate partially or completely. Partial separation may allow time for treatment of the mother and fetus. Complete separation often results in the death of the fetus.
A ruptured uterus is the tearing (rupture) of the uterus. Uterine rupture can occur when the patient has been in strong labor for a long time, which is the most common cause. It can also occur when the patient has sustained abdominal trauma, such as a severe fall or a sudden stop in a motor vehicle collision.
Due to the normal changes in vital signs that occur with pregnancy, assessing the patient's vital signs may not be as useful as it is with a nonpregnant patient. A pregnant patient's heart rate is normally slightly faster than usual. Her breathing rate is also slightly faster and more shallow than normal. Her blood pressure is often slightly lower than normal until the third trimester. It is important to take vital signs in all patients. However, you will need to pay special attention to the pregnant patient's history and look for other signs that suggest a potential problem.
In treating a pregnant patient, you should obtain a SAMPLE history to gather information about the patient's medical history:
Signs and symptoms
Allergies
Medications (prescribed, herbal, or recreational drug use)
(Pertinent) past medical history (prenatal care and preexisting illness)
Last oral intake
E vents leading to the injury or illness
As an Emergency Medical Responder, you must not visually inspect the vaginal area unless major bleeding is present or you anticipate that childbirth is about to occur. In these situations, it is best to have another healthcare professional or a law enforcement officer present. The vaginal area is touched only during delivery and when another healthcare professional or a law enforcement officer is present.
An obstetric emergency is an emergency related to pregnancy or childbirth. It is frequently associated with bleeding. During childbirth, blood and amniotic fluid are expected and may splash. Therefore, in caring for a patient with an obstetric emergency, you should take BSI precautions and put on appropriate PPE. In addition to gloves, you should wear eye protection, a mask, and a gown.
Labor is the time and process in which the uterus repeatedly contracts to push the fetus and placenta out of the mother's body. It begins with the first uterine muscle contraction and ends with delivery of the placenta. Delivery is the birth of the baby at the end of the second stage of labor.
Before labor begins, the head of the fetus normally settles into the pelvis. The cervix begins to open (dilate) and thin out (efface). In addition, the mucous plug may be expelled (bloody show).
The first stage of labor begins with the first uterine contraction. This stage ends with a complete thinning and opening of the cervix. Contractions usually last 30-60 seconds and occur every 5-15 minutes. In a woman who has not previously given birth, this stage of labor lasts about 8-16 hours. It lasts about 6-8 hours in a woman who has previously given birth.
The second stage of labor begins with the opening of the cervix and ends with the delivery of the infant. The contractions during this stage are stronger. They last 45-60 seconds and occur every 2-3 minutes. This stage of labor averages 1-2 hours in a woman who has not previously given birth. In a woman who has given birth, this stage of labor lasts 20-30 minutes.
During this stage, the fetus begins its descent into the birth canal. The presenting part is the part of the infant that comes out of the birth canal first. Normally, the first part of the infant that descends into the birth canal is the head. This type of delivery is called a cephalic (head) delivery. If the buttocks or feet descend first, it is called a breech delivery. Eventually, the presenting part will remain visible at the vaginal opening between contractions, which is called crowning.
The third stage of labor begins with delivery of the infant and ends with delivery of the placenta. The placenta peels away from the wall of the uterus, leaving tiny blood vessels exposed. The uterus normally contracts to close these blood vessels. The placenta usually delivers within 15-30 minutes of the infant's birth. This stage of labor normally lasts 5 minutes to an hour.
Women often have false labor pains about 2-4 weeks before delivery. False labor pains are called Braxton Hicks contractions. These contractions help prepare the woman's body for delivery by softening and thinning her cervix.
As an Emergency Medical Responder, you should transport a woman in labor to the hospital unless delivery of the baby is expected within a few minutes. You must determine if there is time for the mother to reach the hospital or if preparations should be made for delivery at the scene. Consider delivering at the scene in the following three circumstances:
Delivery can be expected in a few minutes.
A woman in late pregnancy feels the urge to push, bear down, or have a bowel movement.
Crowning is present.
No suitable transportation is available.
The hospital cannot be reached due to heavy traffic, bad weather, a natural disaster, or a similar situation.
