Obstetrics

  • Maternal Bleeding During Pregnancy
  • Preeclampsia/Eclampsia
  • Prolapsed Umbilical Cord
  • Breech Presentation
  • Postpartum Hemorrhage

Maternal Bleeding During Pregnancy

BLS

 

  1. Begin Initial Medical Care.

    2.  

  2. Follow Airway Management Protocol.

    3.  

  3. Administer oxygen at 10-15 lpm by NRB mask.

    4.  

  4. If patient has signs/symptoms of shock, call for a paramedic unit. See ALS and BLS Team Approach.

    5.  

  5. Have patient estimate the number of pads soaked per hour. Determine when bleeding began.

    6.  

  6. Prepare to treat for shock.

    7.  

  7. Transport emergent in left lateral recumbent position if ≥ 20 weeks gestation or if uncontrollable bleeding is present.

 

ALS

 

  1. Establish 2 large bore IV’s of 0.9% NaCl or LR. LR should not be used in blood products are being transfused in the same line. Titrate fluids to a SBP of 90 mmHg.

 

Refer to Non-Cardiogenic Shock other protocols as patient condition requires.

Preeclampsia/Eclampsia

Any pregnant or recently delivered (within 4 weeks) woman with the presence of hypertension (BP >140/90) and possibly marked edema of the face, hands, and/or feet.

 

  1. Begin Initial Medical Care.

    2.  

  2. Follow Airway Management Protocol.

    3.  

  3. Transport non-emergently (without lights or siren) in a darkened ambulance.

    4.  

  4. If patient begins to have seizures, see Seizures Protocol

    5. Note that midazolam is still given before the magnesium.

Prolapsed Umbilical Cord

  1. Administer high flow oxygen to the mother. (See Administration of Oxygen Protocol)

    2.  

  2. Place patient in left lateral recumbent position.

    3.  

  3. Elevate presenting part off of the umbilical cord by using a gloved hand in vagina. Keep elevated until relieved at hospital.

    4.  

  4. Call for ALS and initiate transport.

    5.  

  5. Contact receiving facility as early as possible

 

Breech Presentation

  1. Administer high flow oxygen to the mother. (See Administration of Oxygen Protocol)

    2.  

  2. Place patient in left lateral recumbent position.

    3.  

  3. Check for prolapsed cord.

    4.  

  4. Contact receiving facility as early as possible

Postparum Hemorrhage

Any patient who has an estimated blood loss exceeding 500 ml following childbirth.

 

BLS

 

  1. Contact receiving facility for further orders if ALS is not on scene.

    2.  

  2. Call for ALS and initiate transport.

    3.  

  3. Administer high flow oxygen to mother. (See Administration of Oxygen Protocol)

    4.  

  4. Massage the fundus of the uterus after delivery of the placenta until firm. Check fundus every 5 minutes for firmness and repeat massage as necessary.

 

ALS

 

  1. Insert 2 large bore IV's with normal saline or LR and run wide open to maintain a SBP of 90 mm Hg. Do not use LR if blood products are being given in the same line.

    2.  

  2. Contact receiving facility as early as possible. Activate as a medical alert if blood Loss >500ml, HR ≥110 BPM, Systolic BP ≤90mmHg or SPO2 < 94%.