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Obstetrical/Gynecological

Inclusion Criteria: Women of childbearing age with a chief complaint related to pregnancy, impending delivery, 1st month postpartum, or gynecological in nature. Unstable patients require aggressive resuscitation and stabilization measures before routine actions specified in this guideline. Maternal resuscitation is the key to survival of both mother and fetus.

Special Note: High-risk pregnancy/delivery includes pre-term delivery, breech presentation, multiple births, meconium staining, placenta previa, abruptio placentae, prolapsed cord, preeclampsia, eclampsia, drug abuse, or lack of prenatal care.

          Basic Level

  1. Assess and support ABC's. Monitor pregnant patient closely for vomiting and risk of pulmonary aspiration.

  2. Place the pregnant patient in position of comfort. Place third trimester patient on her left side. For trauma, immobilize the pregnant patient supine on a long spine board, but transport with the board at a 10-15° angle to the left.

  3. Administer oxygen, as needed to maintain a SpO2 of at least 96%. If high-risk pregnancy/delivery, administer 100% oxygen by non-rebreather mask.

  4. If delivery is imminent, prepare for immediate childbirth.

    Advanced Level

  5. If bleeding or seizure is present, labor is premature, or high-risk pregnancy/delivery, contact BioTel as early as possible. Begin transport as soon as possible to a facility capable of handling a complicated obstetrical emergency.

  6. Apply ECG and EtCO2 monitors if high-risk pregnancy/delivery.

  7. If the patient is experiencing severe pain, she can self-administer nitrous oxide (optional medication). Instruct the patient to inhale deeply through the patient-held mask or mouthpiece. DO NOT administer nitrous oxide to high-risk pregnancy/delivery patients (100% oxygen only).

  8. Consider establishing IV access at a TKO rate or use a saline lock. Administer 250 ml boluses as needed to maintain adequate perfusion. Do not exceed 1 liter of IV fluids unless authorized by BioTel. If needed, refer to Shock guideline.

  9. For seizures related to eclampsia, administer
    a.    slow IVP diazepam in 2.5 mg – 5 mg increments until seizure stops or to a maximum of 10 mg, or
    b.    midazolam in 2.5 mg – 5 mg increments slow IVP (max 5 mg) or IN (max 10 mg) until seizure stops or max dose
    c.    If seizure persists, contact BioTel for magnesium sulfate consideration

  10. For additional patient care considerations not covered under standing orders, consult BioTel.

 

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