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 these guidelines.  Maternal resuscitation is the key to survival of both mother and fetus. (Pre-)eclampsia can occur as late as 4-6 weeks postpartum.

Special Note:  High-risk pregnancy/delivery includes pre-term delivery, breech presentation, multiple births, meconium staining, placenta previa, placental abruption, shoulder dystocia, prolapsed cord, preeeclampsia, eclampsia, drug abuse, or lack of prenatal care.  Refer to the EMERGENCY CHILDBIRTH Special Procedures.

Basic Level

  1. Assess and support ABCs.  Monitor the pregnant patient closely for vomiting and risk of pulmonary aspiration.
  2. Place the pregnant patient in position of comfort.  Place a 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° to 15° angle to the left (left lateral decubitus).  Refer to the SPINAL MOTION RESTRICTION Policy.
  3. Administer oxygen, as needed, to maintain a SpO2 of at least 94%.  If high-risk pregnancy/delivery, administer 100% oxygen by non-rebreather mask (100% NRBM).
  4. If delivery is imminent, prepare for immediate childbirth.

Advanced Level

  1. For hemorrhage, seizure, pre-term labor, or other 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. Refer to the DESTINATION Policy and the EMERGENCY CHILDBIRTH Special Procedures.
  2. For cord prolapse, apply moist saline gauze to the exposed cord, insert gloved fingers into the vaginal canal and elevate the presenting part off the cord. Maintain elevation until a hospital provider takes over.
  3. Continuously monitor ECG and ETCO2.
  4. Pain management: NON-high risk patient with severe pain – Consider IV/IO analgesia, per the PAIN MANAGEMENT Guidelines. High-risk patient with severe pain – Consult PAIN MANAGEMENT Guidelines, but use extreme caution administering IV/IO analgesia. Monitor all patients receiving IV/IO analgesia (and their infant(s)) for adverse effects, especially cardiorespiratory depression, sedation, & aspiration.
  5. Consider establishing IV/IO access at a TKO rate or use a saline lock.  Administer 20 mL/kg boluses as needed to maintain adequate perfusion.  Do not exceed 1 liter of IV fluids unless authorized by BioTel.  If needed, refer to the SHOCK Guidelines.
  6. For seizures related to eclampsia, refer to the SEIZURE Guidelines and administer:

Adult

Pediatric