Postpartum Carein EMS : Postpartum Carein EMS Lt. Mark Smikahl BS, NREMT-P
Thompson Valley EMS
Loveland, Colorado
Definition of care… : Definition of care… Encompasses care of both the mother and the newborn
The postpartal period is that time after childbirth, and technically is six weeks in length
EMS plays an initial role in the prehospital environment
What is the purpose? : What is the purpose? Immediately following childbirth, the mother will experience many emotional and physical changes
Precautions to consider… : Precautions to consider… Infection
Placental delivery
Hemorrhage
Blood clots
Hypertension
Pain
Immediate depression
Postpartum care…the initial phase for EMS : Postpartum care…the initial phase for EMS This includes the first one to two hours following childbirth
Assessment of pain, the uterus, vaginal discharge, the condition of the perineum, and the presence or absence of bladder distension should all take place every 15 minutes and each should be documented and reported at the receiving hospital
Placental Delivery : Placental Delivery Normally occurs in the first 20 minutes following childbirth
Should not delay transport
Characterized by contractions, palpable rise of the uterus, lengthening of the protruding umbilical cord from the vagina, and a sudden gush of blood on placental delivery
Placental Delivery : Placental Delivery Have the mother bear down with contractions
Hold the placenta firmly with both hands, and gently begin twisting it during its delivery to help it separate from the uterine wall (do not pull the cord!)
Inspect the placenta for tears/hemorrhage and to ensure it is whole, and place in a red bio-bag for re-inspection at the hospital
Placental Delivery : Placental Delivery
Perineal Tears : Perineal Tears Once delivery of the placenta is complete, inspect the perineum for tears or hemorrhage
If tears are present, place sanitary napkins over the tears, and provide direct pressure until the bleeding is controlled
Ice packs can be used with the napkins
Make sure to re-check for blood soaked pads, and document the number of pads used during the increment of time
Note the number and size of hemorrhoids and hematomas
Managing Postpartum Hemorrhage : Managing Postpartum Hemorrhage Characterized by blood loss > 500cc
Often occurs in the first two hours, but in rare cases, it can occur up to 24 hours after childbirth
Occurs in 5% of all childbirths
Often are the result of ineffective or incomplete contraction of the interlacing uterine muscle fibers
Managing Postpartum Hemorhhage : Managing Postpartum Hemorhhage Additional causes may be from an incomplete placental delivery (remember to check!)
Vaginal or cervical tears
Uterine rupture
Managing Postpartum Hemorrhage : Managing Postpartum Hemorrhage Control external hemorrhage
Uterine massage…palpate the uterus for firmness or loss of tone (uterine atony). If atony is present, cup the lower portion of the uterus superior to the symphysis with one hand, and then firmly massage the fundus with the other. This will result in significant pain if done correctly!
Managing Postpartum Hemorrhage : Managing Postpartum Hemorrhage Encourage breast-feeding if both the mother and infant are stable. This stimulates hormonal changes which promote uterine contraction.
Do not attempt vaginal examination!
Do not place packing inside of the vagina!
Do not delay transport!
Use crystalloid IVs per protocol
Managing Postpartum Pain : Managing Postpartum Pain Analgesia is one technique for managing postpartum pain
Fentanyl has been deemed safe by the FDA as there has not been any noted neonatal respiratory depression or neurological impairment in multiple studies
Breast engorgement is often very painful, but can be relieved with breast-feeding and heat packs
Managing Postpartum Pain : Managing Postpartum Pain Breast engorgement is usually bilaterally and accompanied with a low grade fever
If your postpartum patient presents with a headache, you must ensure it is not because of hypertension
Questions? : Questions?
References : References Sanders, M. J. (2007). Mosby's paramedic textbook. St. Louis, MO: Elsevier Mosby.