Name: EMT 5-11：產科和婦科病學 (EMT 5-11: Obstetrics and Gynecology)
Uploaded: 2021-01-14T06:18:47.000Z
Duration: 1 h 3 min 16 s
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關係子句

Welcome to this module in which we will be discussing obstetrics and gynecology.

Upon completion of this module, you should be able to: Define terms associated with female

reproductive anatomy; define terms associated with the process of labor; discuss cultural

values affecting pregnancy; identify special considerations of adolescent pregnancy; summarize

the normal physiology of pregnancy; list and describe signs and stages of labor; list components

of assessment for an obstetrical patient; identify the contents of an obstetrics kit;

state indications of an imminent delivery; list steps for a normal delivery; discuss

initial care of the newborn; summarize neonatal resuscitation procedures; describe complications

of pregnancy, labor, delivery, and postpartum; discuss gynecological emergencies; and, describe

the age-related variations for pediatric and geriatric assessment and management of the

female patient. You should also be able to appreciate the

emotions that a sexual assault victim may be experiencing.

Lastly, as a portion of a subsequent classroom lab, you should be able to: Demonstrate the

steps to assist in the normal delivery of a baby; demonstrate the steps to assist in

complicated deliveries; demonstrate infant neonatal procedures; demonstrate post-delivery

care of an infant; demonstrate the post-delivery care of the mother; demonstrate the steps

in management of the mother with excessive bleeding; and, demonstrate completing a prehospital

care report for patients with obstetrical or gynecological emergencies.

A women�s external genitalia, referred to as the vulva, consists of four major structures:

the labia minora, labia majora, clitoris, and vaginal vestibule or orifice.

The labia minora consists of two thin inner folds of skin within the vestibule of the

vagina. The labia majora is comprised of the outer

folds of skin and adipose tissue surrounding the vaginal opening; this structure defines

the lateral boundaries, if you will, of the external female genitalia.

The clitoris is a small, elongated erectile organ located anteriorly on the vulva.

The vaginal vestibule or orifice is the opening to the vagina. The opening is protected by

the labia minor and majora. These structures are all contained within

an area known as the perineum. The perineum is a diamond-shaped area corresponding to

the outlet of the pelvis. Both men and women have a perineum. In women, the area encompasses

the vulva as well as the anus. It is bounded by the coccyx posterior, the pubic arch anterior,

and the inside of the thighs laterally. Also located within this are is the urethra,

a membranous tube that extends from the urinary bladder to the exterior of the body for the

voiding of urine. Moving to the internal female reproductive

organs, the uterus is a muscular, hollow organ located along the midline in most women�s

lower abdominal quadrants. The organ is designed for implantation of a fertilized egg where

it can develop into a fetus. During the final stages of pregnancy, the uterus is also responsible

for labor and muscular contractions for expulsion of the baby.

Ovaries are small, round organs located on either side of most women�s lower abdominal

quadrants. These organs are responsible for producing ova (eggs) for conception. The ovaries

also produce many of the hormones necessary for the process of reproduction.

The ovaries and uterus are connected via fallopian tubes. When an egg is released from an ovary,

it travels down the fallopian tube into the uterus. If fertilization of an egg occurs,

it commonly does so while in a fallopian tube. In a normal pregnancy, the fertilized egg

will continue its journey down the fallopian tube into the uterus for implantation and

continued development. Given a pregnancy, the woman is carrying a

fetus and other supportive structures. The fetus is simply the developing baby within

the uterus. At eight weeks of development, the fetal stage officially begins. From that

point, until delivery, the developing baby is referred to as a fetus.

The placenta is attached to the wall of the uterus and exchanges oxygen, nutrients, and

wastes between the mother and the fetus through the umbilical cord.

The umbilical cord contains blood vessels that carry blood containing oxygen and nutrients

to the baby, as well as vessels that transport blood with fetal waste products back to the

placenta and the mother. Some additional terms and definitions as they

relate to labor and delivery are as follows: Labor is the process of having (or delivering)

a baby. While various resources define labor as consisting of either three or four stages,

it is commonly held to begin with the first uterine muscle contraction and it ends once

the placenta is expelled from the woman. Bloody show is mucus and blood that may be

expelled from the vagina as labor begins. Presenting part is the body part of the baby

that exits the labor canal first. While this is commonly the head, given a typical delivery,

it can also be an arm, leg, or buttocks. Crowning is the appearance of the fetal scalp

at the vaginal orifice during delivery. Spontaneous abortion, also known as a miscarriage,

is the delivery of the product of conception early in pregnancy (before the 20th week).

While EMS providers must be culturally sensitive in all patient interactions, calls involving

obstetrics and gynecology are even more critical in this regard. Women in all cultures have

a value system that will affect their pregnancy. This can include how the woman cares for herself

during the pregnancy as well as how they have planned the childbirth process. In some cultures,

for instance, it is not permissible for the woman to have a male healthcare provider assisting

in the delivery. These cultural differences may also involve social, psychological, and

emotional factors. In some cultures, being pregnant is associated with achieving status

and recognition within their family unit. For some women, on the other hand, being pregnant

results in a lower self-esteem. As an EMS provider, respect these differences and honor

the patient�s requests, remembering that any competent adult has the legal right to

refuse any part of assessment or care. Adolescent pregnancy is rampant in the United

States with UNICEF reporting in 2001 a birth rate of 52.1 per 1,000, the highest in the

developed world and more than twice the European average. As of 2011, the CDC has reported

a teen birth rate of 31.3. While this rate has decreased over the course of 10 years,

the CDC also recognizes a tremendous disparity in teen birth rates between racial and ethnic

groups with rates anywhere from approximately 10 to 50 per 1,000 based upon the race or

ethnicity of the group. In many instances, socioeconomic factors seem to be involved

and one reason why teen pregnancy is deemed socially undesirable is illustrated by the

CDC statistic that one-half of pregnant teenagers do not finish high school. The trickle-down

effect of that is an inability for the mother to find employment and earn a livable wage

without that basic level of education. Regardless the factors surrounding a teenage pregnancy,

the EMS provider assessing a pregnant teenage female must be professional and non-judgmental

at all times. Depending on the age of the patient, providing care may be complicated

by the level of physical and psychological maturity and development of the patient. Additionally,

a pregnant minor is still a minor, meaning that her parents may still have the legal

authority to authorize or decline healthcare for her. (Remember from the legal module of

this course that Wisconsin does not commonly recognize emancipated minors as other states

do.) It can also be common, depending on how long the patient has been pregnant, for her

to not know about the pregnancy, to be in denial about the pregnancy, or to have not

told her parents about the pregnancy. When assessing female patients, especially those

with gastrointestinal or abdominal complaints, always consider the possibility of the patient

being pregnant. Also keep in mind the patient�s need for independence and privacy. If possible,

it may be better for the teenage patient if any assessment is performed or history is

obtained away from her parents. If you have not covered it yet, one of the

modules within this course will discuss the legal obligation of an EMT to report to law

enforcement any suspected child abuse or neglect. This becomes pertinent when discussing adolescent

pregnancies because it is considered sexual abuse of a child in Wisconsin for a person

to have sex with a minor under the age of 16 (meaning 15 years of age or younger). If