PROTOCOl 24 Pregnacy,childbirth,miscarriage

by Jawad Ahmed
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 OBJECTIVES
To define Pregnancy , Trimester of pregnancy and
Miscarraige.

To define imminent delivery and post dispatch

instraction given by PRO QA .

Emergencies deals by Aman Foundation Area wise,

Code wise and average emergencies a day deals by
AmanFoundation
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 DEFINITION OF PREGNANCY
Period from conception to birth of baby. After the
egg is fertilized by a sperm and then implanted in the
lining of the uterus. Pregnancy usually lasts 40 weeks,
beginning from the first day of the woman's last
menstrual period, and is divided into three
trimesters.

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 STAGES OF TRIMESTERS
 THERE ARE THREE TRIMESTERS IN PREGNANCY#

 1ST Trimester (0 to 3 months)

(0 to 12 weeks )

 2nd Trimester (4 to 6 months)

(13 to 24 weeks)

 3rd Trimester (7 to 9 months)

(25 to 40 weeks)

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 BREECH OR CORD PRESENTATION

During the childbirth

the presentation of
the umbilcal
cord,hands,feets or
buttocks first from
the birth canal is
know as breech
 IMMINENT DELIVERY
AN IMMENENT DELIVERY DEFINE AS

Any PRIMA GRAVIDA (first child or pregnant) women

in her third trimester with labour pains less than two
minutes aparts

 Any MULTI GRAVIDA women ( pregnant and delivered

more than once ) having labour pains less than five
minutes aparts

# AS CONSIDER AS IMMINENT DELIVERY

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 CHARACTERISTICS OF LABOUR

TRUE LABOUR
= Regular interval pains Other cardiac
= Gradually shorten interval
diseases
= Gradually increased pian intensity
= Viginal discharge : water / blood

FALSE LABOUR
= Irregular interval intensity

Smoking

Diabetes

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 INSTRUCTIONS COMMONLY PROVIDED
FOR CHILDBIRTH
 Oral
Donot try to prevent the by holding the legs Contraceptive
together or crossingUse
the legs.
Have mother remove all cloths below the waist

Get mother on the bed or floor and prop her back up with pillows

Have mother take deep breath during pain and try not to push

Following specific childbirth pre arrivals instruction and PDI scripts as written
in the approved MPDS
DFDFS
DFSF
 Obesity

 Physical Inactivity

 Poor Diet/Nutrition

 Alcohol Abuse
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 Drug Abuse
 MISCARRIAGE
Definition of Miscarriage
Miscarriage means
loss of an embryo or fetus before the 20th week
of pregnancy. Most miscarriages occur during
the first 14 weeks of pregnancy. The medical
term for miscarriage is spontaneous abortion.

Miscarriages are very common. Approximately

20% of pregnancies (one in five) end in
miscarriage. The most common cause is a
genetic abnormality of the fetus. Not all
women realize that they are miscarrying and
others may not seek medical care when it
occurs
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 CAUSES OF MISCARRIAGE
 There are many reasons why a woman's
pregnancy ends in miscarriage. Often the
cause is not clear. However, more than half
the miscarriages that occur in the first
eight weeks of pregnancy involve serious
chromosomal abnormalities or
birth defects that would make it
impossible for the baby to survive. These
are different from inherited genetic
diseases. They probably occur during
development of the specific egg or sperm,
and therefore are not likely to occur again.
The most common symptom of
miscarriage is bleeding from the vagina,
which may be light or heavy
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HIGH RISK COMPLICATIONS
Local medical advisory group must define and
authorise any of the patient conditions below
before this determinant can be used. Situations
may include
= premature birth ( 20-36 weeks)
= multiple birth (>or= to 20 weeks)
= blood disorder
= blood thinners

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 SOME VERY IMPORTANT RULES MENTION
IN APPROVED MPDS
1. An unconscious.pegnant patient in her 3rd trimestershould be
placed on her left sede with a pillow or like object wedged
behind her lower back. Airway and CPR instructions should
then be completed in this position

2. When crowning(top of baby’shead is visible and or pushing is

present, turn to PAI crowning since birth is imminent

3. Presentation of cord. hand, feet or buttocks first(BREECH) is a

dire prehospital emergency

4. pregnant patient who have illness as the primary complaint

should be handled on protocol 26 unless the porblems concerns
viginal bleeding labour, MISCARRIAGE. Or water broken.
 COMMON SYPTOMS DESCRIBED BY CALLER

Irregular vaginal
bleeding with associated
shock symptoms

Onset of labour, water

breaking

Imminent birth as
defined above

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PROBLEMS FACES BY EMDS ON CALL IN OUR
ENVIRONMENT
NEVER GIVES PROPER INFORMATION BY
ATTENDENT SIDE

LANGUAGE BARRIER

MAJORITY TIMES ATTENDENT ARE IN VERY

HURRY AND NEVER GIVES ANWERS PROPERLY

CONTRACTION IN CHOOSING IMMINENT

DELIVERY AND LABOUR BUT NO T IMMINENT
AS ATTENDENTS DO NOT KNOW THE
DURATION OF GAPS BETWEEN THE PAINS

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 Key Question in proved MPDS
 How many weeks (or months) pregnant is she ?
 (> or = to 5 months/weeks) Can you see (feel or touch) any part of the baby
now?(Go and check and tell me what u find
BREECH or CORD------------------------------ 24 D 1
Head visible/out-------------------------------- 24 D 2
Baby Born (complication with baby)------ 24 D 6
Baby Born (complication with mother)-- 24 D 7
Baby Born (no complications)-------------- 24 C 3
 (>5 months / 20 weehs) Is she having contractions (labour pains)?
a. (Yes) Is this her first delivery?
b. (Yes) How many minutes apart are the contractions (labour pains)?
 Is there any SERIOUS bleeding?
 Does she have any HIGH RISK complications?
 (>8) Can i speak with the patient to verify her condition?
 (Yes) Did you verify her condition? 16
DETERMINANT DESCRIPTORS
D 1 BREECH or CORD 24 D 1
2 Head visible / out 24 D 2
3 IMMINENT delivery (>5 months/20weeks) 24 D 3
4 3rd TRIMESTER haemorrhage 24 D 4
5 HIGH RISK complications 24 D 5
6 Baby Born (complications with baby) 24 D 6
7 Baby Born (complications with mother) 24 D 7

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DETERMINANT DESCRIPTORS
C12 nd TRIMESTER haemorrhage or MISCARRIGE 24 C 1
2 1st TRIMESTER SERIOUS haemorrhage 24 C 2
3 Baby born (no complications) 24 C 3

B 1 Labour (delivery not imminent >5months/20weeks) 24 B 1

2 Unknown status / Other codes not applicable 24 B 2

A 11 st TRIMESTER haemorrhage or MISCARRIAGE 24 A 1

without 1st party verification
1 Waters broken (no complications or presenting parts) 24 O 1
2 1st TRIMESTER haemorrhage with patient 24 O 2

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 POST DISPATCH INSTRUCTION GIVEN IN MPDS
Im organising help for you now.
 Stay on the line and i’ll tell you exactly
what to do next.
 Do not try to prevent the birth (do not
cross legs).
 Tell her not to sit on the toilet.
 Allow her to assume the most comfortable
position and have her take deep breaths
bewteen contractions (labour pain).
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DLS *Link to X-1 unless
 BREECH or CORD------------------------F-20
 Head visible(crowning)-----------------F-5
 Head out-----------------------------------F-6
 IMMINENT delivery----------------------F-1
 Baby born----------------------------------F-7
 Labour (delivery not imminent)------F-12
 Other situations (MISCARRIAGE)---X-1

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Nature Wise Report In Pregnancy Protocol

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THANK YOU

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HIGH RISK Complications
Local Medical Advisory Group must define &authories
any of patient conditons below,before this
determint can used. Premature
birth(20—36 weeks) Multiple birth(> 20
weeks) Bleeding disorder
Blood thinners Pre
eclampsia/eclampsia Gastational
diabeties(P.I.D) Cord around the neck
M.A.R.S

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