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When the placenta separates from the uterine wall, placenta blood vessels rupture, and
spontaneous bleeding starts. The mother may go into shock, and the fetus may not
have enough oxygen. Signs of this condition include abdominal pain and rapid onset of
labor. The uterus becomes rigid. To treat, transport the mother immediately to a
hospital and treat for shock.
(2) Placenta previa. Here, the presenting part is the placenta. Since the
placenta has many blood vessels, a massive hemorrhage may occur.
(3) Uterine rupture. A uterine rupture is a tearing of a part of the uterus.
The patient has sudden, severe abdominal pain, and a rigid abdomen. Bleeding may
not be apparent externally, but the patient can have profound shock from internal
hemorrhage.
CAUTION: DO NOT attempt to examine the patient internally, regardless of the
cause of antepartum hemorrhage.
b. Management of Antepartum Hemorrhage. Manage as follows:
(1) Place the patient flat on a stretcher, lying on her side.
(2) Administer oxygen to the patient.
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(3) Start at least two large-bore IV lines. Give crystalloid or colloid as
rapidly as needed to maintain the patient's blood pressure.
(4) To treat for shock, it may be necessary to apply a MAST garment. If so,
inflate the leg sections only of this garment.
2-23. POSTPARTUM HEMORRHAGE
Postpartum hemorrhage is excessive bleeding (hemorrhage) that occurs after
delivery. (Normal bleeding after delivery is one to two cups of blood.)
a. Internal Bleeding. Causes of internal bleeding after delivery include retained
placental products, inadequate uterine contractions, or clotting disorders. Treat as
follows:
(1) If the bleeding is profuse, continue uterine massage and put the baby to
the mother's breast.
(2) Continue support of the patient's circulation with colloid or saline by IV.
(3) Transport the patient and baby rapidly to a medical treatment facility.
(4) DO NOT examine the mother's vagina or pack the mother's vagina with
anything.
b. External Bleeding. External bleeding may be caused by perineal tears.
Manage such bleeding with pressure. If necessary, open the labia and lay packs at the
bleeding site.
2-24. EMERGENCY CHILDBIRTH KEY POINTS
There are five key points to remember in any emergency delivery situation.
a. Most deliveries in emergency childbirth situations progress normally. The
mother is actually the one who delivers the baby. Your job is to assist the mother with
her work and to protect the baby.
b. Evacuate the mother, if possible, unless her labor has progressed to the
second stage.
c. Once the baby's head delivers, the baby's airway must be open, and the baby
must breathe.
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d. Be alert for signs of excessive bleeding in the mother.
e. If the progress of labor and delivery seems abnormal, evacuate the mother as
soon as possible. Get medical advice by radio or telephone.
2-25. CLOSING
Childbirth can occur at any moment of the day or night, under any conditions.
You, as a medical specialist, can help in the greatest miracle in life, assisting in bringing
a life into the world. Usually, there are no complications. If there is a problem,
however, you need to know the warning signs and the appropriate actions to take. Your
knowledge as well as your calm, supportive, and professional manner can make the
delivery safe for the mother and newborn child.
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REVIEW of PROCEDURE FOR NORMAL EMERGENCY CHILDBIRTH
1. Be calm. Reassure the mother that you are there to assist her with the delivery.
2. Provide an environment which is as quiet and private as possible.
3. Position the mother as comfortably as possible and concentrate on helping the
mother stay in control
4. DO NOT allow the mother to strain or push during the early stages of labor. This
may cause the cervix to become swollen and unable to dilate. Pushing or
straining might also cause additional bleeding and distress to the mother.
5. Before or during labor, the amniotic sac should burst. Also, some blood-tinged
mucus may appear.
6. Watch for the baby's head to emerge or "crown" at the vagina.
7. Permit the head to deliver between contractions. This avoids perianal tearing
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