7 Obstetrics, Gynecology, and Pediatric Emergencies

Core priorities

The National Registry EMT examination emphasizes practical assessment, treatment, and transport decisions across five domains rather than isolated memorization of diagnoses. Obstetric and pediatric emergencies follow the same priorities as other emergencies: scene safety, rapid recognition of threats, appropriate basic care, and timely transport.

Pediatric care is integrated throughout the National EMS Education Standards. Follow state requirements, local protocols, and EMT scope of practice.

Assessing the pregnant patient

Ask about the approximate stage of pregnancy, prenatal care, contractions, rupture of membranes, bleeding, fetal movement, prior pregnancies and deliveries, and relevant complications. Assess the pregnant patient first, including airway, breathing, circulation, mental status, and signs of shock. Treat life threats and transport promptly; fetal concerns must not delay care for the pregnant patient.

In later pregnancy, lying flat may worsen circulation. If tolerated, position the patient on the left side or use Manual left uterine displacement. Protect the patient’s privacy and explain care before touching them.

Labor, delivery, and newborn care

Delivery may be imminent when contractions are strong and close together and the patient feels an urge to push or presenting parts are visible. If delivery is not imminent and transport is safe, transport to an appropriate facility. If delivery is imminent, prepare where the patient is, request additional resources, use standard precautions, and support the infant as it emerges without pulling. Note the birth time.

After birth, dry and warm the newborn, position the airway neutrally, and assess breathing and heart rate. Assisted ventilation is recommended when the newborn is apneic or gasping, or when the heart rate remains below $100$ per minute despite initial steps. Effective ventilation is reflected by a rising heart rate. Follow neonatal-resuscitation training and local protocols; do not delay ventilation for nonessential tasks.

Complications during delivery

Manage delivery complications according to training and local protocols. Avoid forceful pulling, use only authorized maneuvers, and request advanced assistance when needed.

• Nuchal cord: If the cord is around the infant’s neck, manage it according to training and protocol. Do not pull forcefully on the infant or cord.

• Prolapsed cord: Cord compression can reduce fetal oxygenation. Do not manipulate the cord or push it back. Relieve pressure from the presenting part only as trained and authorized, position to reduce compression if feasible, and expedite transport.

• Breech presentation: Support the infant as it delivers, but do not pull on the body. Seek advanced help and transport rapidly if delivery is incomplete.

• Shoulder dystocia: The shoulders fail to deliver after the head. Use only maneuvers within training and protocol; never apply fundal pressure. Request advanced assistance and prepare for newborn resuscitation.

• Premature delivery: A premature newborn is especially vulnerable to heat loss and respiratory problems. Dry and warm the infant, assess breathing, and provide ventilation if indicated.

Pregnancy-related bleeding and seizures

Significant bleeding during pregnancy warrants urgent evaluation. Placenta previa classically causes painless bleeding in late pregnancy. Placental abruption often causes painful bleeding and abdominal tenderness, although bleeding may be concealed. Do not perform a vaginal examination. Treat shock, keep the patient warm, and transport promptly.

Early-pregnancy bleeding with pelvic or abdominal pain may indicate miscarriage or Ectopic pregnancy. Sudden severe pain, shoulder pain, weakness, dizziness, or fainting may signal a ruptured ectopic pregnancy and internal bleeding, even if external bleeding is slight.

A seizure during pregnancy or shortly after delivery may be Eclampsia. Protect the patient from injury, maintain the airway, support breathing, and transport urgently. Do not restrain the patient or put anything in their mouth. Report the pregnancy and seizure to the receiving team.

Heavy bleeding after birth can rapidly cause shock. Watch for ongoing heavy blood loss, pallor, weakness, altered mental status, or poor perfusion. Provide supportive care, keep the patient warm, and transport urgently. If the placenta delivers, bring it with the patient; do not pull on the umbilical cord or attempt placental removal.

Gynecologic emergencies and sensitive care

Assess vaginal bleeding, pelvic or abdominal pain, fainting, fever, and possible pregnancy. Consider pregnancy-related causes whenever biologically possible, regardless of the patient’s assumptions. Ask sensitive questions privately and without judgment.

For external bleeding, use an external dressing; do not pack the vagina or perform an internal examination. If tissue has passed, save it if feasible and transport it with the patient.

For sexual assault calls, use a calm, trauma-informed approach. Prioritize immediate medical needs, obtain consent before care, preserve privacy, and avoid questions or actions not needed for emergency treatment. Do not promise confidentiality beyond applicable reporting rules. Follow local procedures for evidence preservation and mandatory reporting, without delaying necessary medical care.

Assessing and supporting a sick child

Infants and children may compensate for illness or injury and then deteriorate quickly. Observe before touching: appearance, interaction, work of breathing, and skin circulation can help identify a critically ill child. Then perform an age-appropriate primary assessment, obtain vital signs, and ask the caregiver about the child’s usual behavior, medical history, medications, allergies, and events leading to the emergency.

Use appropriately sized equipment and explain actions in simple language. A caregiver’s knowledge of the child can be valuable; involve the caregiver when it is safe and helpful.

Prioritize airway and breathing. Respiratory distress may present as increased effort, retractions, nasal flaring, abnormal sounds, or difficulty speaking or feeding. Pediatric respiratory failure may be signaled by fatigue, reduced responsiveness, poor air movement, cyanosis, or slowing respirations; these signs do not indicate improvement. Open and maintain the airway, suction visible secretions when appropriate, give oxygen as indicated, and assist ventilation with a bag-mask device if breathing is inadequate. Request additional resources and transport promptly when the child is seriously ill. Respiratory problems are a major cause of pediatric cardiac arrest, so prompt support of oxygenation and ventilation matters.

Shock and seizures in children

Children may be in shock before low blood pressure appears. Assess mental status, skin temperature and color, pulse quality, and Capillary refill alongside blood pressure. Keep the child warm, manage the immediate underlying threat within EMT scope, and transport urgently.

For a seizure, protect the child from nearby hazards, do not restrain them, and put nothing in the mouth. After convulsions stop, reassess airway and breathing, check for injury or altered mental status, and transport as indicated. A first seizure, prolonged or repeated seizure, breathing difficulty, or failure to regain responsiveness is especially concerning.

Airway obstruction and cardiac arrest

For severe foreign-body airway obstruction, use current age-appropriate basic life support. The 2025 AHA/AAP guidance recommends repeated cycles of $5$ back blows and $5$ chest thrusts for infants, and $5$ back blows and $5$ abdominal thrusts for children.

If the patient becomes unresponsive, begin CPR. Remove only a visible object; never perform a blind finger sweep. For pediatric cardiac arrest, provide high-quality CPR with breaths when trained, and apply an AED as soon as available.

Possible abuse or neglect

Consider maltreatment when the history does not fit the injury, the explanation changes, care is delayed, or the injury pattern is concerning. Remain objective: document findings and statements accurately, avoid leading questions or accusations, ensure immediate safety, and follow mandatory reporting and agency procedures. The EMT’s role is to recognize and report concerns, not investigate them.