2 & 3) Obstetrics Flashcards
1
Q
1 Killer 3rd trimester
A
Placenta Abruptio
2
Q
2 Ways to stimulate baby to start respiratory drive
A
Wax on baby & Foot tapping
3
Q
Full-term pregnancy:
Premature (preterm):
Postmature:
Hermaphrodites:
A
= 38-42 Weeks (40 average)
= Any birth before 37 weeks.
= Any birth after 43 weeks.
= Born w/ both sex organs; PC “Intersex”
4
Q
3 general approaches to tocolysis) 2nd approach:
B/c oxytocin & ADH are secreted from the same area:
A
= admin/ 1L IV fluid bolus; increases intravascular fluid vol, thus inhibiting ADH secretion from posterior pituitary
= inhibition of ADH secretion also inhibits oxytocin release, often causing cessation of uterine contractions
5
Q
3 general approaches to tocolysis) if previous failed) 3rd:
A
= mag-Sulfate or a beta-agonist, such as terbutaline or ritodrine, can be admin/ed to stop labor by inhibiting uterine smooth muscle contraction
6
Q
Abnormal Delivery Situations
A
Breech Presentation, Prolapsed Cord, Limb Presentation, Occiput Posterior Position, Multiple Births, Cephalopelvic Disproportion, Precipitous Delivery, Shoulder Dystocia, Meconium Staining
7
Q
Abortion classifications) incomplete abortion:
A
= Abortion in which some but not all fetal tissue has been passed. associated with a high incidence of infection.
8
Q
Abortion classifications) Potential) Threatened abortion:
A
= unexplained vaginal bleeding during 1st half of pregnancy in which the cervix is slightly open & fetus remains alive in uterus (some cases the fetus still can be saved)
9
Q
Abortion classifications) Potential) Inevitable abortion:
A
= bleeding w/ severe cramping & cervical dilation but the fetus hasn’t yet passed from uterus & cannot be saved
10
Q
Abortion classifications) spontaneous abortion:
commonly called what & generally result of:
Most spontaneous abortions occur:
Common occurrences:
A
= Naturally occurring expulsion of the fetus prior to viability
= miscarriage; generally from chromosomal abnormalities
= before week 12 of pregnancy.
= Many occur w/in 2Wks after conception & mistaken for menstrual periods
11
Q
Abortion classifications) elective abortion:
Most elective abortions are performed during:
2nd-trimester elective abortions:
3rd-trimester elective abortions
Elective abortions in 1st & 2nd trimesters:
A
= termination is desired & requested by mom
= the 1st trimester (less complication chances)
= Some clinics perform although higher complication rate
= are generally illegal in this country.
= have been legal in the US since 1973.
12
Q
Uterine inversion) Rx step 1
NEVER EVER:
Step 2:
Step 3:
Uterus Replacement technique:
If this single attempt is unsuccessful:
A
1= place supine & begin oxygen (if hypoxic). Do not attempt = attempt to detach placenta or pull on the cord
2= Initiate 2 big-bore IVs of NS & begin fluid resuscitation
3=Make 1 attempt to replace uterus technique
= w/ palms, push fundus of inverted uterus toward vagina
= cover uterus w/ towels moist w/ NS & transport ASAP
13
Q
Aortocaval compression) Pregnant Cardiac arrest:
A
= In the pregnant PT, the large gravid uterus can compress the aorta & vena cava when PT supine. To facilitate optimal CPR, the uterus must be manually moved off to allow adequate blood return to the heart. Placing PT other than supine position (tilted 30 degrees left) can compromise CPR.
-B/c of this, its now recommended that all pregnant PT in cardiac arrest w/ ~20Wks gestational or greater receive manual lateral uterine displacement (LUD). If difficult to assess, (morbidly obese) LUD should be provided if possible technically feasible.
14
Q
3 general approaches to tocolysis) 1st approach
A
= sedate PT, often w/ narcotics or barbiturates, thus allowing her to rest. Often, after a period of rest, the contractions stop on their own
15
Q
The puerperium is
A
the time period surrounding the birth of the fetus.
16
Q
Assessing contractions)1 Place hand @:
2 Time Contractions:
3 It is important to note:
4 During & between contractions monitor:
A
1= 1 hand on fundus of uterus.
2= from beginning of 1 contraction until beginning of the next.
3= whether the uterus relaxes completely between contractions.
4= fetal heart tones; Occasional bradycardia occurs during contractions, but the HR should increase to a normal rate after the contraction ends (If baby doesn’t deliver after 20Mins of contractions every 2-3Mins, transport immediately)
17
Q
Fetal HR failing to return to normal between contractions:
A drop in the fetal HR <90BPM indicates:
A
= is a sign of fetal distress & transport ASAP
= fetal distress & requires prompt immediate transport w/ PT in L-Lateral Recumbent position
18
Q
Abortion:
A
Expulsion of fetus prior to 20 weeks’ gestation
Most common cause of bleeding in 1st & 2nd trimesters
19
Q
Acrocyanosis
A
= extremities remain dusky after delivering & drying healthy baby (Very common in 1st Hrs of life
20
Q
Mom) After 32 weeks and until pregnancy ends, uterus fills:
3rd trimesters anatomical change:
3rd Trimester v/s change:
Possible effects from changes:
Vascular vol/ increase accompanied by <increase in RBC Result:
A
1= abdominal cavity to level of lower rib margin.
2= Enlarging ABDMMN increases ABDMN P. displaces diaphragm upward
3= Reduced lung capacity, +Circ 45%, +15% CO BPM, CO +40%
4= Anemia <RBC 45% from not keeping up w/ RBC
5= anemia becomes consideration w/ aggressive fluid resuscitation for shock
21
Q
Amenorrhea:
Primary Amenorrhea:
2ndary Amenorrhea :
A
= Absence of menstruation
= Never started periods.
= Periods stopped after being regular.
22
Q
amniotic sac:
After the 20th week of gestation:
A
= Baby grows in w/ amniotic fluid increasing in vol/ throughout course of the pregnancy.
= the volume varies from 500 to 1,000 mL
23
Q
Dysmenorrhea:
A
= Pain/”Severe discomfort” during menstruation & commonly goes w/ PMS
24
Q
APGAR Scoring) Scoring
A
P
G
A
R
A
5 parameters; Scored bad 0 to 2 Normal/healthy
Appearance (skin color)
Pulse rate) Normal 100-180
Grimace (irritability)
Activity (muscle tone)
Respiratory effort) Normal 30-60
25
Fetal Circulation) As soon as a baby takes its 1st breath:
Ductus arteriosus:
Ductus venosus:
Forman Ovale:
= lungs inflate, greatly decreasing pulmonic vascular resistance to blood flow
= closes, diverting blood to the lungs
= closes, stopping blood flow from placenta
= closes stopping blood flow through atriums
26
Begins @ day 15 & ends @ 8Wks
Embryonic stage
27
Fetal Circulation) 1 umbilical vein connects directly to:
2 Blood then travels through:
3 Blood enters R-atrium & passes through & into:
4 Blood exits R-ventricle & travels through & into:
5 The foramen ovale allows:
6 Once in pulmonic artery, blood enters & connects w/:
7 The ductus arteriosus causes blood to:
8 Once in the aorta, blood flow is:
9 Deoxygenated blood w/ waste products exits fetus:
1= Inferior Vena-Cava by ductus venosus
2= the inferior vena cava to the heart
3= the tricuspid valve into the R-ventricle
4= the pulmonic valve into the pulmonary artery
5= mixing oxygenated blood in the R-atrium, leaving the L-ventricle bound for aorta bypassing the lungs &
At this time, the blood is still oxygenated
6= Ductus arteriosus, which connects the pulmonary artery with the aorta.
7= bypass the uninflated lungs.
8= basically the same as in extrauterine life
9= after passage through the liver via the umbilical arteries
28
Braxton-Hicks Contractions:
False labor:
= Painless, irregular contractions.
= increased intensity and frequency; no cervical changes.
29
Breech Presentation:
Risks:
Increased potential for:
Delivering:
If head does not deliver:
= Buttocks or both feet present first
= Increased risk for delivery trauma to mother,
= cord prolapse, cord compression, anoxic insult for infant
= Hold her legs flexed, As infant delivers, DONT PULL LEGS,
Allow entire body to be delivered w/ contractions
= place gloved hand in vagina w/ palm toward infant's face
30
Bright red hemorrhage without pain in a female that is in her third trimester most likely describes:
Placenta Previa
31
by 32 weeks until delivery A&P changes:
The displacement reduces:
= Baby displaces all surrounding organs
= lung capacity, Tidal Vol,
32
Uterine Rupture:
= Actual tearing, or rupture, of uterus; occurs with onset of labor or blunt abdominal trauma.
Rare occurrence; extremely high maternal and fetal mortality rate.
33
Cephalopelvic Disproportion:
Causes:
Delivering:
What can occur:
= Infant's head too big to pass through maternal pelvis easily; oversized fetus.
= Diabetes, multiparity, postmaturity.
= Fetal abnormalities may make vaginal delivery impossible
=Fetal demise or uterine rupture may occur
34
Changes in the body with pregnancy) -O2 consumption
-blood volume:
-Cardiac Output:
-Heart Rate:
-Blood Pressure:
-GI System:
-Urinary System:
-Musculoskeletal System:
= 20% increase O2 consumption
= 45% increase in blood volume
= Cardiac Output Increases by 1 to 1.5 L/min
= 30% increase Heart Rate 15-25% increase
= BP decreases slightly
= Peristalsis is slowed in GI (Digestion)
= Urinary System GFR Increases nearly 50%
= Joints loosen Musculoskeletal System
35
Classifications of Abortion:
= complete, incomplete, Threatened, inevitable, spontaneous, Missed, criminal, habitual, & Elective
36
Abortion classifications) complete abortion:
= An abortion in which all uterine contents, including the fetus and placenta, have been expelled.
37
Ruptured Ovarian Cyst:
= Cysts are fluid-filled pockets. When they develop in the ovary, they can rupture & be source of pain
38
Abortion classifications) criminal abortion
= Intentional termination of pregnancy under any condition not allowed by law. Usually attempt to destroy a fetus by a person who is not licensed or permitted to do so & often attempted by amateurs & rarely aseptic
39
Cystitis
= UTI) Urinary Tract Infection
40
Detachment of the placenta from the uterine wall during pregnancy is called:
Abruptio placentae
41
Drop in fetal HR < 90BPM indicates
fetal distress = immediate transport
42
DUB:
= Dysfunctional Uterine bleeding
43
During pregnancy, maternal O2 demands increase so:
To compensate, the body makes changes:
= progesterone causes a decrease in airway resistance
= 20% increase in o2 consumption & 40% increase in tidal vol/, slight increase in RR, diaphragm is pushed up by the enlarging uterus, resulting in flaring of the rib margins to maintain intrathoracic volume.
44
Dysmenorrhea:
Painful menstruation due to uterine contractions or conditions like endometriosis.
45
Dyspareunia:
Pain is commonly from:
= Painful intercourse
= Ovarion cysts most common cause, glands could undersecrete
46
Dyspareunia:
Painful intercourse often caused by ovarian cysts or infections.
47
Dysuria:
Hesitancy:
= pain during urination
= trouble starting & stopping pee stream
48
Eclampsia:
= Most serious manifestation of hypertensive disorders of pregnancy Generalized tonic-clonic seizure activity
49
Menarche:
of eggs @ Birth:
of eggs @ Menarche:
immature follicles/ova "eggs" are called:
= 1st menstruation, needs 16% body fat, ages 10-14 but now days 8-12
= 3 mil
= 30K
= Primordial Follicle
50
Ectopic pregnancy:
Why is it dangerous:
= fertilized egg implants outside uterus (most commonly in the fallopian tube)
= can rupture by ~8 Wks, causing severe bleeding & leading cause of maternal death in 1st trimester
51
endometriosis:
Cavital-pneumial pneumothorax:
= abnormal growth of endometrial cells make tissue outside the uterus, often causing pelvic pain, heavy periods, & infertility.
= pneumothorax from endometriosis growth on lungs
52
Endometritis:
Complications of endometritis include:
Commonly reported S/Ss:
= Uterine lining infection often mimics PID & can be quite serious if not quickly treated w/ appropriate antibiotics.
= sterility, sepsis, or even death. Can occasional complication of miscarriage, childbirth, or gynecologic procedures such as D&Cs.
= mild to severe lower ABDMN pain; a bloody, foul-smelling discharge; fever (101-104°F)
onset of symptoms is usually 48-72HRs after the gynecologic procedure or miscarriage.
53
Key steps for delivering baby) 1 Cover:
2 Coach Mom:
3 As the baby’s head crowns:
3.1 Checking umbilical cord isn't around the baby’s neck?
4 Procedure for delivering the baby’s shoulders?
5 How to clamp & cut the umbilical cord after delivery?
1= Prep/ PPE; gloves, gown, face shield or goggles
2= push w/ contractions & Breathe inbetween
3= Control head w/ gentle pressure, Support head as emerges & turns, (Tear amniotic sac open if head enclosed)
3.1= Slide finger along head & neck to check for cord
4= Guide head downward for upper shoulder delivery & upward for lower shoulder delivery (Support as emerges)
5= Delay clamping 30Secs after delivery, Clamp cord 4in. (10 cm) from navel; place 2nd clamp 2in (5 cm) from 1st &
Cut cord between clamps
54
Fetal Circulation) Fetus receives its oxygen & nutrients from:
while in the uterus, the fetus does not need to use:
B/c of this, the fetal circulation shunts blood around:
The infant receives blood from
The umbilical vein connects directly to:
= its mother through the placenta
= its respiratory system or its gastrointestinal tract
= the lungs and gastrointestinal tract.
= the placenta by means of the umbilical vein
= the inferior vena cava by a specialized structure called the ductus venosus.
55
8Wks until delivery marks what stage
Fetal stage
56
Straddle injury:
common form of blunt trauma) to genitals commonly from a bike seat
57
Gestational Diabetes:
Rx:
= Diabetes from Carry w/ BGL < 70 mg/dL
= Administer 50-100 mL 50% dextrose
58
Gravidity:
Parity: # of pregnancies carried to full term
= # of times woman has been pregnant
59
Gynecology deals w/
Obstetrics focuses on:
= health & diseases of women's sex organs.
= care of women throughout pregnancy.
60
Abortion classifications) habitual abortion
= Spontaneous abortions that occur in 3 or more consecutive pregnancies.
61
function of the cervix during pregnancy:
= Forms a mucus plug to block pathogens from reaching the fetus & supports the uterus during gestation
62
How to clamp & cut the umbilical cord after delivery:
What to do immediately after the baby is delivered:
= Delay clamping 30Secs after delivery, Clamp cord 4in. (10 cm) from navel; place 2nd clamp 2in (5 cm) from 1st &
Cut cord between clamps
= Dry baby; cover w/ warm, dry blankets or towels.
Position baby on side.
Record time of birth.
63
Labor Stage 1:
= (Dilation) Begins w/ onset of true labor contractions
Ends w/ complete dilation (10cm) & effacement of cervix
64
Labor Stage 3:
(Placental) Begins immediately after birth of infant & Ends w/ delivery of placenta w/in 5-20Mins, Continued vaginal discharge (lochia); blood, mucus, placental tissue
65
Labor Stage 2:
= (Expulsion) Begins w/ complete dilation of cervix & Ends w/ delivery of fetus (50-60Mins) Contractions very strong, every 2Mins, lasting for 60-75Secs
66
Labor:
Puerperium:
Stages of labor:
= Process by which delivery occurs
= Time period surrounding birth of fetus
= Dilation, Expulsion, Placental
67
leiomyomas or myomas, uterine fibroids:
benign (not cancerous) growths/“tumors” that develop from the muscle layer of the uterus.
68
Limb Presentation:
Possible causes:
Absolute:
= a Limb protruding from the vagina
Preterm birth, multiple gestation.
= Cesarean section necessary &NEVER EVER should you attempt field delivery
69
Lochia
Vaginal Discharge of blood, mucus, & placental tissue after delivering
70
Manual LUD can be accomplished:
The clinician must be careful not to:
= either side of PT, using 1 or both hands to move the uterus UPward & LEFTward off the maternal blood vessels
= inadvertently push down, which would actually increase compression of the vena cava.
71
McRobert’s Maneuver
Used w/:
= mother drop butt off end of bed; flex thighs upward to facilitate delivery & Apply firm pressure w/ open hand immediately above pubic symphysis
= Shoulder Dystocia
72
Meconium Staining:
Indicative of:
Causes:
Normally:
Healthy meconium described as:
Unhealthy Meconium described as:
As a general rule:
= Fetus passes feces into amniotic fluid
= fetal hypoxic incident.
= Prolonged labor, term, post-term, lowbirth-weight infants.
May occur prior to delivery or during labor
= amniotic fluid is clear or possibly light straw colored
= the color varies from a light yellowish-green to light green
= dark green, sometimes described as “pea soup.” As a rule, = more thicker & darker, higher risk of fetal morbidity
73
Menopause:
= estrogen secretion & Ovarian Fn ends (45-55Yrs)
(end of reproductive life AKA "climacteric" derived from Greek meaning “critical time of life”)
74
Menorrhagia:
excessive menstrual bleeding “More than usual”
75
Abortion classifications) Missed abortion
= fetal death occurs but is not expelled; posing potential threat to woman’s life if fetus is retained beyond 6Wks
76
most common cause of postpartum hemorrhage is
= uterine atony, or lack of uterine muscle tone. occur most frequently in multigravida & most common following multiple births or births of large infants
77
Multigravida:
Multipara:
= Woman pregnant more than once
= Woman has delivered more than one baby
78
Multiple Births) Suspect if:
Delivering:
= ABDMN remains large after delivery of 1 baby & labor continues
= Normal delivery guidelines Usually, 1 twin presents vertex & other breech.
79
Neonatal Care) 1. Baby Handling:
2. Maintenance
3. Vitals
4. Common indicators for Baby resuscitation:
4.1 Baby Resuscitation
1= Newborns slippery; require both hands to support head and torso.
2= Keep warm, Routine suctioning not recommended, Drying & tactile stimulation will stimulate respirations, crying, activity.
3= RR 30-60PM HR 100-180BPM, APGAR Scoring: 0-10
4= Prematurity, pregnancy & delivery complications, maternal hx probs, inadequate prenatal care.
4.1=Assist ventilations using Pedi-BVM, Assess HR w/ stethoscope, start compressions if HR < 60BPM & not responding to ventilations & Transport to NICU
80
Nulligravida:
Nullipara:
Grand multiparity:
= Woman has not been pregnant
= Woman has yet to deliver her 1st child
= Woman has delivered at least 7 babies
81
Antepartum:
Postpartum:
= Time interval prior to delivery of fetus
= Time interval after delivery of fetus
82
Obtaining OB Hx:
= vaginal bleeding or spotting major concern
= Color, amount, duration; events leading up to bleeding
Count number of sanitary pads or tampons used
If passing clots or tissue, save for evaluation
Determine whether patient thinks membranes have ruptured – When patient in active labor, assess whether mother feels need to push or has urge to move her bowels.
83
Occiput Posterior Position:
Baby Presentation:
Delivering complications:
Possible necessities:
= Infant descends facing forward; passage through pelvis delayed
= Presenting part may be face or brow
= Fetus cannot enter pelvis for delivery; vaginal delivery impossible
= Transport immediately; forceps or cesarean delivery often required.
84
Fetal Circulation) ductus arteriosus:
Connects what w/ what:
= Once in pulmonic artery, the blood enters the structure
= connects the pulmonary artery with the aorta.
85
ovarian torsion (adnexal torsion):
When an ovary becomes twisted around the tissues (stalk) that support it, similar in nature to a testicular torsion in a male.
86
PID (Pelvic Inflammatory Disease):
Organs commonly involved:
More prone to:
= infection of sex organ/s, often caused by untreated STDs (EX: gonorrhea, chlamydia)
= uterus, fallopian tubes, ovaries.
= It leads to inflammation, scarring, & can increase the risk of ectopic pregnancy.
87
Placenta Previa:
= placenta dev/ before uterus so cervix dilates & tears placenta after dropping mucus plug (treat internal hemorrhage for shock & pad vagina)
88
Abruptio Placentae:
= VERY PAINFUL trauma (can be fall onto but or car crash) placenta rips away from uterine way, bright red hem rips away cervix, concealed no leaking,
89
PMS:
Physical S/S prior to period:
= premenstral syndrome caused by hormones
= Breast tenderness or engorgement, Weight gain or bloating, Excessive fatigue, Cravings for specific food, Migraine headaches, Emotional responses
90
Possible spinal column change from pregnancy
Hyper lordosis
91
Postpartum Hemorrhage:
Causes:
Profound Hemorrhage/Shock:
= Loss of more than 500 mL of blood following delivery
= Lack of uterine muscle tone, Multigravida or following multiple births or births of large infants, Uterine Rupture: Actual tearing, or rupture, of uterus, Uterine Inversion
= Blood loss: 800 to 1,800 mL’s
92
Precipitous Delivery:
Complications/affects:
Baby Care:
= Occurs after < 3Hrs of labor
= Higher-than-normal incidence of fetal trauma, tearing of umbilical cord, maternal lacerations.
= Attempt to control infant's head & kept warm
93
Preeclampsia:
= Increase by SBP30 and/or 15DBP over baseline on least 2 occasions at least 6Hrs apart.
94
Preembryonic Stage:
Embryonic stage:
Fetal stage:
= First 14 days following conception
= Begins at day 15 and ends at 8 weeks
= 8 weeks until delivery
95
Pregnancy is broken down into 3 stages:
Preembryonic, Embryonic stage, & Fetal Stage
96
Prenatal Period:
It is the time from conception until delivery of fetus
97
Prenatal:
Gestation:
= Time interval prior to birth, synonymous with antepartum
= Period of time for intrauterine fetal development
98
Preterm Labor:
Rx:
= True labor begins before 38th week (Potentially life threatening situation for mother & fetus)
= Stopped if possible (tocolysis) Admin IV fluid bolus; Inhibits oxytocin release, often causing cessation of uterine contractions. (Mag-Sulfate or beta-agonist may be admin/ to stop labor)
99
Primigravida:
Primipara:
= Woman pregnant for first time
= Woman who has given birth to 1st child
100
Prolapsed Cord:
Risks:
= Umbilical cord precedes fetal presenting part
= Potentially shuts off fetal circulation, Serious emergency & Fetal death w/o prompt intervention
101
PT w/ preterm labor has been given corticosteroid steroids
= accelerate fetal lung maturity.
102
Pulmonary Embolism:
Blood clot in pulmonary vascular system
Result of venous thromboembolism; common cause of maternal death.
May occur any time during pregnancy
103
What internal organs are part of the female reproductive system?
Ovaries, fallopian tubes, uterus, & vagina.
104
What is the role of external female genitalia:
What are the parts of the external genitalia:
= protect body openings & play a role in sexual function.
= vulva, mons pubis, labia majora/minora, & glands (Skene's & Bartholin's).
105
rupture of the membranes (ROM)
amniotic sac breaks & leaks amniotic fluid out of vagina
106
Mom) 12-24Wks 2nd tri/ uterine changes:
= displaces most ABDMN upward; uterus rises out of pelvis & its upper border extends above the umbilicus
107
Several surgical treatments uterine fibroids are:
Hysterectomy:
Myomectomy:
Scleroses:
= removing uterus, various fibroids, & radiation
= complete surgical removal of the uterus
= surgical removal of the various fibroids
= interventional radiology procedure that blocks the blood supply to a particular fibroid, causing it to die and slough off.
108
Shoulder Dystocia:
Causes:
Baby presentation:
Delivering:
= Infant's shoulders larger than head
= Diabetic & obese mothers; post-term pregnancies.
= Head retracts back into perineum; shoulders trapped between pubic symphysis & sacrum
= Have mother drop butt off end of bed; flex thighs upward to facilitate delivery & Apply firm pressure w/ open hand immediately above pubic symphysis (McRobert’s Maneuver)
109
Simple Steps of Before & After of delivering) 1.1
1.2
2.1
2.2
3.1
3.2
4.1
4.2
4.3
1.1(Prep) OBYGN Kit Out, Set up shop, Monitors on
1.2(Cover) 1 Sheet for Poop, Cover mom & Self
2.1(Position) Butt Up, Legs bent & wide
2.2(Coach) Breath, push w/ contraction, & repeat
3.1(Head & Turn) Pressure with head & turn for shoulders
3.2(Support) Support shoulders/body
4.1(Cord) Clamp & Cut after 30secs Cut
4.2(Mom&Kid) Dry & Cover warmth for kid then mom's tit
4.3(Placenta) Fundal massage for placenta delivery
110
Spontaneous abortion:
often called:
most commonly seen w/ & before:
Estimated % of pregnancies effected:
If the pregnancy has not yet been confirmed:
= naturally occurring termination of pregnancy
= Miscarriage
= between 8-14Wks gestation & before 12Wks
= ~10-20% of all pregnancies end in spontaneous abortion.
= the woman often assumes she is merely having a period w/ unusually heavy flow.
111
Steps for placenta delivery & postpartum mom care:
Do not pull on umbilical cord.
Deliver placenta & transport w/ mother.
Massage uterine fundus.
Encourage baby to latch on mother’s breast to stimulate uterine contractions.
112
Steps to prepare delivery area for field delivery) Step 1:
Step 2:
Step 3:
Step 4:
1 Equipment & facilities prepared quickly.
2 Delivery area set up out of public view.
3 PT on back w/ knees & hips flexed, butt slightly elevated
4 Drape mother w/ toweling: under buttocks, below vaginal opening, & across lower ABDMN
113
Fetal Circulation) Foramen ovale:
Function:
Blood @ this time is De or oxygenated:
= hole between fetus's atrias "fetal shunt"
= allows mixing of oxygenated blood in R-atrium, leaving the L-ventricle bound for the aorta. This serves to aid in blood flow bypassing the lungs.
= At this time, the blood is still oxygenated.
114
The number one killer of pregnant females is:
Trauma
115
Abortion classifications) therapeutic abortion
= Termination of a pregnancy deemed necessary by a physician, usually to protect maternal health & well-being
116
Tocolysis
Process of stopping/pausing delivery/labor
117
mLs range in uterus
= 50mLs-1.5Ls in uterus
118
Baby's Blood:
Umbilical cord veins & Arteries
= should never mix w/ Mom's blood; Babys blood has higher oxy affinity & steal blood
= 2 arteries & 1 vein on umbilical's cord) vein bigger than artery (smilely pic) Vein brings oxy & art deoxy}
119
Tubo-ovarian abscess (TOA):
Rupture of the abscess can lead to:
= pocket of pus that forms b/c an infection in a fallopian tube & ovary (adnexa) ~result of PID
= sepsis & other complications including frank peritonitis. Rqs prompt eval/ & Rx of parenteral antibiotics &, in certain situations, surgical drainage.
120
Uterine atony
Lack of necessary uterine musculature
121
Uterine Inversion:
Causes:
= Rare emergency; uterus turns inside out after delivery; extends through cervix.
= profound shock; Blood loss 0.8Ls-1.8Ls
122
vascular system of uterus contains how much of pregnant woman’s total blood volume
= one-sixth (16 percent) of the pregnant woman’s total blood volume.
123
Fetus Oxygenation
Higher oxygen affinity
124
What are the hormones involved in ovulation:
= FSH (follicle-stimulating hormone) triggers egg maturation, & LH (luteinizing hormone) signals ovulation.
125
What are the risk factors for ruptured ovarian cyst:
History of dyspareunia, irregular bleeding, or a delayed cycle
126
What is cystitis:
If untreated, can progess to:
bladder infection
= kidneys infected (pyelonephritis), kidney damage, sepsis, dialysis
127
Significance of Braxton Hicks contractions:
= irregular uterine contractions during pregnancy that help the uterus prepare for labor. They don't cause cervical dilation.
128
You are taking care of a female patient that has been involved in a serious motor vehicle accident. The patient is complaining of severe "tearing" abdominal pain and states she is eight months pregnant. Which of the following would you suspect this patient is most likely suffering from?
Abruptio Placentae
129
1st 14 days following conception
Preembryonic Stage
130
What are the maternal factors for preterm labor?
Contributory factors:
=Cardiovascular disease, Renal disease, Pregnancy-induced HTN (PIH), Diabetes, ABDMN surgery during gestation,
Uterine & cervical abnormalities, Maternal infection, Trauma to ABDMN
=Hx of preterm birth, smoking, and cocaine abuse
131
Most common cause of vaginal bleeding in 1st & 2nd trimesters
Abortions
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Preeclampsia:
Increase in SBP by 30 mmHg and/or diastolic increase of 15 mmHg over baseline on least two occasions at least 6 hours apart.
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Placenta Accreta
placenta embeds itself into uterus & Wont be able to remove self from uterine wall
Percreta: embedded through all 3 metriums & attaches to organ
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Where do most deliveries of babies occur?
in the hospital
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% of childbirths are uneventful & complicated?
= 96% are uneventful, 2% have complications
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What is the prenatal period?
The time from conception until delivery of the fetus
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umbilical cord turn white before cutting meaning:
It is normal and means it has shunted itself closed
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What is delayed cord clamping?
Waiting to cut the umbilical cord to allow extra blood transfer to baby
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Preeclampsia:
Increase in SBP by 30 mmHg and/or diastolic increase of 15 mmHg over baseline on least two occasions at least 6 hours apart.
140
Gestational Diabetes rx:
BGL < 70 mg/dL: Start IV NS & Admin/ 50-100 mL 50% dextrose intravenously
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What 3 shunts are involved in the fetal circulation?
Ductus Venosus later lig terez
Foramen Ovale septum prinium
Ductus Arteriosus
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A surge of what horomone causes the rupture of the mature egg from the ovary.
LH
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B/c CO increases up to 30% during pregnancy, PTs who have serious preexisting heart disease may develop:
Congestive heart failure
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“Spontaneous abortion” used to describe:
expulsion of the fetus before 8 weeks of gestation
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When maternal blood volume increases, pregnant women will often receive supplemental iron to prevent anemia. This is because:
Although both red blood cells and plasma increase, there is slightly more plasma.
