7- OB Flashcards
What does FDLMP mean
First day of last menstrual period
What does GTPALM stand for
Gravies- # of pregnancies Term- # of term births (>37 weeks) Premature- # of births <38 weeks Abortion- Pregnancies before 20 weeks Living children- # of kids still alive Multiple pregnancies- # of times with multiple births
What is the normal gestational period
40 weeks
What is considered premature gestation
Less than 38 weeks
3 important questions for a pregnant patient assessment
- Due date
- Urge to push
- Contraction length
Does spotty, painless vaginal bleeding occur from egg implantation to the endometrium
Yes
What is triggered to happen due to egg implantation in endometrium
- Development of placental tissue
- Release of human chorionic gonadotropin (hCG)
- Corpus luteum is signaled that pregnancy has begun
What is the role of the corpus luteum for pregnancy
Produces hormones to support pregnancy until placenta sufficiently develops to assume this function
What does placenta do at the beginning of pregnancy
Produces projections to tap into the external layer of the blastocysts where spaces called lacunae form, and are filled with maternal blood
What happens when an egg becomes an embryo
Begins the process of forming specialized body systems
At what week does the heart start in an embryo
Around the end of week 3
At week 4 the placenta begins to develop and serves what key roles
- Respiratory gas exchange
- Transport nutrients
- Transfer heat from woman to fetus
- Hormone production
- Form barrier against harmful substances
What is the umbilical cord
Connects the placenta to the fetus via the fetal umbilicus
What do the umbilical vein and umbilical artery do
Umbilical vein- Oxygenated blood from placenta to fetus
Umbilical artery- Ateriovenous blood to the placenta
Role of the ductus veinous
Connects the umbilical vein and the inferior vena cava
Role of the ductus arterious
Connects the pulmonary artery and aorta
What is the foramen ovale
An opening in the atrial septum of the fetal heart
What is the amniotic sac
A membrane bag that encloses the fetus in a watery fluid of amniotic fluid
What is the role of amniotic fluid and the typical amount
Provide fetus with a weightless environment to develop
Typically 500-1000 mL
What can abnormal uterine size at length of time indicate
- Uterine growth problems
- Breech position
- Possibility of twins
What changes are there to a woman in pregnancy (6)
- Possible constipation
- Decreased GI motility
- Increased risk of vomiting
- Kidney increase in size and volume
- Increased urinary frequency
- Pregnancy mask
Circulatory system changes in women during pregnancy (6)
- Blood volume increases to meet new metabolic needs
- Red blood cell count increases
- White blood cell count increases
- Heart increases in size
- Cardiac output increases 30-50%
- HR increases 15-20 beats
What happens to BP during pregnancy and when
0-24 weeks- Decrease
24 weeks to birth- Increase
After birth- Gradual return to normal
What results from slowed venous return due to an enlarged uterus and what can result
- Pooling, defendant edema
- Hemorrhoids
- Vericose veins
-DVT and pulmonary embolism
What effect does slow venous return have on med administration
Delayed absorption of IM and SQ meds
What can increased workload on heart during labor cause (3)
- Ventricular failure
- Pulmonary edema
- Culminating heart failure
*Can result in cardia arrest
What happens to respiratory system during pregnancy (7)
- Abdominal muscles lose tones
- Respiration’s become more diaphragmatic
- Decreased airway resistance
- O2 consumption increases 20-40%
- Increased minute volume
- Resp alkalosis increases and is leveled by met acidosis
- RR increases
What occurs to the endocrine system during pregnancy (3)
- Pancreas secretes more insulin due to increased free cortisol and progesterone
- Estrogen can blunt the action of insulin
- Cellular sensitivity to insulin decreases
What do Primigravida/para, Multigravida/para, Grand Multipara and Nullipara mean
Primigravida- 1st time pregnant Primipara- Has only had 1 delivery Multigravida- 2 or more pregnancies Multipara- 2-5 deliveries Grand Multipara- More than 5 deliveries Nullipara- Woman has never delivered
Ex- 4 pregnancies, 3 miscarriages = G4P1 or G4A3P1
What do gravita and parity mean
Gravita- Number of times pregnant
Parity- Delivery after 20 weeks and alive
Explain Braxton Hicks contractions
False labor, uterus working out to prepare for birth
- Irregularly spaced
- Remains long
- Constant intensity
- Analgesics often abolish the pain
- No cervical changes
What should be done if delivery is imminent
- Vitals
- Estimate gestational age
- Listen for fetal heart tones
What is “lightening” in pregnancy
Feeling of relief of pressure in upper abdomen before labor
What is the “bloody show”
Plug of mucous sometimes mixed with blood from uterus, possibly weeks before labor starts
What is the first stage of labor
Beginning of cramping and contractions until fetus is repositioned to cervical opening
-Amniotic sac should rupture, cervix fully dilates to 10 cm
What is effacement in labor
The less muscular lower segment of uterus is pulled up over the presenting part
What is the second stage of labor
Begins with head of fetus entering birth canal to newborn fully out (crowning)
-Fetus’ head goes chin to chest>Face to woman’s ass>Head to side>Shoulders pop out
What is the third stage of labor
Separation, and expulsion of the placenta. Lasts from delivery of newborn to delivery of placenta
What is fetal acidosis
Acid-base response to hypoxia and the build up of lactic acid due to complications of birth
Steps to assist with delivery (9)
- Control w/ gentle pressure, support head
- Check for nuchal cord w/ middle finger, slip over head or cut if needed
- Clear airway
- Guide head to get shoulders out
- Prepare for shootout after shoulders are out
- Maintain newborn at same or just below level of the mother
- Clamp 4” and 6” from newborn
- Wipe newborn clean, suction is needed
- Wrap in blanket, record time of birth
When to record the APGAR score
1 and 5 min after birth
What is Mag sulfate for in pregnancy and dose
Eclampsia, seizures
2-5 grams IV, 1/2 dose in 2 syringes if IM
What is Calcium chloride for in pregnancy and dose
Hypocalcemia/Reverse Mag sulfate SFx
8-16mg/kg SIVP
What is Terbutaline for in pregnancy and dose
Suppress pre-term labor, possibly if cord prolapse, pregnancy induced asthma
.25mg SQ, .2-.5mg Neb
What is (Diazepam) Valium for in pregnancy and dose
Sedative/Anticonvulsant, eclampsia w/ anxiety
5-10mg SIVP
What is Diphenhydramine (Benadryl) for in pregnancy and dose
Allergic reaction, hyperemesis gravidarum
50mg IV
What is Ondansetron (Zofran) for in pregnancy and dose
Treat nausea and vomiting
.4mg IV/IO/IM
What is Oxytocin (Pitocin) for in pregnancy and dose
Control severe postpartum hemorrhage ONLY after all products of conception leave vagina
What is premature membrane rupture in pregnancy
Amniotic sac ruptures more than an hour before labor
- May self heal
- Risk of infection
What is preterm labor
Regular, intense uterine contractions accompanied by effacement, after 20 less than 37 weeks
What is fetal distress
-Treatment
Distress form hypoxia, trauma, abruptio placenta, prolapsed cord
Best care is quality care for the woman
What is uterine rupture
- S/S
- Treatment
Uterus rupture during labor
S/S- Weak, dizzy, thirsty, weakening contractions, sharp/tearing pain, shock
Treatment- Shock management
What is post term labor
Fetus born after 42 weeks
What is meconium staining
-S/S
Chemical pneumonia from ingestion of meconium in amniotic fluid
S/S-Green/black meconium, depressed newborn
Treatment- Suction as needed
What is Fetal macrosomia
- Complications
- S/S
“Big baby syndrome”- More than 9 lbs
Complications-Cephalopelvic distortion, shoulder dystocia
S/S-Check newborn BGL
What is Hydramnios
-Complications
(Polyhydramnios) There is too much amniotic fluid
Complications-Possible prolapsed cord and abruptio placenta and increased chance of postpartum hemorrhage
What is brow presentation
Head extended slightly
What is Occiput posterior presentation
Face up, can prolong delivery
What is military presentation
Head in a more neutral presentation of only partially flexed
What is a breach presentation
Part of the body estimate first other than the head
What is Frank breech presentation
Hips flexed and knees extended, butt presents first
What is Incomplete breech presentation
One or both hips and knees extended, one or both feet at the presenting part
What is Complete breech presentation
Hips and knees flexed, butt as presenting part
Steps to follow if butt is being delivered first (7)
- Position woman on edge of bed
- Dont pull on newborn
- Support body when legs clear
- Lower newborn slightly
- Lift newborn back up when you can see hairline
- Create air gap if needed
- Proceed the rest of delivery as normal
What is a transverse presentation
Fetus lies crosswise in the uterus and one hand may protrude
*DO NOT ATTEMPT DELIVERY
What is shoulder dystocia
Difficulty delivering the shoulders as they get stuck behind the pelvic bone
What maneuvers are there to widen a woman’s pelvis during birth
Push down on pelvis or have woman hyperflex into abdomen
What is a nuchal cord and a problem with it
Umbilical cord wrapped around the newborns neck, can result in cord compression causing fetal distress
What is a prolapsed umbilical cord and the problem associated
Umbilical cord presents before the fetus and can’t shunt off blood to the fetus if pressure is applied to it
Treatment of prolapsed umbilical cord (5)
1-Woman supine, hips elevated a lot 2- O2 via NRB 3-Have woman pant breath 4-2 fingers gently push presenting part off cord 5-Keep pressure of umbilical cord
What is a problem of substance abuse in pregnancy
-Signs a newborn is born an addict (5)
Fetus can develop birth defects and become an addict
Signs
-Respiratory depression, BradyC, TachyC, Seizures, Cardiac arrest
Placenta previa
S/S
Treatment
Placenta is implanted low in uterus, partial or complete block of cervix
S/S-Painless bleeding, soft/tender uterus, Grey turner or cullens sign, recent sex
Treatment-Shock management
Abruptio Placenta
S/S
Treatment
Premature separation of placenta from uterus
S/S- Sudden, sharp/tearing pain, a lot to no bleeding, stiff abdomen
Treatment-L lateral, treat for shock
Three degrees of uterine inversion, explain each
1st- Cervix drops, remains in vagina
2nd- Cervix lies at the opening to vagina, body of uterus is in the vagina
3rd- Uterus and cervix protrude through vaginal opening
Uterine Inversion
S/S
Cause
Treatment
S/S
- Tissue protrusion
- Heaviness or fullness feeling
- Fatigue
- Lower back pain
Cause
Pulling on umbilical cord
Treatment
- One attempt to replace
- Cover with sterile, moist gauze
- Treat for shock
Ectopic Pregnancy
S/S
Treatment
Ovum develops outside of uterus
S/S
- Rapid onset, unilateral pain
- Radiation to shoulder
- Amenorrhea >5 was since LMP
Treatment-Treat for signs of shock and pain meds
Preeclampsia
S/S
Treatment
HyperT with onset of edema, HyperT and protein in urine after 20th wk of gestation predisposing seizures, can progress to eclampsia
S/S
Systolic over 160 or Diastolic over 110
Headache, dizzy, nausea, vomiting, spots in vision
Treatment
Mag Sulfate 2-5 grams
Labetalol, Hydralazine
Eclampsia
Treatment
Seizures with present S/S of preeclampsia. Usually resolves from 0-10 days after birth.
Treatment
Mag Sulfate 2-5 grams
Other Hypertensive meds
Gestational diabetes
S/S
Complications
Treatment
Inability to process carbs, insulin increase
S/S-Polyuria, polydipsia, polyphagia
Complications- Oral glucose crosses placental barrier
Treatment- O2, BGL, Fluids
Pregnancy Asthma
Complications
Treatment
A common condition to complicate pregnancy, can produce progressive hypoxia to both
Complications- Preature labor, preeclampsia, resp failure, vag hemorrhage, eclampsia, low birth weight, retardation, potential fetal death
Treatment- Asthma protocol
Findings in injured pregnant women from truama
Abnormal fetal position, easily palpated fetus, unable to palpate fundus, vaginal bleeding
What % of blood loss do signs of Hypovolemic present in pregnant patients
About 40%
What is the best treatment for the fetus in trauma
Care for the mother
How should you transport a pregnant patient on a back board
Elevate right hip 6 inches
Treatment for pregnant trauma patient
1-Airway, early ET if needed and O2 NRB 2-Control bleeding ASAP 3- 1 or 2 IV lines and bolus if needed 4-Notify ER 5-Tilt backboard 30* left
CPR differences in pregnant patients
- Left lateral uterine displacement
- Hands 5-7” below angle of Louis for CPR
- Can do CPR on dead woman to save baby
Potential causes for maternal cardiac arrest
BEAUCHOPS
- Bleeding/DIC
- Embolism
- Anesthetic complications
- Uterine Antony
- Cardiac disease
- Hypertension
- Other Hs and Ts
- Placenta abruptio/previa
- Sepsis
Maternal arrest treatment
- IV above diaphragm
- Assess for hypovolemia
- Anticipate difficult airway
- Stop mag is used (calcium to reverse)
- Continue CPR
Full APGAR scoring system
Appearance: 2- Pink, 1-Acrocyanosis, 0-Cyanotic
Pulse: 2->100, 1-<100, 0-No pulse
Grimace: 2-Great, 1-Poor, 0-None
Activity: 2-Resistant, 1-Some, 0-None
Respirations: 2-Strong cry, 1-Weak, 0-None
Postpartum bleeding
Causes
Treatment
> 500 mL blood loss, can last up to 24 hrs
Causes-Ineffective contractions, retaining placenta pieces, vag/cervix tears
Treatment- Control bleed, massage uterus, encourage breast feeding, fluid, oxytocin
