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AEMCA Study Guide > AEMCA - Obstetrics > Flashcards

AEMCA - Obstetrics Flashcards

1
Q

How much does blood volume increase during pregnancy?

A

30%

  • To compensate for increased renal and uterine blood flow
  • This allows to oxygenate/remove waste for fetus
  • Increased volume also causes peripheral edema (due to higher pressure gradient)
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2
Q

What supplement is recommended in pregnancy?

A

Iron

  • To compensate for low hemoglobin
  • Due to increased blood and plasma volume (anemia)
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3
Q

When does blood pressure decrease during pregnancy? How much does it decrease by? And why does it decrease?

A

2nd Trimester (around 13-26 weeks)

  • BP decreases by 10-15 mmHg (normally returns to normal by third trimester)
  • As blood volume increases, blood vessels dilate in response.
  • Hormonal changes (such as increased production of progesterone and estrogen) can also cause vasodilation
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4
Q

How much does pulse rate increase during pregnancy, and when specifically does it increase?

A

Pulse rate increases 15-20 BPM above patient’s baseline in the THIRD TRIMESTER

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5
Q

What should you encourage before and after delivery?

A

Peeing

  • Empties bladder before delivery (uterus and baby put pressure on bladder > full bladder can make it harder for baby to descend)
  • Prevents bladder distention (uterus continues to contract and shrink post-delivery > can cause bladder to become compressed and distended if full)
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6
Q

Why is identifying the fundus important?

A

Allows us to estimate gestation based upon fundal height

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7
Q

What is most common in the first 6-14 weeks of pregnancy?

A

Nausea/vomiting (morning sickness)

  • Can occur during the entirety of pregnancy or not at all
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8
Q

What is the medication commonly used for morning sickness classified as?

A

Antihistamines

  • Crosses the blood brain barrier blocking H1 receptors (ex: Diclectin)
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9
Q

As blood volume and HR increase, how does this impact Cardiac Output?

A

It increases it

  • Specifically by 30% in the THIRD TRIMESTER
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10
Q

What is Supine Hypotension Syndrome?

A

Compression of the inferior vena cava by the uterus

  • Pregnant women >20 weeks have higher potential of this happening
  • Compression of IVC causes decrease in preload
  • Decrease in preload results in decreased cardiac output, which leads to hypotension and syncope

*Left lateral position limits compression and increases uterine blood flow. SUPER IMPORTANT IN CARDIAC ARREST

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11
Q

How much does Functional Residual Capacity (volume left after normal exhalation) decrease by during pregnancy?

A

25%

  • Can cause increased RR
  • Can also be from enlarged uterus placing pressure on diaphragm
  • Fetus also requires more O2
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12
Q

What are considered Child Bearing Years?

A

14-50 years of age

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13
Q

What does Primip mean?

A

Short for PRIMIPARA

  • Means that patient has only had one birth/delivery (past 20 weeks)
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14
Q

What does Multip mean?

A

Short for MULTIPARA

  • Means that patient has had 2 or more deliveries (past 20 weeks)
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15
Q

What is considered a Geriatric Pregnancy?

A

If a woman is aged 35+

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16
Q

How many weeks/months is the FIRST TRIMESTER?

A

Week 1 - Week 12 (Approx. 3 months)

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17
Q

How many weeks/months is the SECOND TRIMESTER?

A

Week 13 - Week 27 (Approx 4 - 6 months)

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18
Q

How many weeks/months is the THIRD TRIMESTER?

A

Week 28 - Birth (usually around 40-42 weeks). Approx 7-9 months.

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19
Q
  • These contractions last approx 30-60 seconds
  • Benign and painless
  • Do not progress in regularity or severity
  • Body’s way of “training” for delivery

What is this called?

A

Braxton Hicks Contractions

  • Can occur as early as the 2nd trimester
  • Increase in frequency 2-3 weeks before onset of labour
  • Uterus undergoes effacement (thinning of cervix) and dilation
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20
Q

During true/actual contractions, what will the abdomen feel like?

A

Rock hard

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21
Q

What are the Stages of Labour?

A
  • Late Pregnancy/ Pre-Labour
  • Stage One: Early Labour + Active Labour
  • Stage Two: Passive + Active Phase
  • Third Stage
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22
Q

What happens in Stage One: Early Labour + Active Labour?

A
  • Begins with descent of infant - relieves pressure on upper abdomen but increases pressure in pelvis
  • Contractions described as cramping, back pain, generalized abdo pain
  • Mucus plug is expelled; “bloody show”
  • Lasts 8-12 hours in first delivery, 6-8 or less thereafter
  • 2 phases:
    Latent (Dilation 3-4 cm)
    Active (Dilation 5cm to 10cm)
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23
Q

What happens in Stage Two: Passive + Active Phase?

A
  • FULL DILATION (10 cm): fetal head enters birth canal
  • Urge to push or bear down is a HUGE indicator
  • Heavy red show of blood
  • Head (crowning) or other presenting part emerges
  • Contractions are intense; 2-3 min intervals lasting 60-90 seconds
  • Ends with delivery of infant

*500 mL of blood loss during labour
* Urination and BM may also occur during delivery

24
Q

What is imminent birth described as according to the ALS?

A

Crowning or other presenting part is visible OR:

  • In primips, presenting part is visible during and between contractions. Contractions <2 mins apart. Maternal urge to push + bear down

-In multips, contractions are 5 mins apart or less + any other sign of second stage labour present.

25
Q

What happens in the Third Stage?

A
  • Begins with delivery of infant and ends with placental delivery
  • Placenta takes 30-60 mins to deliver
26
Q

What are some good hx gathering and assessment questions?

A
  • Do you know your due date?
  • Last menstrual period?
  • Are you receiving prenatal care?
  • How far apart are your contractions? How frequent are they? How long do they last?
  • Have you given birth before? Any complications or regular deliveries?
  • Any past medical hx? (diabetics = huge babies)
27
Q

What happens in NORMAL LABOUR?

A

1) Descent - Fetus moves down towards pelvis
2) Flexion - Fetal chin to chest
3) Internal Rotation - Fetal occiput turns towards maternal pelvis
4) Extension - Birth with head facing down
5) Restitution - Baby’s head rotates to side
6) Expulsion - Birth of baby

28
Q

How do you deliver the placenta?

A
  • Gush of blood (placenta will separate from uterine wall)
  • May notice lengthening of cord or contractions afterwards

-Apply GENTLE controlled cord traction (CCT) & guard uterus with other hand (only after there is evidence of detachment)

  • Encourage delivery and perform CCT if hemorrhage seems to be occuring
  • Document time of delivery.
29
Q

When the placenta is delivered, what should you do?

A
  • Inspect it for wholeness
  • Place in plastic bag from OBS kit: label with maternal patient’s name, time of delivery
  • Delivery of placenta should not delay transport considerations/initiation
30
Q

What is the importance of cranial sutures?

A

To allow for flexibility during birth

  • Cranial sutures also allow for reshaping of the fetus’ head during delivery
  • Complete fusion of cranial suture lines is ~18 months of age in child
31
Q

What is Precipitous Labour?

A

Extreme rapid delivery:

  • Delivery of baby within 3 hours of regular contractions
  • More common with 2nd births “multips”
  • Rapid labour may increase risk of perineal lacerations & postpartum hemorrhage due to uterine atony
32
Q

What is uterine atony?

A

Medical condition: when uterus fails to contract properly after childbirth.

  • Can lead to excessive bleeding and is a serious complication of childbirth.
  • Most common cause of PPH (more than 500 ml of blood loss)
33
Q

What are some things to be concerned about with Premature Births?

A
  • Always at risk for hypothermia (true for all neonates)
  • Usually requires resuscitation: poor lung compliance + no surfactant since alveoli are not fully formed
34
Q

What are some malpresentations that will NOT deliver?

A
  • Transverse lie
  • Shoulder presentation
  • Oblique lie

*In these scenarios, inspect perineum to rule out cord prolapse or limb presentation

35
Q

What should you do with limb presentations?

A
  • Do NOT push back in
  • Discouraging patient from pushing - tell them to “pant” instead
  • WRAP LIMB AND KEEP WARM
  • Load and go babyyyy
36
Q

Types of Breech Presentations?

A
  • Frank Breech (most common): hips flexed and legs extended. Buttocks will present first
  • Complete Breech: hips and knees are flexed. Buttocks and feet present together
  • Footling Breech: One hip and knee flexes, other remains straight and enters birth canal first. Risk of cord prolapse is HIGH

*In all these scenarios, colour of amniotic fluid is important. Should be clear. If not, fetus may be in distress.

37
Q

Should you attempt to deliver a baby if you see that they are in Frank Breech?

A

Yes

  • Position patient, then tell them to push with contractions. HANDS OFF BREECH
  • Once baby has been born to the umbilicus, you have 4 MINS TO DELIVER BABY COMPLETELY. Consider gentle release of legs if possible. HANDS OFF BREECH.
  • Consider gentle release of arms at this point if possible. ALLOW GRAVITY TO BIRTH BABY. If hairline visible, do MSV

*Never touch cord in all circumstances

38
Q

What is Placenta Previa?

A

When the placenta partially or completely covers the cervix

  • Bleeding is bright red and PAINLESS
  • Can occur when blastocyst implants too close to cervix
39
Q

What is Placenta Abruptio?

A

Partial/full detachment of placenta at 20 weeks.

  • Significant bleeding
  • Severe abdominal pain; tearing pain
  • Risk factors: trauma, previous c-section, pre-eclampsia/eclampsia, age of 35 years
  • SECOND/THIRD TRIMESTER COMPLICATION
40
Q

What is Placenta Accreta?

A

When the placenta grows too deeply into the wall of the uterus

41
Q

When should you assume Pre-Eclampsia in patients?

A
  • > 20 weeks gestation
  • BP >140/90 (severe pre-eclampsia has a diastolic value of >110)
  • Generalized edema
  • c/o of headache, nausea, abdominal pain (with or without vomiting), blurred vision, fatigue, rapid weight gain
42
Q

What is Pre-Eclampsia?

A

Pregnancy complication that typically develops after 20 weeks of gestation

  • Characterized by high BP (>140/90)
  • Proteinuria (protein in the urine)
  • Proteins are big and shouldn’t be in urine. This is due to osmotic pressure
43
Q

A pregnant woman is having a seizure. Immediately, what should the first thing be in your mind?

A

Eclampsia.

  • Treat how you would normal seizures (maintain ABC’s: consider airway, O2)
  • Only exception is to position left lateral
44
Q

What is Gestational Diabetes?

A

Type of diabetes that develops during pregnancy.

  • Typically develops in second or third trimester; goes away after baby is born
  • Women who develop GD are at increased risk of developing Type 2 Diabetes later on in life
  • BIG BABIES: be mindful of breech/shoulder dystocia with these patients
45
Q

What is a Spontaneous Abortion (Miscarriage)?

A

Loss of pregnancy without outside intervention before 20 weeks gestation

  • Often presents with light bleeding; possibly some clots
  • Cramping and lasts for approx. 1 week
46
Q

What is Gestational Trophoblastic Disease?

A

When abnormal cells or tumour develops in uterus from cells that would normally develop placenta

  • Mostly benign but can be malignant
  • Risk factors: maternal age <20 or >35, previous spontaneous abortion, molar pregnancy
47
Q

What is Dysmenorrhea?

A

Pain during menstruation

  • Very common
  • Can be secondary to other factors such as endometriosis, pelvic infections, and fibroid tumours
48
Q

What is Endometriosis?

A

When endometrium tissue grows abnormally

  • Normally, endometrium (lining of the uterus) grows and sheds each month
  • In endometriosis, tissue similar to lining of uterus grows on other areas such as ovaries, fallopian tubes, or other organs in pelvic area
49
Q

S&S of Endometriosis?

A
  • Dysmenorrhea
  • Lower back and pelvic pain
  • Pain during intercourse or after
  • Painful bowel movements or pain when urinating
  • Infertility
50
Q

What is Disseminated Intravascular Coagulation (DIC)?

A

Serious medical condition that affects the body’s ability to control blood clotting

  • Body normally forms blood clots to stop bleeding during injuries
  • In DIC, body forms too many blood clots throughout the body
  • These blood clots can block blood flow to important organs; leads to organ damage and failure

*Body depletes platelets and coagulation factors, leading to thrombolysis and massive bleeding

51
Q

Stages of Shock?

A

Stage 1 (Compensated or Nonprogressive)
- Vasoconstriction, tachycardia, tachypnea occurs to retain fluid, along with renal
- This is due to blood shunting to core; pt may appear cyanosed with cool skin, poor cap refill
- Anaerobic metabolism begins, producing lactate and H+ ions (start of acidosis)

Stage 2 (Decompensated or pressive)
- Compensation is failing.
- Hypotension due to vasodilation, which decreases cardiac output.
- Possibility of decreased LOA here

Stage 3 (Irreversible)
- End of organ dysfunction and death

52
Q

What is a thready pulse?

A

A pulse that’s longer instead of one quick beat. This is bad LOL.

53
Q

What is a Uterine Rupture?

A

Spontaneous or traumatic rupture of uterine wall.

  • Fetus can be expelled into peritoneal cavity.
  • For this reason, limbs/head of fetus may be able to be palpated outside uterus
  • May result from old scar openings (c-section) and trauma to uterus
  • High fetal mortality: 50-75%
54
Q

What are Ovarian Cysts?

A

Fluid filled sacs on ovaries

  • As sacs grow and stretch, pain and discomfort results
  • Eventually ruptures, which can cause serious hemorrhage
  • C/O: unilateral lower abdominal pain, sudden and sharp
55
Q

What is one of the most dangerous FIRST TRIMESTER complications, occurly most often at 6 weeks?

A

Ectopic Pregnancy

56
Q

What is the clinical triad of ECTOPIC PREGNANCY?

A
  • Pain
  • Amenorrhea (lack of menstruation)
  • Vaginal bleeding

AEMCA Study Guide (6 decks)

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