Chapter 32: Obstetric and Gynecologic Emergencies Flashcards
Name the external genitalia.
Labia, perineum, mons pubis
Name the internal genitalia.
The vagina, the ovaries and fallopian tubes, and the uterus
What is the vagina?
The birth canal and smooth muscle
What are characteristics of ovaries and fallopian tubes?
Ovaries are responsible for producing ova; fallopian tubes (oviducts) are where fertilization usually occurs; ectopic pregnancy occurs outside of fallopian tubes
What are characteristics of the uterus?
Muscular, hollow organ located along midline in women’s lower abdominal quadrants; intended site for fertilized egg to impolite and develop into a fetus
What is the cervix and where is it located?
It’s a muscular ring separating the uterus and vagina
Name characteristics of menstruation.
Stimulated by estrogen and progesterone; ovaries release ovum; uterus walls thicken; fallopian tubes move egg; uterine walls expelled
What is peristalsis?
Fallopian tubes move egg
What is the process of fertilization?
Sperm reaches ovum, ovum becomes embryo, embryo implants in uterus, fetal stage begins
How long is pregnancy?
Nine months of pregnancy (Three 3-month trimesters)
What is a placenta?
Organ of maternal and fetal tissues; exchange area of oxygen and nutrients between mother and fetus
What is the function of the umbilical cord?
Circulates blood and is expelled with delivery of baby, placenta
What is the purpose of the amniotic sac?
Fluid that allows fetus to float, cushions fetus, and maintains constant fetal body temperature
What are some changes in the cardiovascular system during pregnancy?
Increased blood volume, cardiac output, and heart rate
What are some changes in the respiratory system during pregnancy?
Increased oxygen demand and consumption
What are some changes in the gastrointestinal system during pregnancy?
Nausea and vomiting, slowed digestion
Changes in hormones during pregnancy causes what to ligaments?
Ligaments made more elastic, thus more vulnerable to injury
What can the additional weight during pregnancy cause?
affects posture, possible leading to back pain and balance issues
What is Supine Hypotensive Syndrome?
Placenta, infant, and amniotic fluid total 20-24 lbs; when supine, mass compresses inferior vena cava; cardiac output decreases; dizziness and drop in blood pressure
What is the first stage of labor?
Starts with regular contractions and ends when cervix fully dilated
What is the second stage of labor?
Baby enters birth canal and is born.
What is the third stage of labor?
Begins after baby is borne and ends when afterbirth is delivered
What are Braxton-Hicks contractions?
Irregular, not sustained and not indicative of impending delivery in the first stage of labor
What is lightening?
Fetus’s moment from high in the abdomen down toward birth canal in the first stage of labor
What are characteristics of labor pains?
Contraction time or duration; contraction interval or frequency; when they last 30 seconds to 1 minute and are 2-3 minutes apart, delivery of the baby me be imminent.
How do you to tell if the amniotic sac should be broken?
If fluid has meconium staining it indicates that there may be fetal distress
What are specific characteristics of the second stage?
Full dilation of cervix; contractions increasingly frequent; labor pain severe; mother feels urge to push or move bowels
What are specific characteristics of the third stage?
After baby’s birth, contractions resume until placenta is delivered; used lasts 10-20 minutes
What are things to assess when woman is in labor?
Assessment should be focused on imminent delivery; name, age, expected due date; first pregnancy? Has patient seen doctor about pregnancy? When did labor pains start? Patient feeling the urge to push or to move her bowels? Examine for crowning? Feel for uterine contractions; Take vital signs
What are findings that might indicate the need for neonatal resuscitation?
No prior prenatal care; premature delivery; labor induced by trauma; multiple births; history of pregnancy problems; labor induced by drug use; meconium staining when water breaks
True or False: EMTs do not deliver babies: mothers do.
TRUE
What is the primary role of the EMT with pregnant mother?
Primary role is to determine whether the delivery will occur on scene and if so, to assist mother as she delivers her child
How do you prepare a mother for delivery?
Control scene; wear proper PPE; place mother on bed, floor, or ambulance stretcher; remove clothing obstructing vagina; position assistant and OB kit; if possible, make environment as warm as possible
What are Off-duty delivery supplies?
Clean sheets and towels; heavy, flat twine or new shoelaces; towel or plastic bag (for placenta); clean, unused rubber gloves and eye protection; head covering for the baby
How do you assisted with a normal delivery?
Keep someone at mother’s head; position gloved hands at vaginal opening when baby’s head starts to appear; place hand on baby’s head as it bulges out to prevent sudden uncontrolled expulsion; place one hand below baby’s head as it delivers
If amniotic sac is not broken what do you do?
Use your finger to puncture the membrane
What do you do after the head is delivered?
Check to see if the umbilical cord is wrapped around the baby’s neck?
TRUE or FALSE: Do not support the baby during the entire process
FALSE
How do you assess the baby’s airway?
Use syringe to suction mouth and nose if necessary
TRUE or FALSE: you do not need to note the exact time of birth.
FALSE
Once the baby is born, what should you note first?
Note ease of breathing, heart rate, crying, movement, and skin color
What is the APGAR score?
Based on Appearance, Pulse, Grimace, Activity, and Respiratory effort. Does not guide resuscitation efforts
How do you keep the baby warm?
Dry baby; discard wet blankets; wrap baby in a dry blanket (infant swaddler or space blanket); cover head; encourage
What circumstances necessitate cutting the umbilical cord?
If cord wrapped around baby’s neck and cannot be slipped over head; if attachment impedes resuscitation effort; if attachment interferes with urgent need for transport of mother or baby; if protocol requires it
What are the steps to cutting the umbilical cord?
Keep infant warm; use sterile clamps or umbilical tape; apply one clamp about 10 inches from the baby; place a second clamp about 7 inches from the baby; cute cord between clamps using surgical scissors; be careful when moving the baby so no trauma is brought to hate clamped cord
Should you place the baby on the mother’s abdomen after the birth process?
Yes
If baby has shallow breathing, what should you do?
Provide positive pressure ventilation at a rate of 40 to 60 per minute
What do you do if infant’s heart rate is less than 100bpm or 60bpm?
If less than 100 bpm, initiate chest compressions at 120 compressions per minute. If less than 60 bpm, initiate chest compressions at 120 compressions per minute
What is afterbirth?
Placenta with umbilical cord, amniotic sac membranes, and tissues lining uterus
How do you control vaginal bleeding after birth?
Place a sanitary napkin over the mother’s vagina opening (Do not place anything in the vagina); have the mother lower her legs and keep, but not squeeze, them together; massaging the uterus will help it contract, which controls the bleeding; encourage the mother to begin nursing the baby.
What are common complications of delivery?
cord around the neck; unbroken amniotic sac; infants who need encouragement to breathe
How is breech presented?
Most common abnormal delivery; buttocks- or both legs first delivery; risk of birth trauma to baby is high; meconium staining often occurs
What is limb presentation?
A limb of the infant protrudes from the vagina; commonly a foot when baby in breech position; rapid transport is essential; baby cannot be delivered in a prehospital setting
What is a prolapsed umbilical cord?
when umbilical cord presents first and becomes squeezed between vaginal wall and baby’s head; oxygen supply to the baby may be totally interrupted; life-threatening condition
What is meconium and what are the procedures when this occurs?
Stains amniotic fluid greenish or brownish yellow in color; do not stimulate infant before suctioning; suction mouth, then nose; maintain open airway; provide ventilations and/or chest compressions; transport was soon as possible
What are the signs and protocols for excessive rebirth bleeding?
Main sign is unusually profuse bleeding; abdominal pain may or may not be felt; assess for signs of shock; provide high-concentration oxygen and transport; place sanitary napkin over vagina; save all tissue that is passed
What should you be alert for during an ectopic pregnancy?
Acute abdominal pain, can be referred to the shoulder; vaginal bleeding; rapid and weak pulse; low blood pressure; absent menstrual period
What are indications of seizures in pregnancy?
Existing preeclampsia; elevated blood pressure; excessive weight gain; excessive swelling to face, ankles hands and feet; altered mental status, headache, or other unusual neurological findings
What are implications of a miscarriage or abortion?
Spontaneous or induced; cramping, abdominal pains; bleeding raging from moderate to severe; noticeable discharge of tissue and blood from vagina
What do you do in the case of a stillbirth?
Do not resuscitate if it is obvious the baby died some time before birth; provide full resuscitation measures if baby is borne in pulmonary or cardiac arrest; prepare to provide life support; provide emotional support for family
What do you do when vaginal bleeding occurs?
Treat as potentially life-threatening; check for associated abdominal pain; monitor for hypovolemic shock
What do you do in case of sexual assault?
Treat immediate life threats; do not disturb potential criminal evidence; examine genitals only if severe bleeding is present; discourage bathing, voiding or cleansing woads; fulfill mandated reporting requirements
