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Emergency Care and Transportation of the Sick and Injured > Chapter 33 Obstetrics and Neonatal Care > Flashcards

Chapter 33 Obstetrics and Neonatal Care Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Page 1192

A

Test

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2
Q

Questions to ask when taking a pregnant woman’s history

A 
Due date
Any complications
Prenatal care
Fetal movements
Frequency of contractions
History of previous pregnancies
Multiples
Drugs or medications during pregnancy
If water broke, was the fluid green
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3
Q

Meconium

A

Fetal stool

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4
Q

The presence of meconium

A

Can indicate fetal distress and can be aspirated during delivery

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5
Q

How the length and frequency of contractions is assessed

A

By asking the patient and placing a hand on the abdomen

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6
Q

A woman’s blood pressure typically drops slightly during these trimesters

A

The first two

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7
Q

In a scenario where you are transporting a pregnant patient with complaints unrelated to childbirth, the hospital will want to know these things

A

Weeks of gestation, due date, and complications of pregnancy

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8
Q

The three stages of labor

A

Dilation of the cervix, delivery of the fetus, delivery of the placenta

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9
Q

Signals the beginning of the first stage of labor

A

Onset of contractions

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10
Q

Signals the end of the first stage of labor

A

When the cervix is fully dilated

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11
Q

Usually the longest stage of labor

A

1st

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12
Q

Average length of the first stage of labor in a first pregnancy

A

16 hours

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13
Q

Other signs of the beginning of labor

A

Bloody show(blood-streaked mucus) and rupture of the amniotic sac(water breaking)

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14
Q

Initially, uterine contractions may not occur at regular

A

Intervals

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15
Q

In true labor, contractions increase in

A

Frequency and intensity overtime

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16
Q

Uterine contractions become more regular and last about this long

A

30 to 60 seconds each

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17
Q

Labor lasts longer in _______ than in a ______.

A

Primigravida, multigravida

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18
Q

Primigravida

A

A woman who is experiencing her first pregnancy

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19
Q

Multigravida

A

A woman who has experienced multiple pregnancies

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20
Q

Another name for false labor

A

Braxton-Hicks Contractions

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21
Q

The number of characteristics that define Braxton-Hicks contractions

A

5

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22
Q

First characteristic of Braxton-Hicks contractions

A

Irregular and do not increase in intensity or frequency

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23
Q

Second characteristic of Braxton-Hicks contractions

A

Pain and contractions start and stay in the lower abdomen

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24
Q

Third characteristic of Braxton-Hicks contractions

A

Contractions and pain may be alleviated by physical activity or a change in position

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25
Q

Fourth characteristic of Braxton-Hicks contractions

A

If present, bloody show is brownish

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26
Q

Fifth characteristic Braxton-Hicks contractions

A

If leakage of fluid occurs, it is usually urine. It will be in small amounts and smell of ammonia

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27
Q

Number of characteristics of true labor

A

Five

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28
Q

First characteristic of true labor

A

Contractions, one started, consistently get stronger and closer together

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29
Q

Second characteristic of true labor

A

Pain and contractions may start in the lower back and “wrap around” to the lower abdomen

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30
Q

Third characteristic of true labor

A

Physical activity may intensify the contractions. A change in position does not relieve contractions

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31
Q

Fourth characteristic of true labor

A

The bloody show is pink or red in general a company by mucus

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32
Q

The fifth characteristic of true labor

A

The amniotic sac may break before contractions start or may break during contractions. A moderate amount of fluid that may smell sweet will be present, and fluid will continue to leak.

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33
Q

Should you transport in the presence of Braxton-Hicks contractions?

A

Yes

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34
Q

Premature rupture of the amniotic sac can occur as early as

A

Several months before they are due to deliver

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35
Q

Premature rupture of the amniotic sac may or may not cause ____

A

The woman to go into labor

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36
Q

A woman who experiences a premature rupture of the amniotic sac needs ___

A

Transport to the hospital

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37
Q

Lightening

A

When the head of the fetus descends into the woman’s pelvis as the fetus positions for delivery, toward the end of the third trimester

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38
Q

Following lightening, it becomes easier to _____

A

Breathe

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39
Q

Why does it become easier to breathe after lightening?

A

Because the fetus has moved from under the rib cage

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40
Q

This marks the beginning of the second stage of labor

A

When the fetus enters the birth canal

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41
Q

This marks the end of the second stage of labor

A

The delivery of the newborn

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42
Q

During the second stage of labor, the fetus goes to positional changes as it moves through the birth canal. This causes ____

A

Contractions to become closer together and last longer

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43
Q

During the second stage of labor, the woman may feel as if she needs to have a bowel movement. This is because

A

The fetus puts pressure on the rectum

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44
Q

Crowning

A

When the top of the fetus his head begins to appear at the vaginal opening

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45
Q

This marks the beginning of the third stage of labor

A

The birth of the newborn

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46
Q

This marks the end of the third stage of labor

A

The delivery of the placenta

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47
Q

Delivery of the placenta may take up to this long

A

30 minutes

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48
Q

During the delivery percent of contractions continue. This functions to ____

A

Assist in the separation process and in clamping down and closing the blood vessels that connected the placenta to the uterine lining

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49
Q

The number of questions the textbook lists in order to determine whether delivery is imminent

A

Eight

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50
Q

First question the text book lists in order to determine whether delivery is imminent

A

How long have you been pregnant?

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51
Q

The second question the text book lists to help determine whether delivery is imminent

A

When are you due?

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52
Q

The third question the text book lists to help you determine whether delivery is imminent

A

Is this your first pregnancy?

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53
Q

The fourth question the text book lists to help you determine whether delivery is imminent

A

Are you having contractions? How far apart are the contractions? How long do the contractions last?

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54
Q

The fifth question the textbook lists in order to help you determine whether delivery is imminent

A

Have you had any spotting or bleeding?

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55
Q

The sixth question the textbook lists in order to help you determine whether delivery is imminent

A

Has your water broken?

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56
Q

The seventh question the text book lists in order to help you determine whether delivery is imminent

A

Do you feel as though you need to have a bowel movement?

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57
Q

The eighth question the text book lists in order to help you determine whether delivery is imminent

A

Do you feel the need to push?

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58
Q

The number of questions in the textbook lists in order to help you determine any potential complications in pregnancy

A

Five

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59
Q

The first question the textbook lists in order to help you determine any potential pregnancy complications

A

Were any of your previous deliveries by cesarean section?

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60
Q

Second question the textbook lists to help determine any potential pregnancy complications

A

Have you had any problems in this or any previous pregnancy?

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61
Q

The third question the textbook lists in order to determine any potential pregnancy complications

A

Do you use drugs, drink alcohol, or take any medications?

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62
Q

The fourth question listed by the textbook to help you determine any potential pregnancy complications

A

Is there a chance you will have multiple deliveries (having more than one baby)?

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63
Q

The fifth question listed by the textbook to help you determine any potential pregnancy complications

A

Does your physician expect any other complications?

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64
Q

Three scenarios in which you should prepare for immediate delivery

A

If the patient says she’s about to deliver, so she has to move her bowels, or feels the need to push

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65
Q

During delivery, put a blanket or pillow under the patient tips so that they are elevated about

A

2 to 4 inches

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66
Q

How should the patient’s hips, legs, knees, and feet be positioned?

A

Hips and legs flexed. Feet flat on the ground. Knees apart

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67
Q

The number of steps in preparing for a field delivery

A

Four

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68
Q

First step in preparing for a field delivery

A

If time allows, put on a face shield and gown and place towels or sheets on the floor around the delivery area to help soak up body fluids and to protect the woman and the newborn

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69
Q

The second step in pairing for a field delivery

A

Open the OB kit carefully so its contents remain sterile

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70
Q

Third step in preparing for a field delivery

A

Put on sterile gloves. After this, handle only sterile materials

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71
Q

Fourth step in preparing for a fuel delivery

A

Using sterile sheets in drapes from the OB kit to make a sterile delivery field. Place one sheet under the women’s buttocks and unfold it toward her feet. Wrap another behind the patients back and drape it over each thigh. Drape one sheet across the abdomen

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72
Q

Precipitous labor

A

Fast labor

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73
Q

What type of woman is at greater risk for precipitous labor

A

Women who have previously had children

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74
Q

When laborers to fast

A

The tissues do not have time to stretch and the patient is at risk for tears in the peroneal area

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75
Q

Frequency of contractions is measured

A

By starting your time at the beginning of one contraction and ending at the beginning of the next contraction

76
Q

The duration of each contraction is measured

A

By feeling the patient’s abdomen. Contractions begin with uterus and abdomen tightening and end with uterus and abdomen relaxing

77
Q

During contractions, you want to remind the patient to breathe this way.

A

In quick, short breaths but not to strain

78
Q

Between contractions, you want the patient to breathe this way

A

Rest and breathe deeply through her mouth

79
Q

The number of steps in delivering a newborn according to skill drill 33–1

A

10

80
Q

Step one in delivering a newborn

A

Crowning is the definitive sign that delivery is imminent and the transport should be delayed until after the child has been born

81
Q

Step two in delivering a newborn

A

Allow the woman to push the head out. Use your hands to support the bony parts of the head as it emerges. The child’s body will naturally rotate to the right or left at this point in the delivery. Continue to support the head to allow it to turn in the same direction. Avoid the eyes and fontanelles. Feel at the neck to see if the umbilical cord is wrapped around it. If it is, gently lift it over the head without pulling hard on the cord.

82
Q

Step three in delivering a newborn

A

Once the head is delivered, it will rotate on its own to one side. At the next contraction, the upper shoulder will be visible. Guide the head down slightly by applying gentle downward traction to help the upper shoulder deliver.

83
Q

Step four in delivering a newborn

A

Support the head and upper body as the shoulders deliver. You may need to guide the head up slightly to help deliver the lower shoulder.

84
Q

Step five in delivering a newborn

A

Once the body is delivered, support the newborn firmly but gently. The newborn will be very slippery. Support the newborn’s head with the neck in a neutral position to keep the airway open.

85
Q

Step six in delivering a newborn

A

If the mother is willing and able, place the new one directly on the mother’s abdomen, with the cord still intact. The skin to skin technique keeps the newborn warm and perfused; the mother’s skin provides warmth while the placental perfusion continues until the pulsations in the cord stop.

86
Q

Step seven in delivering a newborn

A

After delivery and prior to cutting the cord, if the child is gurgling or shows other signs of respiratory distress, suction the mouth and oropharynx to clear any amniotic fluid and facilitate the infant’s initiation of air exchange.

87
Q

Step eight in delivering a newborn

A

Place a clamp on the umbilical cord. Milk the blood from a small section of the cord on the placental side of the clamp. This prevents the cord blood located between the clamps from spilling onto the floor when you eventually cut the cord. Then place a second clamp 2 to 3 inches away from the first.

88
Q

Step nine in delivering a newborn

A

Cut between the two clamps

89
Q

Step 10 in delivering a newborn

A

The placenta will deliver itself, usually within 30 minutes of birth. Never pull on the end of the umbilical cord in an attempt to speed the delivery of the placenta.

90
Q

Cephalic presentation

A

When the fetus is positioned head first in the birth canal

91
Q

The risk of peroneal tearing during labor can be reduced by

A

Applying gentle pressure across the perineum with a sterile gauze pad

92
Q

The location of the two primary fontanelles

A

One at the top of the head and one near the back of the head

93
Q

And unruptured amniotic sac is potentially life-threatening for the fetus because

A

The sac will suffocate the fetus if it is not removed

94
Q

Two ways you can puncture the amniotic sac

A

With a clamp or by twisting it between your fingers

95
Q

If you puncture the amniotic sac, make sure that the puncture site is where

A

Away from the fetus’ face

96
Q

Do not puncture the sac if the fetus’ head is not

A

Crowning

97
Q

After you’ve punctured the sac, push it

A

Away from the fetus’ face

98
Q

Nuchal cord

A

When the umbilical cord was wrapped around the fetus’ neck

99
Q

How to check for a nuchal cord

A

Use one finger to feel whether the umbilical cord is wrapped around the neck

100
Q

How to release a new cord from around the neck

A

Slip the cord gently over the delivered head, or shoulder if necessary. If the cord is too tight, you must cut the cord by placing two clamps about 2 inches apart on the cord and cutting between the clamps.

101
Q

If a new cord is wrapped more than once around the neck

A

You still only cut once, but then you unwrap the cord from around the neck

102
Q

Once the nuchal cord is cut

A

You must attempt to speed delivery by encouraging the women to push harder and possibly more often because the fetus will have no oxygen supply until it is delivered and breathing spontaneously

103
Q

Vernix caseosa

A

A white, cheesy substance that covers the body of the fetus

104
Q

After delivery, aspiration can be prevented by

A

Keeping the head slightly lower than the rest of the body

105
Q

For the newborns birth certificate and as the starting point from which to time the intervals for Apgar scores, it is important that you record this

A

Time of birth

106
Q

Post delivery care of the umbilical cord is important because

A

Infection is easily transmitted through the cord to the newborn

107
Q

When the umbilical cord is typically cut

A

After the cord has stopped pulsating

108
Q

How far away from the newborns body that you want to place the first umbilical clamp

A

6 inches

109
Q

If handled roughly, the umbilical cord could be torn from the newborn’s abdomen, resulting

A

In fatal hemorrhage

110
Q

Before the delivery of the placenta, this amount of bleeding is normal

A

500 mL or less

111
Q

Characteristics of a normal placenta

A

Round, about 7 inches in diameter, and about 1 inch thick. One surface is smooth and covered with a shiny gray membrane. The other surface is rough, divided into lobes, and is a dark reddish brown color similar to raw liver

112
Q

What you do with the placenta and umbilical cord after they have been delivered

A

Wrap them in a towel and place them in a plastic bag. Take them to the hospital

113
Q

If a piece of the placenta has been retained inside the woman

A

It could cause persistent bleeding or infection

114
Q

Fundal massage

A

Massaging the woman’s abdomen with a firm, circular, kneading motion.

115
Q

Fundal massage is used to

A

Slow vaginal bleeding

116
Q

Fundus

A

A firm, grapefruit sized mass in the lower abdomen which is actually the upper end of the uterus

117
Q

Another way in which the uterus can be stimulated to contract

A

Breast-feeding

118
Q

The release of which hormone during fundal massage and breast-feeding helps to contract uterus and slow bleeding

A

Oxytocin

119
Q

Three emergency scenarios listed by the book that occur during the third stage of labor

A

The placenta has not delivered after 30 minutes, more than 500 mL of bleeding occurs before delivery of the placenta, and significant bleeding occurs after delivery of the placenta

120
Q

Expectations of a newborns breathing and circulation within 15 to 30 seconds after birth

A

The newborn will be breathing spontaneously and its heart rate will be 120 bpm or higher

121
Q

If a newborn’s breathing is not spontaneous and their heart rate is not 120 bpm or higher

A

Gently tap or flick soles of the newborn feet or rub the back to stimulate breathing

122
Q

Begin newborn resuscitation efforts if

A

They do not breathe after 10 to 15 seconds of stimulation

123
Q

The number of measures you can take to stimulate breathing and circulation in a newborn

A

Five

124
Q

First measure you can take to stimulate breathing and circulation in a newborn

A

Position the newborn on his or her back with a towel or blanket under the shoulders so that the head is down and the neck is slightly extended

125
Q

The second measure you can take to stimulate breathing and circulation and a newborn

A

Drying

126
Q

The third measure you can take to stimulate breathing and circulation in a newborn

A

Warming

127
Q

The fourth measure you can take to stimulate breathing and circulation in a newborn

A

Suction the mouth and then the nose using a bulb syringe or an eight or 10 French catheter. Avoid deep suctioning of the mouth and throat, as this can cause the heart rate to slow down. Aim blow by oxygen at the newborns mouth and nose during resuscitation.

128
Q

The fifth measure you can take to stimulate breathing and circulation in a newborn

A

Tactile stimulation. Rub the newborns back and gently flick or slap the soles of their feet

129
Q

If newborn respiratory effort appears appropriate, this vital sign becomes the most important measure in determining the need for further resuscitation

A

Heart rate

130
Q

If a newborn’s heart rate is more than 100 bpm

A

Keep the newborn warm, transport, and reassess

131
Q

If a newborn’s heart rate is 60 to 100 bpm

A

Begin assisted ventilation with a BVM and room air. Reassess the newborn after 90 seconds and if the heart rate and respirations are not normal, begin to ventilate with 100% oxygen. Continue to reassess the newborn. Call for ALS back up if available. Keep the newborn warm

132
Q

If a newborn’s heart rate is fewer than 60 bpm

A

Begin assisted ventilation with a BVM and 100% oxygen. Reassess the newborn every 90 seconds until heart rate and respirations are normal. Begin chest compressions. Call for ALS back up is available. If the heart rate does not increase, medication and ALS will be needed

133
Q

How chest compressions and ventilations should be delivered on a newborn

A

Use the hand-encircling technique for 2 person resuscitation. Use a 3 to 1 ratio of compressions to BVM ventilations.

134
Q

A 3 to 1 ratio of compressions to ventilations should produce a total of

A

90 compressions in 30 ventilations per minute

135
Q

If you see meconium in the amniotic fluid or meconium staining in the newborn is not breathing adequately,

A

Consider quickly suctioning the newborns mouth and then nose after delivery before providing rescue ventilation

136
Q

Meconium aspiration can lead to

A

Significant lung disease and even death

137
Q

Any newborn who requires more than a routine resuscitation requires transport to

A

A hospital with a level three neonatal intensive care unit

138
Q

Apgar score

A

Used to assess the status of a newborn

139
Q

Five areas of activity in the Apgar scoring system

A

Appearance, pulse, grimace or irritability, activity or muscle tone, and respiration

140
Q

Apgar score of 0 in appearance

A

Entire newborn is blue or pale

141
Q

Apgar score of 1 in appearance

A

Body is pink, but hands and feet remain blue

142
Q

Algae score of 2 in appearance

A

Entire newborn is pink

143
Q

Apgar score of 0 in pulse

A

Absent pulse

144
Q

Apgar score of 1 in pulse

A

Fewer than 100 bpm

145
Q

Apgar score of 2 in pulse

A

More than 100 bpm

146
Q

Apgar score of 0 in grimace or irritability

A

Newborn does not cry or react stimulus

147
Q

Apgar score of 1 in grimace or irritability

A

Newborn gives a weak cry in response to stimulus

148
Q

Apgar score of 2 in grimace or irritability

A

Newborn cries and tries to move foot away from finger snap against sole of foot

149
Q

Apgar score of 0 in activity or muscle tone

A

Newborn is completely limp, with no muscle tone

150
Q

Apgar score of 1 in activity or muscle tone

A

Newborn makes weak attempts to resist straightening

151
Q

Apgar score of 2 in activity or muscle tone

A

Newborn resists attempts to straighten hips and knees

152
Q

Apgar score of 0 in respiration

A

Absent respirations

153
Q

Apgar score of 1 in respiration

A

Slow respirations

154
Q

Apgar score of 2 in respiration

A

Rapid respirations

155
Q

Newborns often have cyanosis where for a few minutes after birth

A

Extremities

156
Q

Apgar should be calculated when

A

One minute after birth and again at five minutes after birth

157
Q

Reassess respirations in heart rate at least every

A

30 seconds

158
Q

Blow by oxygen should be administered

A

Using oxygen tubing or an oxygen mask close to the newborn’s face at a flow rate of 5 L per minute

159
Q

Bag valve mask ventilation should be performed on a neonate at a rate of

A

40 to 60 breaths per minute or 1 breath every 1 1/2 seconds to 1 breath a second

160
Q

You may need to bypass the pop off valve

A

To accomplish good chest rise and fall

161
Q

Do not give up!

A

Many newborns have survived without brain damage after prolonged periods of effective CPR

162
Q

Presentation

A

The position in which an infant is born or the body part that is delivered first

163
Q

Headfirst presentation

A

Vertex presentation

164
Q

When the buttocks are delivered first

A

Breech presentation

165
Q

Breeched presentations are dangerous because

A

The infant is at risk of trauma and also prolapsed cords are more common

166
Q

The relative length of breech deliveries compared to normal deliveries

A

Breech deliveries are usually longer

167
Q

During a breech presentation you should reach into the vagina and

A

Make a V with your gloved fingers and position them to keep the walls of the vagina from compressing the fetus’ airway

168
Q

Limb presentation

A

When a single arm or leg exits first

169
Q

Limb presentations require

A

Surgical intervention and cannot be delivered in the field

170
Q

The position that a mother with limb presentation should be placed in

A

On her back, with her head down, and her pelvis elevated

171
Q

A mother with limb presentation should be given

A

High flow oxygen

172
Q

Prolapse of the umbilical cord

A

When the umbilical cord presents first

173
Q

The first position in which a patient with a prolapsed umbilical cord can be placed

A

With the foot end of the cot raised 6 to 12 inches higher than the head and her hips elevated on a pillow or folded sheet.

174
Q

Second position in which a patient with a prolapsed umbilical cord can be placed

A

Knee chest position: kneeling and bent forward, face down.

175
Q

How a fetus’ head is kept off of a prolapse in umbilical cord

A

Using a gloved hand, reach into vagina and gently push the fetus’ head away from the umbilical cord. This position may need to be maintained until the patient is in the operating room.

176
Q

This should be used to cover a prolapsed cord

A

Sterile towel moistened with saline

177
Q

Spina bifida

A

A developmental defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly outside of the body

178
Q

What you do with the exposed portion of spinal cord in a patient with spina bifida.

A

Cover the open area of spinal cord with moist, sterile dressing and then an occlusive dressing to seal the area. It should be done immediately after birth to prevent a potentially fatal infection

179
Q

Full term gestation

A

Between 39 weeks and 40 weeks, six days. This is approximately nine calendar months. On average full-term newborns weigh 7 pounds

180
Q

Preterm gestation

A

Any newborn who delivers before eight months (36 weeks of gestation) or weighs less than 5 pounds

181
Q

Post term gestation

A

Gestation period is longer than 42 weeks

182
Q

Delivery without sterile supplies should occur this way

A

Using freshly laundered sheets and towels, if possible. A gloved finger should be used to clear away blood and mucus from the mouth as soon as the newborn is delivered. The placenta should not be cut, but instead should be wrapped in a clean towel or put in a plastic bag. It should be kept at the same level as the newborn

183
Q

A normal amount of blood loss during childbirth

A

That which is below approximately 500 mL

184
Q

Postpartum patients are at increased risk of this

A

Embolism. Particularly pulmonary embolism

185
Q

The length of time in which a woman is susceptible to a postpartum pulmonary embolism

A

Days to several months after childbirth

186
Q

Blood vessels in the umbilical cord

A

2 arteries and 1 vein, from the perspective of the fetus/infant

Emergency Care and Transportation of the Sick and Injured (2 decks)

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