Chapter 37: Obstetrics and Care of the Newborn Flashcards
1
Q
ovaries
A
female gonads or sex glands, two, one on each side of uterus in upper portion of pelvic cavity, secrete estrogen and progesterone and develop/release mature eggs
2
Q
ovum
A
the mature egg that is released from the ovary each month
3
Q
fallopian tubes
A
aka uterine tibes, thin flexible structures that extend from the uterus to the voaries, end near ovaries is funnel with fingerlike projections and is open to abdominal cavity
4
Q
peristalsis
A
wavelike movement from muscular contraction
5
Q
uterus
A
pear shaped organ that contains the developing fetus, allows for great expansion during pregnancy and forcable contractions during labor and delivery
6
Q
fetus
A
unborn infant
7
Q
fundus
A
top portion of uterus
8
Q
body/corpus
A
middle portion of uterus
9
Q
cervix
A
narrow, tapered neck
10
Q
endometrium
A
innermost lining of uterus, sheds
11
Q
myometrium
A
middle lining of uterus, thick, smooth muscle
12
Q
perimetrium
A
serous membrane that partially covers corpus of uterus
13
Q
bloody show
A
the expulsion of the plug of mucus in the cervix, signals the first stage of labor
14
Q
placenta
A
“organ of pregnancy,” disk-shaped inner lining of the uterus, begins to develop after ovum is fertilized and attaches itself to uterine wall, rich in blood, sole organ through which fetus receives oxygen/nutrients and discards CO2/waste
15
Q
afterbirth
A
placenta separates from uterine wall after infant is born, delivered, generally 1/6th infants weight (~1lb)
16
Q
umbilical cord
A
unborn infant’s lifeline, attaches fetus to placenta, contains 1 vein and 2 arteries, vein carries oxygenated blood and nutrients to fetus, arteries carry deoxygenated blood and waste back to placenta
17
Q
wharton jelly
A
protective substance that covers vein and arteries in umbilical cord
18
Q
amniotic sac
A
bag of waters, filled with amniotic fluid in which infant floats, sac tears at onset of labor
19
Q
vagina
A
lower part of birth canal from cervix to opening of body
20
Q
pre-embryonic stage
A
first 14 days after conception
21
Q
embryonic stage
A
day 15 to 8 weeks
22
Q
fetal stage
A
from 8 weeks to delivery
23
Q
neonate
A
newly delivered baby
24
Q
gestation
A
pregnancy
25
trimester
each 3 month period of the pregnancy
26
antepartum
prior to the onset of labor
27
hyperemesis gravidarum (HG)
severe nausea and vomiting during pregnancy, due to hormonal increases, persistent nausea and vomiting associated with weight loss and ketone body formation
28
hemorrhage
one of the leading causes of death in the pregnant patient
29
spontaneous abortion
aka miscarriage, can occur for any number of reasons, delivery of the fetus and placenta before the twentieth week of gestation, most occur before twelfth week
30
ectopic pregnancy
one occurring outside the uterus, relatively rare, can be fatal
31
placenta previa
a cause of third-trimester vaginal bleeding WITHOUT pain, abnormal implantation of the placenta over or near the opening of the cervix, 3 types: total, partial, marginal
32
total placenta previa
placenta completely covers the cervix
33
partial placenta previa
placenta covers the cervix partially but not completely
34
marginal placenta previa
placenta implanted near the neck of the cervix, cervical dilation can cause partial tears
35
emergency medical care for hyperemesis gravidarum
supportive: airway, ventilation, oxygenation
36
emergency medical care for spontaneous abortion
antepartum care, ask when patient's last menstrual period began, emotional support, assess for signs/symptoms of hypovolemic shock
37
emergency medical care for ectopic pregnancy
administer high O2 concentration (nonrebreather 15lpm), transport
38
emergency medical care for placenta previa
antepartum emergency care, administer high conc O2 via nonrebreather 15lpm, transport
39
abruptio placentae
aka placental abruption, premature separation of the placenta from the uterine wall, small vessels rupturing causes bleeding and this blood pushes the placenta away from the uterine wall, making it tear away more. causes: fetal hypoxia, inadequate nutreitn delivery, poor elimination of waste. also causes: maternal blood loss, hypovolemic shock. 2 types: complete and partial. signs/symptoms: vaginal bleeding with abdominal pain/tenderness in the second half of pregnancy
40
complete abruptio placentae
the placenta completely separates from the uterine wall, has a 100% fetal mortality rate
41
partial abruptio placentae
placenta is partially torn from uterine wall, 30-60% fetal mortality rate
42
emergency medical care for abruptio placentae
same as placenta previa: administer high concentration of O2 via nonrebreather 15lpm, treat for shock, transport
43
ruptured uterus
a life threatening emergency, due to the uterine wall becoming thin as it stretches, results in severe maternal hemorrhage and severe fetal distress. signs/symptoms: history of previous uterine rupture, abdominal trauma, large fetus. having born 2+ children, history of prplongued/diffucult labor, prior c-section or uterine surgery. tearing/shearing pain, constant severe abdominal pain, etc...
44
emergency medical care for ruptured uterus
general guidelines for emergency medical care for a pre-delivery emergency, high concentration O2 via nonrebreather 15lpm, treat for shock, transport
45
seizures during pregnancy
can be life threatening emergency for mother and fetus, care: prevent injuries, transport calmly, care as normal for seizure patient
46
pregnancy-induced hypertension (PIH)
blood pressure in a pregnant woman that is greater than 140/90mmHg on two or more occasions at 6 hours apart
47
preeclampsia
aka toxemia during pregnacy, common condition, usually in the last trimester, high blood pressure and protein in urine
48
eclampsia
more severe form of preeclampsia that includes an unexplained coma or new onset of generalized tonic clonic seizures in a patient with preeclampsia
49
emergency medical care for preeclampsia/eclampsia
high concentration of O2 via nonrebreather at 15lpm, keep suction close at hand, transport, monitor and be prepared for seizure
50
supine hypotensive syndrome
second or third trimester complication, the weight of the fetus compresses the inferior vena cava when the patient is in a supine position, which reduces the blood flow to the right atrium, which decreases stroke volume, reduces stroke volume and decreases cardiac output, which reduces systolic BP and perfusion. signs/symptoms: dizziness/light-headedness when ina supine position
51
emergency medical care for supine hypotensive syndrome
keep patient (in 20th week of gestation or later OR fundus of uterus is at umbilicus or above) sitting, lying on site, supine with right hip elevated at least 15 degrees
52
obstetric emergency
an emergency having to do with pregnancy or childbirth
53
gravida
refers to pregnancy, roman numeral after it refers to the number of pregnancies (e.g. gravida I = a patient who is pregnant for the first time)
54
primigravida
patient who is pregnant for the first time
55
para
refers to a woman who has given birth to a fetus of 20 weeks of gestation or greater, regardless of whether it was live birth or stillborn. para I = a mother who gave birth to the first time. refers to delivery events, NOT number of children birthed
56
general emergency care guidelines for pre-delivery emergency
1. ensure adequate airway, breathing, oxygenation, circulation (administer high conc. O2 via nonrebreather 15lpm)
2. care for vaginal bleeding
3. treat for shock if needed
4. provide emergency medical care as you would for the non-pregnant woman based on any other signs/symptoms
5. transport patient on side
57
labor
term used to describe the process of birth, consists of contractions of the uterine wall which expel the fetus and the placenta out of the uterus and vagina
58
three stages of labor
dilation, expulsion, placental delivery
59
dilation
the first stage of labor, from the beginning of true labor (contractions) to complete cervical dilation and 100% effacement
60
effacement
the thinning and shortening of the uterus
61
Braxton-Hicks contractions
"false labor," painless, short-duration, irregular contractions that can occur as early as 13 weeks gestation
62
expulsion
second stage of labor, begins with complete cervical dilation, ends with delivery of baby
63
perineym
area of skin between vagina and anus, bulges during expulsion (sign of impending birth)
64
crowning
the top of the infant's head appearing at the vaginal opening
65
placental delivery
third stage of labor, begins following the delivery of the baby, ends with the expulsion of the placenta
66
neonate
newborn infant
67
neonate
newborn infant (within the first 28-30 days after birth)
68
newly born
at time of birth
69
newborn
within the first few hours of birth
70
infant
from 28-30 days to 1 year of age
71
fundus at the umbilical
approximate gestational age is 20 weeks
72
fundus at the xiphoid process
approximate gestational age is 38 weeks
73
three cases in which you must assist in the delivery of the infant
- if you have no suitable transportation
- if the hospital or physician cannot be reached due to bad weather
- if delivery is imminent
74
imminent delivery
- crowning has occurred
- contractions are less than 2 minutes apart and they are intense and last from 60-90 seconds
- patient feels the infant's head moving down the birth canal (urge to defecate)
- patient has a strong urge to push with contractions
- patient's abdomen is extremely hard
75
emergency medical care for a patient in active labor for a normal delivery
- position the patient with knees drawn up and legs far apart (McRoberts position)
- administer oxygen (nasal cannula 2lpm
- create a sterile field around the vaginal opening
- monitor patient for vomiting
- assess for delivery of the baby's head
- place your gloved fingers on the bony part of the infant's skull when it crowns, exert gentle pressure horizontally across the perineum to reduce the risk of traumatic tears
- tear the amniotic sac if it is not already ruptured with your fingers
- assess for a nuchal cord (umbilical cord around the infants neck), slip cord over infants shoulders or head with two fingers or place two clamps 2-3 inches apart and cut clamps with scissors
- suction neonate's airway only if obvious obstruction to breathing exists (with bulb syringe)
- deliver the anterior (upper) shoulder with both hands supporting the head, apply slight downward movement that enables the upper shoulder to deliver
- deliver the posterior (lower) shoulder with both hands supporting the hand, apply slight upward movement that enables the lower shoulder to deliver
- as the torso and full body are expelled support the newborn with both hands
- secure the head neck and body and grasp the feet to complete the delivery
76
occiput anterior
back of the head facing upward, face is facing downward
77
occiput posterior
fetal face is upward, back of head is facing downward
78
emergency care for the newborn
- dry, wrap, warm, and position the patient and suction only if necessary
- clamp, tie, and cut the umbilical cord (30 second delay), place clamps on cord about 3in apart, cut between two claps leaving about 6 inches attached to abdomen
- perform an APGAR score 1 minute and 5 minutes following birth
- keep newborn warm, continually reassess
79
emergency care for the mother post normal delivery
- deliver the placenta (usually within 10 minutes of infant, almost always within 20 min)
- keep the delivered placenta (place in plastic bag from OB kit)
- place one or two sanitary pads or sterile dressings over the vaginal opening and perineum (if perineum torn, apply direct pressure/sterile dressings to control)
- for excessive blood loss: perform uterine massage, allow infant to suckle on mother's breast, transport immediately
- record time of delivery, transport mother, newborn, placenta to hospital
80
general emergency care for an abnormal delivery
immediate transport, administration of high-concentration oxygen, restraining delivery, continuous assessment of vital signs
81
intrapartum emergency
emergency that occurs during the period from the onset of labor to the actual delivery of the newborn
82
prolapsed cord
the umbilical cord is the first part presenting at the vaginal opening, can cut off the infant's oxygenated blood supply, a true emergency
83
emergency medical care for prolapsed cord
- instruct patient to NOT push (tell them to pant like a dog during contractions)
- administer high conc. O2 via nonrebreather 15lpm
- position patient on stretcher in a "knee chest" position (kneeling, bent forward, face down, head down, chest to knees)
- insert a gloved hand into vagina, gently push or lift the presenting part of the fetus away from the cord
- cover the umbilical cord with a sterile dressing moistened with a sterile saline solution
- transport patient immediately while maintaining pressure on the head, buttocks, or other presenting part
84
breech birth
one in which the fetal buttocks or lower extremities are the presenting part and the first to be delivered, the most common abnormal presentation, most significant problem is the lack of "wedge" to stretch and dilate the pelvic opening to deliver the remainder of the fetus --> the head can get stuck in the sacrum/symphysis pubic
85
frank breech
hips flexed, knees extended, the most common breech presentation, fairly good dilating wedge
86
complete breech
both hips and knees flexed, less common, not as good of a wedge as frank breech
