EAC Obstetrics and Neonatal Resuscitation

Question 1

anatomical changes during pregnancy:

respiratory system

Answer 1

> tidal volume 20% at 12wks and 40% by 40wks

O2 demand increases by 15% in the well pt

Rib cage becomes splayed outwards to accommodate the growing uterus

Question 2

anatomical changes during pregnancy:

Cardiovascular System

Answer 2

Blood volume inc 50% by 3rd trimester

Relative anaemia and haemodilution

> cardiac output by 40% mid pregnancy.

Can cause postural hypotension and fainting due to reduced vascular resistance

Systolic BP falls initially but returns near normal at term

Supine hypotension due to the uterus compressing the vena cava

In the event of blood loss, the compensatory mechanism is restriction of blood flow to the uterus (and foetus)

Question 3

anatomical changes during pregnancy:

Gastrointestinal Tract

Answer 3

Gastric tone and emptying rates reduced

Secretion of gastric acid is increased in the 3rd trimester

Cardiac sphincter tone is lax due to hormonal action

Gravid uterus compresses the stomach

Question 4

anatomical changes during pregnancy:

Genital Tract

Answer 4

Increase in blood supply to the uterus

high muscle tone increases risk of uterine rupture in trauma

Question 5

the 3 trimesters of Pregnancy

Answer 5

Pregnancy = first day of LMP up to 42wks

1st trimester - 1 - 12wks

2nd trimester = 13 - 23+6wks

3rd trimester = 24+wks

Question 6

First stage of Labour

Answer 6

Dilation of the cervix 0-10cm

Longest stage of labour

Show (blood stained mucus discharge)

Contractions become more frequent

Membranes may rupture (SROM)/breaking of waters - but not always - colour of liquor is important

Often at around 8cm dilation, women becomes very vocal - soon before onset of 2nd stage, then will become very focused

Question 7

Second stage of Labour

Answer 7

Spontaneous rupture of membranes (if not already)

Cervix dilated fully

Changes in contractions (transition - becomes expulsive)

Baby’s head descends into the birth canal creating an urge to push

Baby’s head becomes visible at the introitus (entrance that goes into a canal or hollow organ) - crowning

Completed with delivery of the baby’s body

Question 8

Third stage of Labour

Answer 8

The expulsion of the placenta and membranes 15-20mins after delivery

Cord lengthens indicating placenta and membranes have separated from the uterus and entered the birth canal.

Pains return, mother may also experience the urge to bear down as the placenta is delivered

Gush of blood can be expected not usually exceeding 200-300ml

Any loss of blood >500ml is considered post partum haemorrhage PPH

Question 9

management of:

Normal Labour

Answer 9

Gain consent

If unable to move to hospital (contractions

Question 10

management of:

new-born

Answer 10

Gently wipe any mucous away from baby’s nose and mouth
Dry thoroughly, new-born assessment can be done concurrently APGAR, dispose of towel
Wrap in clean dry towel
Place hat from maternity pack on baby
If baby’s condition is satisfactory hand to mother

Question 11

APGAR

Answer 11

refer to JRCALC

Question 12

define:

Premature Delivery

Answer 12

pre-term delivery =

Question 13

management of:

Premature delivery

Question 14

define:

Delayed Delivery of Shoulders (Dystocia)

Answer 14

Impaction of baby’s shoulder on the maternal pelvis preventing delivery

Question 15

signs and symptoms of:

Delayed Delivery of Shoulders (Dystocia)

Answer 15

Difficulty with delivery of the head and face

Head remaining tightly applied to the vulva or retracting (turtle-neck sign)

Failure of restitution of the foetal head

Failure of the shoulders to descend

Question 16

management of:

Delayed Delivery of Shoulders (Dystocia)

Answer 16

Call for early help

DO NOT pull on the baby’s head/put pressure on the fundas/pull the cord

Get mum into MacRoberts position / advise not to push

If unsuccessful within 1-2 contractions use suprapubic pressure then suprapubic rocking

If unsuccessful, utilise all fours, head down position and try to deliver the posterior shoulder

If unsuccessful transfer to obstetric unit with pre-alert

Paramedic to gain IV access and prepare for risk of PPH

Question 17

define:

Prolapsed Cord

Answer 17

the umbilical cord emerges form the uterus ahead of the baby

each contraction compresses the cord compromising the baby’s O2 supply

Question 18

management of:

Prolapsed Cord

Answer 18

Request midwife and 2nd crew

Get mother on all fours

Minimise handling of cord to prevent spasm

Prepare ambulance

Bring trolley bed as close to Pt as possible

Pt walk to bed and positioned left lateral tilt (hips raised)

If midwife ONS, bladder filling can assist

Transfer with pre-alert to consultant led obstetric unit

Question 19

signs and symptoms of:

Pre-Eclampsia

Answer 19

Sever pre-eclampsia is high blood pressure (160/110)

If BP ≥140/90 if any of the following present: 
Headache
Epigastric or R upper quadrant pain
Visual disturbance
Vomiting
Facial oedema (not a consistent sign)
Proteinuria

TIME CRITICAL pre-alert smooth transport to obstetric unit

Question 20

define:

Eclampsia

Answer 20

Convulsions associated with pregnancy.

During pregnancy
During labour
Up to 48 hours after delivery

Question 21

management of:

Eclampsia

Answer 21

Left lateral tilt, once fitting stopped

Maintain the airway

High % O2

Check BM

Paramedic for Diazepam

Correct A and B then pre-alert to consultant led obstetric unit

Lights and Sirens kept to a minimum as these may precipitate fits

Question 22

define:

Breech and Malpresentations

Answer 22

According to the leading part, this is identified as a cephalic, breech, or shoulder presentation.

A malpresentation is any presentation other than a vertex presentation (with the top of the head first).

Question 23

define:

Placental Abruption

Answer 23

Premature separation of the placenta. bleeding may be revealed or concealed

can be before or during birth, causes abdominal pain which remains after a contraction has gone

TIME CRITICAL

Question 24

signs and symptoms of:

Placental Abruption

Answer 24

severe or constant Abdo pain

Hypertension

Tense woody abdomen

Tenderness

Dark blood loss

Reduced/no foetal movements

Question 25

define:

Placenta Previa

Answer 25

Placenta drops partially or wholly covering the cervix

Question 26

signs and symptoms of:

Placenta Previa

Answer 26

Blood loss may be significant

Often bright red blood

Relaxed uterus/non-tender

May be pain free

Question 27

define:

Post-Partum Haemorrhage

Answer 27

tear in perineum or bleeding from vagina before placenta is delivered

Bleeding after delivery more then expected (300ml)

Primary PPH: >500ml within 24hours of delivery

Secondary PPH: Abnormal or excessive bleeding from the birth canal between 24hours and 12 weeks post-natally

Trickling blood is normal BUT pulsating/pouring out is not

Question 28

define:

Ectopic Pregnancy

Answer 28

Foetus develops outside the uterine cavity, most commonly in the fallopian tubes

Question 29

signs and symptoms of:

Ectopic Pregnancy

Answer 29

Acute lower abdominal pain/tenderness

Slight bleeding/spotting

Signs of shock/tachycardia/hypotension

Unexplained fainting/dizziness

R Shoulder tip pain

Unusual bowel/urinary symptoms

Rectal pain or pain on defecation

Question 30

management of:

PPH - perineum tear

Answer 30

Apply a pressure dressing

Question 31

management of:

PPH from vagina

Answer 31

Keep mother still

NOT pulling on cord

Feeling for the top of the uterus and massaging with a circular motion if bleeding continues after delivery of the placenta; massage at umbilicus, should become firm

Transport immediately to nearest obstetric unit

Treating for shock

Question 32

compression:breath ratio for Neo-Natal resuscitation

Answer 32

placenta still in womb = 3:1

Placenta out of womb = 15:2