EAC Obstetrics and Neonatal Resuscitation Flashcards
anatomical changes during pregnancy:
respiratory system
> 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
anatomical changes during pregnancy:
Cardiovascular System
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)
anatomical changes during pregnancy:
Gastrointestinal Tract
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
anatomical changes during pregnancy:
Genital Tract
Increase in blood supply to the uterus
high muscle tone increases risk of uterine rupture in trauma
the 3 trimesters of Pregnancy
Pregnancy = first day of LMP up to 42wks
1st trimester - 1 - 12wks
2nd trimester = 13 - 23+6wks
3rd trimester = 24+wks
First stage of Labour
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
Second stage of Labour
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
Third stage of Labour
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
management of:
Normal Labour
Gain consent
If unable to move to hospital (contractions
management of:
new-born
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
APGAR
refer to JRCALC
define:
Premature Delivery
pre-term delivery =
management of:
Premature delivery
define:
Delayed Delivery of Shoulders (Dystocia)
Impaction of baby’s shoulder on the maternal pelvis preventing delivery
signs and symptoms of:
Delayed Delivery of Shoulders (Dystocia)
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
management of:
Delayed Delivery of Shoulders (Dystocia)
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
define:
Prolapsed Cord
the umbilical cord emerges form the uterus ahead of the baby
each contraction compresses the cord compromising the baby’s O2 supply
management of:
Prolapsed Cord
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
signs and symptoms of:
Pre-Eclampsia
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
define:
Eclampsia
Convulsions associated with pregnancy.
During pregnancy
During labour
Up to 48 hours after delivery
management of:
Eclampsia
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
define:
Breech and Malpresentations
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).
define:
Placental Abruption
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
signs and symptoms of:
Placental Abruption
severe or constant Abdo pain
Hypertension
Tense woody abdomen
Tenderness
Dark blood loss
Reduced/no foetal movements
define:
Placenta Previa
Placenta drops partially or wholly covering the cervix
signs and symptoms of:
Placenta Previa
Blood loss may be significant
Often bright red blood
Relaxed uterus/non-tender
May be pain free
define:
Post-Partum Haemorrhage
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
define:
Ectopic Pregnancy
Foetus develops outside the uterine cavity, most commonly in the fallopian tubes
signs and symptoms of:
Ectopic Pregnancy
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
management of:
PPH - perineum tear
Apply a pressure dressing
management of:
PPH from vagina
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
compression:breath ratio for Neo-Natal resuscitation
placenta still in womb = 3:1
Placenta out of womb = 15:2
