EM OB 1: Emergency Delivery, part 1 Flashcards
Most common reasons for transport to obstetric centers
1) preterm labor
- premature rupture of membranes
- hypertensive disease
- antepartum hemorrhage
remarks on rupture of membranes
50% of women will deliver within 5 hours
95% will deliver within 28 hours
Explain nitrazine paper test
Amniotic fluid has a pH of 7.0 to 7.4
it will turn the nitrazine paper to dark blue
Vaginal fluid has a pH of 4.5-5.5
it will turn allow the nitrazine paper to remain yellow
false positive results in nitrazine paper test occurs when?
presence of
blood
lubricant
Trichomonas vaginalis
semen
even cervical mucus
these serve as reference point in determining station
maternal ischial spines
located at 4 and 8 o’clock of the vaginal canal
a +3 station corresponds to
visible scalp at the introitus, indicating a fetal position consistent with impending delivery
Describe a false labor
aka Braxton Hicks contractions
irregular, brief contractions
usually confined in the lower abdomen
do not produce cervical changes
Describe a true labor
painful , repetitive uterine contractions that increase steadily in both intensity and duration
results in cervical effacement and diltation
pains typically commence in the fundal region and upper abdomen and radiate into the pelvis and lower back
rate of cervical dilatation in the active phase
nulliparous: 1.2 cm/hour
multiparous: 1.5 cm/hour
typical duration of second state of labor
nulliparous: 54 mins
multiparous: 20 mins
typical duration of third stage of labor
10 mins
active intervention is usually not required until after 30 minutes, unless hemorrhage occurs
indicators of fetal distress
fetal bradycardia or tachycardia
late decelerations
(persistent drops in fetal heart rate both during and more than 30 seconds after a contraction)
What to do if decelerations are suspected?
Obtain emergency obstetrics consultation
Try to increase maternal blood flow by
- positioning the patient in the left lateral decubitus position
- providing IV hydration
Administer oxygen
normal fetal heart rate
120-160 bpm
bradycardia: <110 bpm
tachycardia: >160 bpm
Used to estimate gestational age
Nägele’s rule
-3 to months
+7 to days
remarks on using fundal height to estimate gestational age
cm = weeks of gestation +/- 2 weeks
remarks on using bedside US to estaimate gestational age
if used in the third trimester, can very by +/- 3 weeks
What to ask in history in a patient in labor
onset and frequency of uterine contractions
+/- gush of water
+/- vaginal bleeding
+/- fetal movement
Patient with vaginal bleeding should be evaluated with:
bedside ultrasound prior to speculum or bimanual examination in order to rule out placenta previa
simplest method to verify presentation
bedside US
remarks on meconium
if meconium is present on the examining finger, be prepared for neonatal resuscitation
what to do if rupture of membranes is suspected?
Perform a sterile speculum examination.
Do not use lubricant because it may produce a false positive nitrazine test.
Do not perform a digital examination because even one digital examination increases the risk of infection
Also avoid digital examinations in the preterm patient in whom the prolongation of gestation is desired.
How to administer Oxytocin?
20 units in 1000 mL normal saline
or
10 units IM
How to administer hydralazine?
5 mg IV,
followed by 5- to 10-mg boluses every 20 mins
How to administer Labetalol
20 mg IV,
followed by doubled doses up to 80 mg every 10 mins
(20-40-80-80)
max total dose, 220 mg
C/I: sinus bradycardia
How to administer magnesium sulfate
LD 4-6 g IV over 15 mins,
MD 2g/hr infusion
or
5 g IM in each buttok
max serum Mg = 8 mg/dL
C/I: myasthenia gravis
How to administer Naloxone?
0.4 - 2.0 mg IV every 2-3 mins as needed up to 10 mg cumulative dose
