EMRG 1305 - Complicated OB Flashcards
What’s an Ectopic Pregnancy?
Fertilized egg implants outside the uterus (usually on Fallopian tubes)
Usually happens around 6 week marks
Signs and symptoms of an Ectopic pregnancy
pain
amenorrhea (missed periods)
A lot of vag bleeding
Complaints of shoulder pain (due to irritation)
- can cause Bradycardia or lack of tachycardia in hypovolemic pt
syncope
hypotension
SHOCK
Treatment for ectopic pregnancy
Treat for shock
give IV fluids (they will be hypotensive, it meets the conditions)
load and go
Miscarriage
loss of pregnancy naturally before 20 weeks
commonly in the first trimester
chromosomal problems cause most misscarriages
massive bleeds with hypolvolemia
Treatment for miscarriage
Give fluids i.e. IV
Oxygenate if sat go low
treat symptoms found
Hyperemesis Gravidarum (morning sickness) s/s
Severe nausea and vomiting during pregnancy
Vomiting > 3 times per day
vertigo
weight loss
dehydration
shock (from dehydration and loss of volume)
Treatment for morning sickness
Treat based on symptoms
Preeclampsia
Hypertensive disorder that occurs after 20 weeks
can occur unto 10 weeks after delivery
Signs and symptoms for Preeclampsia
BP higher 140/90
severe headache
blurred vision
upper abdo pain (RUQ)
SOB
edema (due to hypertension)
Proteinuria (elevated protein in the urine)
Eclampsia
Someone with preeclampsia goes into seizure
Treatment Eclampsia
Bring to hospital
Vitals
Treat for seizure
Load and Go
Gestational Diabetes
Mother is not able to produce and use all the insulin required
Excess glucose is transferred to fetus and stored as fat (transfers to baby= big baby)
Signs and Symptoms of gestational diabetes
Frequent urination
nausea
fatigue
increased thirst
yeast infection
sugar in urine
frequent infections
dry mouths
blurred vision
Treatment for gestational diabetes
load and go
can’t deliver easily
Placenta Previa
Placenta partially or fully covers the cervix, this is easy to detect on ultrasound, so mother should be aware
Detached from where its suppose to be, sometimes it comes off and covers the cervix
S/S of Placenta Previa
Asymptomatic
painless bleeding bright red
Blood transfusion may be needed
Abruptio Placenta
Partial/full detachment of placenta at 20 weeks
Blood behind the placenta
S/S abruptio placenta
severe abdominal pain, described as tearing
Risk Factors of abruptio placenta
Trauma
multiple fetuses
short umbilical cord previous c-section
pre-eclampsia/eclampsia
S/S abruptio placenta
Vag bleeding
Contractions that do not relax
abdo pain (rigid abdomen)
Amniotic Fluid Embolism (AFE)
amniotic fluid, fetal cells, hair or other debris enters into the maternal pulmonary circulation causing cardiovascular collapse (you just die)
Typically 30 minutes after delivery
Pt presentation of AFE
rapid and/or abnormal HR
Low blood pressure
chills
vomiting
severe anxiety
Trauma in pregnant pt
most common cause MVC’s, assaults and falls
60-70% of fetal loss is reported from minor injuries
call another ambulance 2 pt
mortality of the infant relies on the mother, prehospital treatment should be maximized for maternal survival
Vertex presentation
path of least resistance, crowning
Twin complications
40-50% are preterm (<37wks)
2nd twin is usually malpresentation due to room once the 1st is delivered
Postpartum Hemorrhage
Overdistention of uterus may result in uterine atony. Higher incidence of mean blood loss with twins
Delivering a Twins
clamp right away and label the placenta, you don’t know if they are shared or separate and you need to keep the placentas to right pt
you may be able to transport between the twins after delivering the first twin, may be 17-20 minutes in between
if you are on route you will need to stop and deliver the second baby
Fraternal Twins
TWO eggs are released from ovaries
each egg fertilized by SEPERATE sperm
seperate placenta and are separately implanted in the wombs
Maternal Twins
ONE egg released from ovary and fertilized by ONE sperm
When is there a separate placenta and inner sac
when an early embryo splits BEFORE implanting in the womb
when is there a shared placenta and seperate inner sacs
when an early embryo implants in womb AND THEN splits
when is there a shared sac and placenta
when an early embryo implants in the womb AND THEN splits later
how do you know if its twins when they don’t know
smaller than anticipated birth weight (fetus competing for space)
Fundal height remains high (2nd or more fetus in utero)
Fetal parts may be able to be palpated through abdomen
Always reassess baby
Premature birth, what does it look like?
anytime < 37 wks
usually requires resuscitation
poor lung compliance (hard to squeeze BVM)
- you are trying to open the alveoli because they can’t on their own yet
- 35 wks there’s usually sufficient amount to prevent alveoli collapse “atelectasis”
What is a Nuchal Cord
the umbilical cord is wrapped around the babies neck
How do you manage a nuchal cord
try to get two fingers under the cord to pull it over the babies head. it is stretchy
if the cord is tight, clamp, cut and deliver the baby ASAP
Precipitous labour
delivery of baby is usually within 3 hours or regular contractions.
most moms don’t make it to the hospital before it’s time to deliver.
common with 2nd birth
How to manage a precipitous Labour
encourage panting vs pushing to slow it down
place mom in a position where gravity isn’t working against you
what are all the malpresentation and which is more common?
Occiput Anterior (most common)
Occiput posterior
Breech
Transverse Lie
Face
Compound
Brow
