EMRG 1305 - Complicated OB Flashcards by Aurelia McReynolds

What’s an Ectopic Pregnancy?

Fertilized egg implants outside the uterus (usually on Fallopian tubes)
Usually happens around 6 week marks

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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

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Treatment for ectopic pregnancy

Treat for shock
give IV fluids (they will be hypotensive, it meets the conditions)
load and go

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Miscarriage

loss of pregnancy naturally before 20 weeks
commonly in the first trimester
chromosomal problems cause most misscarriages
massive bleeds with hypolvolemia

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Treatment for miscarriage

Give fluids i.e. IV
Oxygenate if sat go low
treat symptoms found

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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)

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Treatment for morning sickness

Treat based on symptoms

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Preeclampsia

Hypertensive disorder that occurs after 20 weeks
can occur unto 10 weeks after delivery

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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)

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Eclampsia

Someone with preeclampsia goes into seizure

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Treatment Eclampsia

Bring to hospital
Vitals
Treat for seizure
Load and Go

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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)

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Signs and Symptoms of gestational diabetes

Frequent urination
nausea
fatigue
increased thirst
yeast infection
sugar in urine
frequent infections
dry mouths
blurred vision

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Treatment for gestational diabetes

load and go
can’t deliver easily

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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

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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