EMRG 1305 - OB Flashcards
How long is a full term of pregnancy?
37-42 weeks
What are the 3 stages of pregnancy?
Germinal stage 0-2 weeks
Embryonic stage 3-8 weeks
Fetal stage 9-birth
When is the start of a pregnancy counted from
last menstrual cycle
child bearing years are considered what years
14-50 yrs of age
what is the total weight gain during pregnancy
25 to 35 lbs
What does an uncomplicated Pregnancy, labour and birth include
A healthy pt without medical conditions
Uncomplicated pregnancy
term gestation
singleton pregnancy (single child)
Vertex presentation (crown of baby)
Spontaneous labour (no induction)
Clean Amniotic fluid (fluid in sac)
what are normal maternal changes
Circulatory system: 10-20bpm increase, need for iron increases
Respiratory: increase in rate, diaphragm moves up into chest, consumption rate increases
Genital Tract: fundal grows a cm per week of pregnancy. 20 weeks, should be at belly button (umbilicus). Bladder has extra weight on it, urinate frequently
GI system: elevated progesterone = vomitting, also relaxation of smooth muscle - decrease gastric mobility = constipation
Metabolism: 10-20 percent increase in BMR (base metabolic rate), insulin resistance, fat deposition
Gravida
how many times they’ve been pregnant - includes miscarriage/abortions
Para
of pregnancies a woman carried past 20 wks live or dead
20 wks is considered a liable child, it actually gets a death certificate
twins count as 1
Amniotic Sac
the fluid filled, bag like membrane where the fetus grows
Abortion
expulsion of the fetus, from any cause before the 20th week
Ectopic pregnancy
any egg that attaches outside the uterus, usually Fallopian tube
Primipara
the pt has only had one birth/delivery
Multipara
the pt has had 2 or more deliveries
how to time contractions
Frequency - time between the start of one contraction and the start of the next
Duration - how long one contraction last
Braxton Hicks contraction
contractions of the uterus that typically are not felt until the second or third trimester of the pregnancy
Painless
Stage 1 - Labour
dilation and effacement of the cervix
longest stage
begin with contractions that gradually increases in frequency, strength and length
fetus descends into pelvis (decrease in fundal height)
cervix softens, shortens, thins and dilates until at 10 cm
Early Labour
you can still walk around fine
bloody show - pink, red or brown discharge
Spontaneous rupture of the membrane (SROM) - water breaks
contractions are mild and irregular
Contractions: F - far apart and irregular, L- short ~20-30 sec, S - mild
Active Labour
Can’t walk, to strong
SROM may or may not occur
bright red blood show
dilation to 10 cm progresses
vomiting, shaking, overwhelming emotions
Contractions: F - 3 to 4 min, L- 45 to 60 sec, S - moderate to strong
Stage 2
Fully dilated to 10cm
Feels the urge to push
ends when baby is born
Contractions: F - 2 min or less, L - 60-90 secs, S- strong
uterus will change shape and rise up
bloody show, stool amniotic fluid drainage
bulging until presenting part Is visible
Clinical considerations - When do we look?
dangle - umbilical cord
baby’s coming
decrease blood - vaginal bleeding is heavy and the pt is hypotensive or in shock
body parts decreased LOC
Imminent birth as per ALS - how is it different between Primips and Multips
Primps - presenting par visible during and between contractions, maternal urge to push, contractions are less than two min apart
Multips - contractions 5 min apart of less and any other sings of second stage are present
Stage 3
Birth of the baby to delivery of the placenta
Occurs 5-30 min after birth
Observation - lengthening of cord, sudden gush or trickle of blood, uterine contractions
Placenta delivery
placenta will separate from uterine wall
apply gentle controlled cord traction (CCT) and guard the uterus with other hand
encourage delivery, ask mom to push
when delivered - inspect for wholeness, put in bag from OBS kit, label it with maternal patients name and time of delivery
HIGHEST RISK stage because of increase bleeding
How to prepare
get pt on a firm surface (if they don’t want to move, leave them where they are
prepare a neonatal resus station
open OB kit
dispatch for a second crew
Phase of a normal labour and delivery
decent
flexion
internal rotation
extension
restitution
external rotation
expulsion
Decent
Fetus moves down toward the pelvis and becomes engaged (duck waddle)
Flexion
fetal chin to chest
Internal Rotation
Fetal occiput turns toward maternal pelvis
Extension
Birth with head facing down
Restitution
baby’s head rotates to the side
External Rotation
Fetus turns to deliver shoulder
Expulsion
Birth of baby
Cord Clamping
Clamp and hand width of baby’s abdomen, cut the cord when it stops pulsating up to 2 minute mark ( wait till blood is no longer pumping, plus avoids mother from having anemia)
No crying - cut the cord and CPR
Multiple babies - Cute and deliver other baby
Uncomplicated Delivery Care
massage uterus to help minimize bleeding- should feel firm and central
Check for bleeding every 5 min for the first 15 min
monitor vitals
encourage voiding to decrease the risk of postpartum hemorrhage
keep newborn warm, skin to skin, breastfeed (if possible)
monitor newborn using APGAR
Oxytocin - what does it do?
Increases the amplitude a frequency of uterine contractions, delays uterine blood flow and decreases cervical activity causing dilations and thinning of cervix
what are all the malpresentation that we can deliver?
Occiput anterior (face down)
occiput posterior (sunny side up)
breech
transverse
face
compound
brow
what are malpresentation that we CAN’T deliver?
Transverse Lie - head and breech can be felt with exam of abdomen
Shoulder presentation - shoulder is presenting part
Oblique Lie - fetus lies diagonal
Limb presentation, do we deliver?
Not possible to deliver, we discourage pushing, wrap the presenting limb and keep it warm while we transport
Brow presentation, how do they present?
the face is coming out first, its nose is leading they’re way
Frank breech, what is it?
Hips flexed and legs extended, the butt is coming out first from the cervix
Complete Breech, what is it?
both hips and knees are flexed, both butt and feet enter the cervix first
Footling breech, what is it?
one hip and one knee flexes, the other is presenting out of the cervix.
How do you approach a breech presentation?
Hands off approach, just have your hands there to catch the baby, let gravity of the work, have mom on the end of the bed.
during the hands off approach, how does the timing work?
8 min for a full delivery
4 min from when you see the umbilicus
3 min when you see neck, at 1 min left, use the smellie veit maneuver
What is the smellie veit maneuver?
have a hand on the babies chest and two fingers exerting gentle pressure on the face to increase flexion
place other hand on the baby’s back with two fingers hooked to pivot around the symphysis pubis and allow the fave to be born
Cord prolapse, what do you do?
L&G, if there is a pulse, put cord gentle back in, ask mom if she wants to do it.
if there is no pulse, put it back in and push the object to make it pulse again, use gravity to your advantage
what is the Exaggerated “sims” position?
On the side, with the R arm behind and the hips propped up by a pillow to have gravity working with you
What is a sing of shoulder dystocia?
turtle sign, the head comes out and back in because the shoulders are stuck
what does ALARM stand for?
Ask for help
Lift legs, hyperflex thighs
Adduct shoulders (apply suprapubic pressure)
Rollover (all fours)
Manual posterior arm (try to grab and torpedo)
do x2 then leave
Postpartum Hemorrhage, when does it happen and what happens?
occurs either right after <24hrs or up to 12 weeks later
Excessive bleeding is defined as 500 ml or more of blood. Severe PPH is at 1L
Pt will be pale, confused, light headed, diaphoretic, in hypovolemic shock
PPH causes are the 4T’s what are they?
Tone - exhausted uterus & cannot contract
Tissue - parts of the placenta retained and clotting compromised
Trauma - uterine rupture/lac during delivery
Thrombin - coagulation abnormalities
How to treat PPH
Fundal massage - one hand on lower abdomen and use smooth circular movement to massage. Do for 10 - 15 min and
Breast feed to help release oxytocin
Bimanual Compression - one hand above symphysis pubis & other on top of fundus and squeeze together - for 5-10 minutes until bleeding stops
Meconium, what is it?
Newborns first stool/bowel movement
