General Obstetrics Flashcards
What is a full term Pregnancy?
37-42wks
What are the general child-bearing years?
14-50 years of age
When is a pregnancy considered viable, and what is done after this point?
20 weeks, every effort to resuscitate must be made
What are the 3 stages of Pregnancy?
Germinal, embryonic, fetal
When is the germinal stage?
0-2 weeks
When is the embryonic stage?
3-8 weeks
When is the fetal stage?
9 weeks to birth
What are the normal Circulatory changes for a pregnant woman?
^ blood volume (5-6 total volume)
Cardiac Output ^by 40-50%
HR increases by 10-20 bpm
SV ^ 30%
Intravascular volume ^45%
Systolic BP - minimal change
Diastolic - 20% decrease mid pregnancy
How does resp. system change suring pregnancy?
30-40% increase o2 consumption
Resp rate ^ slightly
30-35% ^ tidal volume
25% decrease residual capacity
What is the fundus?
Top part of the uterus
Where is the fundus at 20wks?
at the umbilicus
How can fundal height be used to predict gestational age?
Umbilicus is 20wks, 1 cm above is another week
What are the normal gastrointestinal changes in pregnant women?
Elevated progesterone - causes nausea and vomit (first6-14wks)
constipation, heartburn
What is the metabolism like in early pregnancy?
Anabolic state, increase maternal fat stores, small ^ insulin sensitivity. Nutrients stored to meet demands of mother and fetus
What is metabolism like in late pregnancy?
Catabolic state, decreased insulin sensitivity, ^ maternal glucose/free fatty acid, fetal growth
What does gravida mean?
How many times pregnant? Includes miscarriages/abortions
What does Para mean?
Number of pregnancies a woman carried past 28 weeks (dead or living, current not counted, multiples counted as 1)
What is an Amniotic Sac?
Fluid filled, bag like membrane where the fetus grows
What is an abortion
Expulsion of the fetus, for any cause before 20 wks
What does primipara (primip) mean?
First time pregnancy/labour
What is a multipara (multip)?
Pt has had 2 or more deliveries
What is a pt who is pregnant for the 3 time, with no children at home described?
G3P0
What are the two notable factors of contractions?
Frequency (interval between), duration (of contraction)
What are Braxton hicks contractions?
False labour pains, 2/3 trimester, body’s way of preparing.
Not in regular pattern, and go away
uncomfortable, but don’t get worse
What does the first stage of labor involve?
Uterine contractions that increase in strength, length and frequency. fetus descends, cervix softens, shortens, thins and dilates
How is the first stage of labour broken down?
Early and Active labour
What are the characteristics of early labour?
Mild and irregular contractions (20-30secs long), bloody show, SROM may occur
How may the patient present in early labour?
Walking and talking through mild, irregular, short contractions
What characterizes active labour?
Regular, continuous, strong contractions (3-4 mins, lasting 45-60 seconds), progressive dilation, bright red bloody show
How might the patient present during active labour?
Difficulty walking and talking through contractions, may be distressed. Vomit/shaking overwhelming emotions possible
When does stage 2 of labour start and end?
Starts when pt is fully dilated (10cm), and feels the urge to push, ends once baby is born.
What do contractions look like in Stage 2?
less than 2 mins apart, lasting 60-90 seconds, strong.
What characterizes Stage 2 of labour?
The uterus will rise up and change shape
Urge to push occurs when the presenting part reaches the pelvic floor
Pt is actively bearing down
Bloody show, stool, amniotic fluid drainage
Pain and perineal pressure with distention
Bulging perineum until presenting part is visible
How is imminent birth explained as per ALS for Primips?
presenting part is visible during and between contractions,
maternal urge to push or bear down,
contractions are less than two (2) minutes apart
How is imminent birth explained as per ALS for Multips?
contractions five minutes apart or less and any other signs of second stage labor present.
When does stage 3 start and finish?
Starts from the birth of baby till delivery of placenta?
What are paramedic observations of Stage 3?
Lengthening of the cord.
Sudden gush or trickle of blood
Uterine Contraction
What does CCT stand for in delivery?
Controlled Cord Traction
What is an Indication that the placenta is being delivered?
Gush of blood, lengthening of cord, contractions
What is done with a placenta after it is delivered?
Inspect for wholeness, place in plastic bag (mark mother name and time), transport with patients
Why is placental delivery considered high risk?
Increased risk of bleeding and post-partum hemorrhage
In an ideal situation, how would you set up the delivery station?
Call for additional crew. Open OBS Kit, Pt on firm surface, prepare neonate resus station, prepare towels and blankets
What happens if midwife is on scene?
Let them take over - assist them where they ask
What are the 7 phases of a normal birth?
Engagement, Flexion, Internal Rotation, Extension, Restitution, External Rotation, Expulsion
What is Restitution?
When baby’s (delivered) head turns to side
How is external rotation of baby different from internal and why is it important?
External happens once the head is delivered, it allows for the shoulder to deliver
Where should the umbilical cord be cut?
at approx. 15 cm and 7 cm
What must be done prior to cutting the umbilical cord?
It must be clamped
What is delayed cord clamping?
Delaying clamping the cord until pulsations stop (about 2 minutes)
What is the benefit of delayed cord clamping?
Increase blood flow, and decrease probability of anemia
What does APGAR stand for?
Appearance, pulse, grimace, activity, respirations
What is the APGAR criteria at 0
Pale and blue, no pulse, no response, limp, no respirations
What is APGAR criteria at 1
Body pink with blue limbs, HR<100, grimace, weak activity, slow/irregular respirations
What is APGAR criteria at 2
pink, pulse>100, coughing and crying, strong activity, good resp
What are the basics of oxytocin?
promotes uterine contraction, fast onset, duration 2-3hrs, minimal side effects
What is Vertex Presentation?
head first, face toward back of mom. majority of births
What are some indications that the maternal pt may be having twins?
Smaller than anticipated, fundal height stays high, additional fetal parts palpated through abdomen
