Maternity Emergencies - Assessment and Physiology Flashcards
Define term.
Maternity Emergencies
37 - 42 weeks gestation
Define preterm.
Maternity Emergencies
24 – < 37 weeks gestation
Define show.
Maternity Emergencies
Vaginal discharge of mucous and blood
Define SROM.
Maternity Emergencies
Gush of normally clear or pink coloured fluid. Can occur from prior to
onset of labour until baby is born.
Define meconium stained amniotic fluid.
Maternity Emergencies
Greenish / brown stained amniotic fluid
Define first stage of labour.
Maternity Emergencies
Onset of regular painful contractions to full cervical dilatation
(i.e. contractions every 2 - 20 minutes, 20 - 60 seconds duration)
Define second stage of labour.
Maternity Emergencies
Full cervical dilatation to birth of baby
typical duration Primipara 1 - 2 hours, Multipara 15 - 45 minutes
Define imminent birth presentation.
Maternity Emergencies
Active pushing / grunting
Rectal pressure – urge to use bowels or bladder
Anal pouting / bulging perineum
Strong unstoppable urge to push
Presenting part (baby’s head) on view - crowning
Mothers statement – “I am going to have the baby”
Define precipitate birth.
Maternity Emergencies
Unusually rapid labour (less than 4 hours) with extremely quick birth. The rapid change in
pressure from intrauterine life may cause cerebral irritation.
The majority of the time, in an predetermined homebirth, the midwives on scene will have clinical lead, instructing AV paramedics. In what circumstance will AV paramedics have the clinical lead?
If reason for call is not specifically related to the birth, or if the home birth is not a part of an obstetric hospital staffed and support program.
Resolve issues via PIPER.
In terms of a focussed maternity history, what 4 questions should be asked about past pregnancies?
- Any / number of previous pregnancies?
- Prior caesarean sections / interventions?
- Complications / problems with previous pregnancies?
- Length of previous labours?
In terms of a focussed maternity history, what 10 questions should be asked about current pregnancy?
• number weeks pregnant • singleton or multiple pregnancy • membranes ruptured + colour of the amniotic fluid • having contractions? Assess frequency and duration. • urge to push • fetal movements - more/less/same • Hospital interventions • anticipate any problems / complications • any antenatal care • Any current complaints - vaginal bleeding / PV loss - high BP - pain - trauma - any other issues
What changes to cardiovascular parameters would be expected in a maternity patient with regards to BP?
Initial increase in 1st/2nd trimester - normal in 3rd trimester
What changes to cardiovascular parameters would be expected in a maternity patient with regards to HR?
Increase by 15 to 20bpm.
Normal HR 80-110.
What changes to cardiovascular parameters would be expected in a maternity patient with regards to C.O?
Increase by 30-40%.
Normal volume 6-7L/m.
What changes to cardiovascular parameters would be expected in a maternity patient with regards to ECG?
Non-specific ST changes, Q waves in leads III and avF
Atrial and ventricular ectopics
What changes to cardiovascular parameters would be expected in a maternity patient with regards to SVR?
Decreased due to progesterone and blood volume.
What changes to respiratory parameters would be expected in a maternity patient with regards to RR?
Increase by 15% (2-3 resp/min)
14-19 breaths per minute at term.
What changes to respiratory parameters would be expected in a maternity patient with regards to O2 demand?
Increase by 15 - 20%.
What changes to respiratory parameters would be expected in a maternity patient with regards to minute ventilation?
Increase by 25-50%.
What changes to respiratory parameters would be expected in a maternity patient with regards to tidal volume?
Increase by 25-40%.
What changes to respiratory parameters would be expected in a maternity patient with regards to arterial pH?
increased to 7.4 - 7.45
What changes to haematological parameters would be expected in a maternity patient with regards to blood volume in mL?
Increase by 30-50%
5.5L at term.
What changes to haematological parameters would be expected in a maternity patient with regards to haematocrit and haemoglobin?
Significant decrease, maternity pts experience physiological anaemia.
What note is made about red cell mass in proportion to blood volume for maternity pts?
Increased red cell mass by 20-30% but still insufficient compared with total blood volume increase (anaemia, reduced O2 carrying capacity).
What note is made about plasma volume in maternity patients?
Increased by 30-50% in preparation for increased requirement of clotting factors, however no oxygen carrying capacity so contributes to physiological anaemia.
