Maternity Emergencies - Assessment and Physiology

Question 1

Define term.

Maternity Emergencies

Answer 1

37 - 42 weeks gestation

Question 2

Define preterm.

Maternity Emergencies

Answer 2

24 – < 37 weeks gestation

Question 3

Define show.

Maternity Emergencies

Answer 3

Vaginal discharge of mucous and blood

Question 4

Define SROM.

Maternity Emergencies

Answer 4

Gush of normally clear or pink coloured fluid. Can occur from prior to
onset of labour until baby is born.

Question 5

Define meconium stained amniotic fluid.

Maternity Emergencies

Answer 5

Greenish / brown stained amniotic fluid

Question 6

Define first stage of labour.

Maternity Emergencies

Answer 6

Onset of regular painful contractions to full cervical dilatation
(i.e. contractions every 2 - 20 minutes, 20 - 60 seconds duration)

Question 7

Define second stage of labour.

Maternity Emergencies

Answer 7

Full cervical dilatation to birth of baby

typical duration Primipara 1 - 2 hours, Multipara 15 - 45 minutes

Question 8

Define imminent birth presentation.

Maternity Emergencies

Answer 8

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”

Question 9

Define precipitate birth.

Maternity Emergencies

Answer 9

Unusually rapid labour (less than 4 hours) with extremely quick birth. The rapid change in
pressure from intrauterine life may cause cerebral irritation.

Question 10

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?

Answer 10

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.

Question 11

In terms of a focussed maternity history, what 4 questions should be asked about past pregnancies?

Answer 11

• Any / number of previous pregnancies?
• Prior caesarean sections / interventions?
• Complications / problems with previous pregnancies?
• Length of previous labours?

Question 12

In terms of a focussed maternity history, what 10 questions should be asked about current pregnancy?

Answer 12

• 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

Question 13

What changes to cardiovascular parameters would be expected in a maternity patient with regards to BP?

Answer 13

Initial increase in 1st/2nd trimester - normal in 3rd trimester

Question 14

What changes to cardiovascular parameters would be expected in a maternity patient with regards to HR?

Answer 14

Increase by 15 to 20bpm.

Normal HR 80-110.

Question 15

What changes to cardiovascular parameters would be expected in a maternity patient with regards to C.O?

Answer 15

Increase by 30-40%.

Normal volume 6-7L/m.

Question 16

What changes to cardiovascular parameters would be expected in a maternity patient with regards to ECG?

Answer 16

Non-specific ST changes, Q waves in leads III and avF

Atrial and ventricular ectopics

Question 17

What changes to cardiovascular parameters would be expected in a maternity patient with regards to SVR?

Answer 17

Decreased due to progesterone and blood volume.

Question 18

What changes to respiratory parameters would be expected in a maternity patient with regards to RR?

Answer 18

Increase by 15% (2-3 resp/min)

14-19 breaths per minute at term.

Question 19

What changes to respiratory parameters would be expected in a maternity patient with regards to O2 demand?

Answer 19

Increase by 15 - 20%.

Question 20

What changes to respiratory parameters would be expected in a maternity patient with regards to minute ventilation?

Answer 20

Increase by 25-50%.

Question 21

What changes to respiratory parameters would be expected in a maternity patient with regards to tidal volume?

Answer 21

Increase by 25-40%.

Question 22

What changes to respiratory parameters would be expected in a maternity patient with regards to arterial pH?

Answer 22

increased to 7.4 - 7.45

Question 23

What changes to haematological parameters would be expected in a maternity patient with regards to blood volume in mL?

Answer 23

Increase by 30-50%

5.5L at term.

Question 24

What changes to haematological parameters would be expected in a maternity patient with regards to haematocrit and haemoglobin?

Answer 24

Significant decrease, maternity pts experience physiological anaemia.

Question 25

What note is made about red cell mass in proportion to blood volume for maternity pts?

Answer 25

Increased red cell mass by 20-30% but still insufficient compared with total blood volume increase (anaemia, reduced O2 carrying capacity).

Question 26

What note is made about plasma volume in maternity patients?

Answer 26

Increased by 30-50% in preparation for increased requirement of clotting factors, however no oxygen carrying capacity so contributes to physiological anaemia.