Module 26: OBGYN emergencies Flashcards by Una Yarsky

The superior portion of the birth canal is

the cervix

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Fertilization occurs in ____

the fallopian tubes

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When the placenta is at the top of the uterus, it is called

the fundal position

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Cephalic deliveries are…

when baby’s head is downward

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The two umbilical arteries are carrying _____ blood away from the baby to the placenta, the and the umbilical vein is carry ______ blood from the placenta to the baby

deoxygenated
oxygenated

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Describe the typical respiratory changes during pregnancy

increased
obstructed by baby

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Describe the typical cardiovascular changes during pregnancy

increased blood volume
increased heart rate

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Describe the typical musculoskeletal changes during pregnancy

relaxed joints
center of gravity off

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What occurs during the first stage of birth?

Contractions begin
Dilation of cervix

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Describe the second stage of birth

Baby moves into birth canal
delivery

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Describe the third stage of birth

placenta is delivered

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Describe differences in contractions in Braxton Hicks v Labor

Braxton: irregular, intensity/strength not consistent

Labor: regular, increasing intensity of pain

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What does primigravida mean?

First pregnancy

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Name the stage:
the baby starts to move into the birth canal, with consistent and regular contractions

first stage

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Which is the longest stage of birth?

first

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How can an EMT help to prevent perineal tearing?

Putting pressure on perineum

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Name the stage: Placenta is being delivered

third

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Childbearing age begins at ______

menarchy

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Compare abruption placenta and placenta previa

Both present in later stages and both cause bleeding due to premature separation of placenta from uterine wall

in AP: Placenta in fundal position, painful

in PP: placenta not in correct position, painless

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Can you deliver a baby when the pregnant patient has placenta previa?

No, the placenta is blocking the baby from leaving

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What is preeclampsia? Describe the signs and symptoms

pregnancy induced hypertension
can develop after 30th week of gestation

headache, seeing spots, swelling in hands/feet, anxiety, high BP

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What is eclampsia? How should it be treated?

Seizures in the presence of hypertension

treat like any other pt with the exception of laying on left hand side to prevent supine hypotensive syndrome, possibly place NPA

Where should the lap belt be for pregnant women in motor vehicles?

Under belly/across hips

Why might a pregnant woman not show signs of shock shortly after being stabbed?

Their bodies are preparing to bleed throughout pregnancy, however they may quickly dive into shock after a certain amount of blood is lost

Cardiac arrest care for a pregnant woman is the same except for _____

notifying the hospital

How are preeclampsia and eclampsia typically treated in hospital?

magnesium

Describe what sort of information should be gathered during obstetric history taking

expected due date any complications if she is receiving prenatal care medical history if her water has broken, ask whether the fluid was green (Meconium)

TorF: a primigravida delivery will take less time than a multigravida

False

Describe the general steps of preparing for delivery

1. Lift hips up 2-4" 2. Drape w sheets and towels both under mom and on (preferably in ambulance) 3. Support head and neck of mom 4. choose area to put newborn after delivery

If bulging is occurring in perineum, EMT should...

Put pressure against perineum and block with towel Put hand on head to guide baby out so they don't pop out

What is a nuchal cord? What should EMT do to manage it?

Cord wrapped around neck first try to loosen it around neck rather than cut, as baby is still receiving nutrients If above doesn't work, clamp two sides of cord and cut.

When the shoulders and head start to rotate, what should be done?

DO NOT PULL Guide baby in downward position Put mom in supine position and bring knees to chest to avoid hitting pubic bone

The neonate should be held at level of _____ until cord is cut

mom's vagina

How do you stimulate breathing in neonates?

Flick feet, rub chest

Describe where an EMT should clamp/cut the cord

clamp--> First: 8-10" from baby then 3" from first Cut with sterile shears

An EMT can help slow bleeding post birth by ...

massaging the uterus by cupping fundus with one hand and massaging with the other. Place obstetrics pad outside of vagina

When should APGAR score be assessed?

one and five minutes after birth

APGAR is scored through five categories, which are...

appearance pulse grimace/irritability activity/muscle tone respiration

Describe what should be done during a breach delivery

support until back appears grab iliac wings of baby and move downward find path of least resistance

Describe what should be done for limb presentation

will not deliver in field rapid transport-NOTIFY cover limb provide comfort for mother and oxygen

Describe what should be done if there is a prolapsed umbilical cord

elevate hips knee-chest position insert gloved finger into vagina to keep head of infant off cord keep cord moist with a sterile dressing, do not attempt to push back into vagina

What should be done if a neonate has spina bifida?

cover bifida with sterile dressing (can consider occlusive dressing), keep warm and transport

In case of spontaneous abortion, what should EMT do with tissue? How should pt be treated?

collect tissue and bring to hospital treat w shock protocol (O2, position of comfort, temp control) use pad to manage bleeding

What is fetal demise?

When a baby is obviously dead, due to indicators like skin slothing, abnormality in head, foul smell Do not attempt resuscitation

Describe appearance of premature infant

smaller, thinner, and head is proportionately larger vernix (coating on infant) will be missing/minimal less body hair

describe newborn resuscitation if respirations >30 OR HR 60-100

ventilate 40-60 breaths/minute

describe newborn resuscitation if HR >60

CPR ratio of three compressions to one breath (3:1)

An infants heartrate should be in the

150s-160s

You can monitor the HR of an infant by...

looking at pulse rate of umbilical cord

for neonate resuscitation, the depth of compression should be ___ depth of chest. While keeping airway open, EMT should also keep one hand ....

1/3 keep one hand on baby's head to stabilize

The leading cause of maternal death during the first trimester of pregnancy is: massive brain damage secondary to status epilepticus urecognized or untreated hypotensive syndrome blunt trauma to abdomen after motor vehicle crash internal bleeding caused by a ruptured ectopic pregnancy

internal bleeding caused by a ruptured ectopic pregnancy

TorF: the placenta allows oxygen, carbon dioxide, and other products to transfer between the mother and fetus but does not allow blood to mix between the mother and fetus

True

Signs and symptoms of preeclampsia include dysuria and constipation dyspnea and bradycardia marked hypoglycemia headache and edema

headache and edema