Module 26: OBGYN emergencies Flashcards
The superior portion of the birth canal is
the cervix
Fertilization occurs in ____
the fallopian tubes
When the placenta is at the top of the uterus, it is called
the fundal position
Cephalic deliveries are…
when baby’s head is downward
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
Describe the typical respiratory changes during pregnancy
increased
obstructed by baby
Describe the typical cardiovascular changes during pregnancy
increased blood volume
increased heart rate
Describe the typical musculoskeletal changes during pregnancy
relaxed joints
center of gravity off
What occurs during the first stage of birth?
Contractions begin
Dilation of cervix
Describe the second stage of birth
Baby moves into birth canal
delivery
Describe the third stage of birth
placenta is delivered
Describe differences in contractions in Braxton Hicks v Labor
Braxton: irregular, intensity/strength not consistent
Labor: regular, increasing intensity of pain
What does primigravida mean?
First pregnancy
Name the stage:
the baby starts to move into the birth canal, with consistent and regular contractions
first stage
Which is the longest stage of birth?
first
How can an EMT help to prevent perineal tearing?
Putting pressure on perineum
Name the stage: Placenta is being delivered
third
Childbearing age begins at ______
menarchy
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
Can you deliver a baby when the pregnant patient has placenta previa?
No, the placenta is blocking the baby from leaving
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
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
- Lift hips up 2-4”
- Drape w sheets and towels both under mom and on (preferably in ambulance)
- Support head and neck of mom
- 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
