OB and care of the newborn

Question 1

Ovaries

Answer 1

• Female gonads, or sex glands
• Secrete hormones estrogen and progesterone
• Release egg needed for reproduction

Question 2

Fallopian tubes

Answer 2

• Extend from the ovaries to uterus
• Hold the eggs

Question 3

Uterus

Answer 3

• Pear shaped organ that hold the fetus
• Top: FUNDUS
• Middle: BODY
• Bottom: CERVIX

Question 4

Placenta

Answer 4

• Organ of pregnancy
• Provided oxygen and nutrients to fetus

Question 5

Umbilical cord

Answer 5

• Infants life line
• One vein: Carries oxygenated blood to fetus
• Two arteries: Carries waste back to the placenta

Question 6

Amniotic Sac

Answer 6

• Bag of water
• Contains amniotic fluid
• Insulates and protects the pregnancy

Question 7

Vagina

Answer 7

• The birth canal

Question 8

What are predelivery emergencies?

Answer 8

• Emergencies relating to pregnancy prior to onset of labor
• Spontaneous abortion, Ectopic pregnancy, Placenta previa, Abruptio placenta, Ruptured uterus, Preeclampsia/ Eclampsia, and Supine hypertensive syndrome

Question 9

Spontaneous Abortion

Answer 9

• Miscarriage
• Passage of tissue before the 20th week or gestation
• USUALLY in the first trimester, between 8-12 weeks gestation

Question 10

Ectopic Pregnancy

Answer 10

• First trimester
• Fertilized egg implants anywhere but the uterus
• Usually in fallopian tubes
• Egg starts to grow and develop, rupturing the fallopian tubes

SXSX:
- Intense lower quadrant abd pain described as dull, then sharp, and knife like
- Can lead to internal bleeding and signs of shock possible

Question 11

Placenta Previa

Answer 11

• 3rd trimester emergency
• Placenta implants itself over the cervix

SXSX:
- LOTS of vaginal bleeding
- NO pain

Question 12

Abruptio Placenta

Answer 12

• Common in 1st pregnancy
• 3rd trimester emergency
• Placenta prematurely tears away from the uterine wall
• High mortality rate for mom and baby
• Many causes, from hypertension to trauma

SXSX:
- LOTS of pain
- LITTLE/ NO bleeding (infants head is covering the cervix)

Question 13

Ruptured Uterus

Answer 13

• 3rd trimester
• Spontaneous or traumatic rupture of the uterine wall
• Release fetus into abdominal cavity

Special question:
- Has the patient has a c- section before?

Question 14

Preeclampsia/ Eclampsia

Answer 14

• 3rd trimester
• Characterized by hypertension and swelling of the extremities
• Preeclampsia turns into Eclampsia when the mother has seizures
• Pregnancy related seizures have high mortality rate for mother and baby

Question 15

Supine Hypertensive Syndrome

Answer 15

• 2nd and 3rd trimester
• Uterus and growing fetus compress the inferior vena cava when the mom lays flat on her back
• Leads to hypotension when laying down
• Prop a pillow or similar under the patients right side to ensure the fetus does not compress the inferior vena cava

Question 16

Gravida

Answer 16

• How many pregnancies?

Question 17

Para

Answer 17

• How many deliveries past 20 weeks gestation

Question 18

Stage one

Answer 18

• Dilation phase
• Beginning of true labor until full dilation of the cervix
• Braxton hicks contractions: False labor

Question 19

Stage two

Answer 19

• Expulsion phase
• Full dilation of the cervix until the baby is born
• Look for Nuchal Cord: cord wrapped around babys neck

SXSX:
- Contractions 2-3 minutes apart and lasting 60-90 seconds
- Urge to bear down
- Crowing

Question 20

Stage three

Answer 20

• Placenta phase
• Delivery of the baby until delivery of the placenta
• 5-20 minutes after

Question 21

Prolapse Cord

Answer 21

• Umbilical cord presents before the head
• TRUE EMERGENCY
• Baby can compress the cord, cutting off blood supply
• Can insert gloved hand into birth canal to lift presenting part of the baby off of the cord

Question 22

Breech birth

Answer 22

• Butt or legs present first
• Allow deliver to happen
• If head gets stuck, after 2 minutes, may insert gloved hand into birth canal to make an airway for the baby

Question 23

Limb presentation

Answer 23

• Single arm or leg is presenting
• TRUE EMERGENCY, cannot deliver in the field
• Patient will need c section

Question 24

Multiple Births

Answer 24

• Proceed as normal
• Suspect twins or more if: Belly is large after the baby is born, Size of baby does not correlate to the size of the abd, Intense contractions start after delivery of the first baby

Question 25

Meconium

Answer 25

• Baby had a bowel movement in the amniotic sac
• When water breaks, fluid is greenish or brown
• Tells you that the baby was in distress at one time

Question 26

Postpartum Hemorrhage

Answer 26

• Any bleeding over 500cc after baby is born
• Place mom on high flow O2
• Massage fundus
• Baby to breast

Question 27

APGAR out of 10

Answer 27

APPEARANCE: 0-2
PULSE: 0-2
- 1: <100
- 2: >100
GRIMACE: 0-2
ACTIVITY: 0-2
RESPIRATIONS: 0-2

Question 28

APGAR Scoring

Answer 28

• 7-10: only routine care
• 4-6: Simulate baby, O2
• 0-3: BVM, CPR as needed

Question 29

How often is APGAR done?

Answer 29

• One minute after birth and five minutes after birth
• As needed after that

Question 30

Premature birth

Answer 30

Less than 5 pounds or born before 38th week

Question 31

Postterm Pregnancy

Answer 31

Gestation greater than 42 weeks

Question 32

Precipitous Delivery

Answer 32

Delivery <3 hours from onset of labor

Question 33

Shoulder Dystocia

Answer 33

Shoulders larger than head

Question 34

Premature Rupture of Membranes

Answer 34

Water breaks before onset of true labor

Question 35

Preterm Labor

Answer 35

Labor between 20th and 37th week