OB Emergencies

Question 1

Obstetrical pts are defined as gestation

Answer 1

> 20 weeks

Question 2

Physiological changes during pregnancy

Answer 2

• Mother’s HR increases
• HR can be 15-20 bpm above normal range by the third trimester
• Systolic and Diastolic BP decreases by 5-15 mm Hg during the second trimester
• Mother’s cardiac output and blood volume increases
• therefore, mom can lose 30-35% of her blood volume before the signs of shock become apparent
• Supine hypotension can occur

Question 3

Pts in third trimester and not in active labor transport

Answer 3

Left side

Question 4

If water has broken

Answer 4

Document time and color of fluid

Question 5

If blood is present

Answer 5

Document time and volume

Question 6

If crowning

Answer 6

• Prepare for delivery
• Transport to the closest appropriate hospital

Question 7

Focus History

Answer 7

• Gravida
• Para
• Multiple birth
• Gestational diabetes
• Due date
• Frequency of contractions
• Feeling of having to push or bowel movement

Question 8

First trimester

Answer 8

1- 12 weeks (1-3 Month)

Question 9

Second trimester

Answer 9

13-27 weeks (4-6 Month)

Question 10

Ectopic Pregnancy

Answer 10

• Usually first trimester
• sudden onset of severe abdominal pain
• Vagina Bleeding
• Amenorrhea (Absent period)
• Cullen’s Sign (periumbilical ecchymosis)
• Grey’s Tuner (Bruise flanks)
• Abdominal Distention and tenderness

Question 10

Spontaneous Abortion Signs and symptoms

Answer 10

• Abdominal cramping
• Vaginal bleeding
• Passage of tissue or fetus

Question 11

For active bleeding

Answer 11

• Loosely place trauma pads over the vagina in an effort to stop the flow of blood
• DO NOT pack the vagina

If hypotensive: NS 1L
x1

Question 12

Placenta Eruption

Answer 12

• Sudden onset of severe abdominal pain and tenderness
• Painful uterine contractions
• Vaginal bleeding with dark red blood
• Patient may present in shock

Question 13

Placenta Previa

Answer 13

Painless vaginal bleeding (bright red blood)

Question 14

Uterine Rupture

Answer 14

• Sudden, intense abdominal pain
• Vaginal bleeding

Question 15

For pregnant pts transport

Answer 15

Place 4-6 inches of padding under the patient’s right side while maintaining normal anatomical alignment

If hypotensive: NS 1L
x1

Question 16

Severe pre-Eclampsia/Eclampsia

Answer 16

• Begins after 20 weeks of pregnancy
• HTN (SBP > 160 mm Hg OR a DBP of > 110 mm Hg) with any of the following:
• AMS
• Visual disturbances
• Headache
• Pulmonary edema

Question 17

Severe Eclampsia not in active labor

Answer 17

Either condition can occur for up to 60 days postpartum. Transport ALL PATIENTS to OB Hospital.
* Mag Sulfate: 2g in 50mL, 10gtt, 1gtt/sec
over 10 mins MUST repeat x1

Question 18

Eclampsia

Answer 18

• Versed 5mg IV/IO in 5 mins
  May repeat x1
• Mag Sulfate 4mg in 50mL, 60gtt, run wide open

Question 19

If unable to stablish an IV for eclampsia

Answer 19

• Mag sulfate 4mg (8mL total) IM
  4mL per injection site

Question 20

Normal delivery positioning

Answer 20

• Place patient on her back with knees flexed and feet flat on the floor
• Control delivery of the head, with gentle perineal pressure

Question 21

Once the baby’s head delivers

Answer 21

• Suction the mouth and then the nose
• Support the neonate’s head as it rotates to align with the shoulders, and gently guide the
  neonate’s head downward to deliver the anterior shoulder
• Once the anterior shoulder delivers, gently guide the neonate’s head upward to deliver the
  posterior shoulder and the rest of the body

Question 22

Upon delivery of the Neonate

Answer 22

• Dry, warm, and stimulate the neonate
• Keep the neonate at the same level of the placenta

Question 23

When to perform APGAR Score

Answer 23

1 and 5 minutes after birth

Question 24

Once the umbilical cord stops pulsating (usually 3-5 minutes)

Answer 24

• Clamp the cord in the following fashion:
• Place the first clamp 4” away from the neonate’s body
• Milk the cord away from the neonate and towards the mother (this will minimize
  splatter)
• Place the second clamp 2” away from the first, towards the mother
• Cut the cord between the 2 clamps
• Place the neonate on the mother’s chest, skin-to-skin, and cover with a dry blanket
• Record and encode an APGAR score at 1 and 5 minutes and document the delivery time
• Apply firm continuous pressure, manually massaging the uterine fundus after the placenta delivers
• Preserve the placenta in the bag provided with the OB Kit or a “Red Bio-Hazard bag” for inspection by the receiving hospital

Question 25

APGAR Score Criteria

Answer 25

Activity
* No Movement 0
* Some Movement 1
* Active Movement 2

Pulse
* No Pulse 0
* Less than 100 bpm 1
* Greater than 100 bpm 2

Grimace
* No response 0
* Grimace or feeble cry 1
* Active Motion 2

Appearance
* Blue all over 0
* Body pink, extremities blue 1
* Completely pink 2

Respiration
* Not breathing 0
* Slow, irregular 1
* Strong cry 2

Question 26

Breech presentation

Answer 26

If the head does not deliver within 3 minutes of the body:
* Elevate the mother’s hips (knee to chest position)
* Insert a gloved hand into the vagina
* Push the vaginal wall away from the neonate’s nose and mouth
* Expedite transport while maintaining the knee to chest position and the neonate’s airway
* Administer blow-by OXYGEN to the neonate

Question 27

Shoulder Dystocia

Answer 27

MCROBERT’S PROCEDURE:
* Hyperflex the mother’s legs tightly to her abdomen
* It may be necessary to apply suprapubic pressure (mother’s lower abdomen)
* Gently pull on the neonate’s head

Question 28

Nuchal Cord

Answer 28

• Check for the presence of a nuchal cord after delivery of the head
• If the cord is around the neck:
• Gently hook your finger under the loop
• Pull it over the neonates head
• You may have to repeat this if there is more than 1
  loop present
• If you are unable to free the cord:
• Clamp the cord in 2 places
• Cut the cord between the clamps

Question 29

Prolapsed Umbilical Cord

Answer 29

• Place mother in the knee to chest position
• Manually displace the uterus to the left
• Insert a gloved hand into the vagina
• Push the neonate up and away from the umbilical cord regardless if there is a pulse present or
  not
• Maintain this position during transport
• Frequently reassess the umbilical cord for the presence of a pulse, as contractions are likely to
  compress the umbilical cord
• Wrap the exposed cord in a moist sterile dressing
• Expedite transport to closest OB facility