OB Emergencies Flashcards
Obstetrical pts are defined as gestation
> 20 weeks
Physiological changes during pregnancy
- 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
Pts in third trimester and not in active labor transport
Left side
If water has broken
Document time and color of fluid
If blood is present
Document time and volume
If crowning
- Prepare for delivery
- Transport to the closest appropriate hospital
Focus History
- Gravida
- Para
- Multiple birth
- Gestational diabetes
- Due date
- Frequency of contractions
- Feeling of having to push or bowel movement
First trimester
1- 12 weeks (1-3 Month)
Second trimester
13-27 weeks (4-6 Month)
Ectopic Pregnancy
- 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
Spontaneous Abortion Signs and symptoms
- Abdominal cramping
- Vaginal bleeding
- Passage of tissue or fetus
For active bleeding
- 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
Placenta Eruption
- Sudden onset of severe abdominal pain and tenderness
- Painful uterine contractions
- Vaginal bleeding with dark red blood
- Patient may present in shock
Placenta Previa
Painless vaginal bleeding (bright red blood)
Uterine Rupture
- Sudden, intense abdominal pain
- Vaginal bleeding
For pregnant pts transport
Place 4-6 inches of padding under the patient’s right side while maintaining normal anatomical alignment
If hypotensive: NS 1L
x1
Severe pre-Eclampsia/Eclampsia
- 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
Severe Eclampsia not in active labor
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
Eclampsia
- Versed 5mg IV/IO in 5 mins
May repeat x1 - Mag Sulfate 4mg in 50mL, 60gtt, run wide open
If unable to stablish an IV for eclampsia
- Mag sulfate 4mg (8mL total) IM
4mL per injection site
Normal delivery positioning
- Place patient on her back with knees flexed and feet flat on the floor
- Control delivery of the head, with gentle perineal pressure
Once the baby’s head delivers
- 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
Upon delivery of the Neonate
- Dry, warm, and stimulate the neonate
- Keep the neonate at the same level of the placenta
When to perform APGAR Score
1 and 5 minutes after birth
Once the umbilical cord stops pulsating (usually 3-5 minutes)
- 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
APGAR Score Criteria
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
Breech presentation
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
Shoulder Dystocia
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
Nuchal Cord
- 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
Prolapsed Umbilical Cord
- 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
