OB Emergencies Flashcards
Name the three events that occur to allow for pregnancy
Ovulation, Fertilization, Implantation
Name the three anatomical structures that are specialized for pregnancy
Placenta, Umbilical cord, Amniotic sac and fluid
What does the placenta do?
-Provides for respiratory gas exchange
-Transports Nutrients
-Removes waste
-Transfers Heat
-Serves as an endocrine gland
The umbilical cord contains what vessels?
2 arteries and 1 vein
What structure allows for blood to bypass the lungs in a fetus?
Ductus Arteriosus
How much fluid does the amniotic sac contain at the time of birth approximately?
1 L
An infant is defined as
Any time after 37 weeks but before 42 weeks
Gravida refers to
All current and past pregnancies
Para refers to
Number of past pregnancies to delivery
Antepartum refers to
Period before delivery
Gestation refers to
The period of intrauterine fetal development
Grand Multipara is how many deliveries or more?
7
Multipara means
2 or more deliveries
Natal means
Connected to birth
Nullipara means
Has never delivered
Perinatal-occurring means
At or near the time of birth
Postpartum means
Period after delivery
Prenatal means
Before birth
Primigravida means
Pregnant for the first time
Primipara means
Gave birth once
A full-term baby is anywhere after
37 weeks (Ideally 40)
Who is your main concern in a trauma involving a pregnant patient?
The pregnant individual. To keep the mother alive is to keep the baby alive (Ideally)
What are the two most important times to document?
Infant birth time and placenta delivery time
Symptoms of Preeclampsia
High blood pressure, Sudden weight gain, Protein in urine, Vision changes, headache, Edema, Seizures
Eclampsia may result in
Coma, death
Preeclampsia and Eclampsia are treated with
Magnesium Sulfate 2-4 G
Preeclampsia should be considered if
The patient is over 20 weeks’ gestation
Preeclampsia MOA
an acute rise in blood pressure
causes loss of cerebral blood flow (CBF) autoregulation
and hyper perfusion of the brain that results in
vasogenic edema formation and subsequent seizure.
How to treat a prolapsed cord
Place the mother in a head down/buttocks up position. Check the cord for a pulse and wrap in a towel. Push the infants head off the cord and drive code 3
Prolapsed cords cause
Compression of the cord
Nuchal cord is defined as
The umbilical cord wrapped around the babies neck
List at least 4 possible causes of vaginal bleeding
Miscarriage, Menstruation, Ectopic pregnancy, abruptio placenta, Placenta previa, uterine rupture, Postpartum hemorrhage.
Abortion is defined as
Termination of pregnancy from any cause before 20 weeks gestation
An ectopic pregnancy is defined as
the ovum implanting outside the uterus
List the three classic symptoms of ectopic pregnancy
Abdominal pain, Vaginal bleeding, Amenorrhea
Third trimester bleeding is
never normal
Name the three most common causes of third trimester bleeding
Abruptio placenta, placenta previa, Uterine rupture
Abruptio placenta presents with
Severe abdominal pain that occurs outside of contractions. Extent of bleeding may not be apparent.
Placenta previa is
the attachment of the placenta partially or totally over the internal cervix
Uterine rupture
Spontaneous or traumatic rupture of the uterine wall
Name the three stages of childbirth
Stage 1: Regular contractions
Stage 2: Begins with crowning. Birth of the baby
Stage 3: Delivery of the placenta
Crowning is defined as
The first presentation of the baby from the vaginal opening
Cephalic presentation is
initial presentation of the head
Breech presentation is
The presentation of a limb or the flank first
True or false: You should always let the mother leave to use the bathroom during labor as it can prevent a messy accident later on
False! (Lest you wish to see the baby flushed down the toilet)
If the amniotic sac has not broken during childbirth you should
Puncture the sac and remove it from the baby’s face
If your pt has nuchal cord, you should
If possible, unwrap the cord. If not possible then clamp and cut
Neonate suction order
Mouth, nose
True or false: You should keep you hands by the bay during delivery to guide it, but you should not place any pressure
False: Put light pressure on the baby’s head to prevent an explosive birth
A baby should be kept
Warm
List three ways to prevent after delivery bleeding
- Administer oxytocin
- Massage the fundus
- Allow the baby to nurse
How much blood loss is tolerated in childbirth
50 cc
Shoulder dystocia is
When a shoulder gets stuck during delivery
What should be done for shoulder dystocia
McRoberts, Suprapubic pressure, Remove the posterior
Supine hypertensive syndrome
occurs in the third trimester and happens due to an increased mass in the abdomen. The inferior Vena cava is compressed
Pregnant patients should be placed in what position
Left lateral recumbent
What is the most frequent surgical emergency of pregnancy
appendicitis
APGAR is
Appearance, Pulse, Grimace, Activity Respiratory effort
What’s the highest APGAR score that can be received?
10
Appearance scoring for APGAR
0: Blue, pale
1: Pink body, Cyanosis of extremities
2: Pink body and extremities
Pulse scoring for APGAR
0: Absent
1:<100
2: >100
Grimace scoring for APGAR
0: No response
1: grimaces
2: Cries
Activity scoring for APGAR
0: Limp
1: Some flexion
2: Active motion
Respiration scoring for APGAR
0: Absent
1: Slow/Irregular
2: Strong cry
A cord should be clamped
2 inches from the baby’s belly
Arguments against resuscitating SIDS victims
Crime Scene
CPR presents a slight risk of infection for EMTs.
Emergency transport, with lights and siren, increases the risk of
motor vehicle crashes, injury, and death.
Premature babies get a size ___ Et tube
0 or 00
Neonate ppv should start at
20-25 mmHg
Neonate cardiac reflex
Pressure on the eyes lowers HR and RR
If a baby is intubated but is not having chest rise
use a meconium aspirator
What should you do if presented with a neonate with a HR of 60-99 and no chest rise?
MR SOPA
MR SOPA stands for
Mask adjustment
Reposition the airway
Suction
Open the airway
Increase pressure by 5cm x2
Alternative airway
Neonate ET depth is measured from the
nasal septum to the ear tragus with one extra CM
What should be done for a neonate with a HR less than 60
An alternative airway should be placed and breathed through for 3 seconds. If that doesn’t work CPR should be done for 60 seconds. If that still doesn’t work complete another round of CPR and administer EPI
PPV in a neonate should start at
20-25 cm
Max PPV in a neonate should be at
40 cm
Neonate HR is measured by
counting for 6 seconds and multiplying by 10
Neonate fluid administration should be at
10ml per kg
What causes low HR in a neonate typically
Acidosis
Neonate epinephrine is administered at
0.02 mg/kg
A neonate can stay with its mother if
It has good tone, is crying, and is to term
Neonate cpr follows a
waltz pattern. 1 and two and breathe and one and two and breathe
How do you treat a Tension Pneumo in a neonate
PPV, Needle decompression in the 4/5 intercostal space with a 16 G
Whats the highest in utero sat a baby can have
55%
Highest PH of the umbilical cord
7.25
If a neonate is <26 weeks they should be
Placed in a warming bag
Birth is an ___ event
asphyxiating
Babies are ___ breathers
nose
Aspiration babies may need
higher ppv pressure
