OB/GYN Flashcards

Question

OB Kit

Answer 1

Have everything out and ready to use, but to the side out of "splash zone." any complications or delay, give mother high flow o2 towels ready to catch baby, they're slippery. pillows below if there's a drop zone -King County Medic One BLS CBT Course 2020

Answer 2

floor is best. but if you can't get mother there, position her at the end of the bed -King County Medic One BLS CBT Course 2020

Answer 3

Crowning - support perineum with towel to prevent tearing. Extension of Head - sweep neck of baby to check for nuchal cord with index finger Restitution - provided gentle downward traction for anterior shoulder, then upward traction for rest of body Stimulate newborn and continue postpartum care of mother -King County Medic One BLS CBT Course 2020

Answer 4

resistance from the pelvic floor assists with extension of baby head as it pass under the symphysis pubis

Answer 5

head extends further, head and chin are birth

Answer 6

anterior shoulder is delivered first as it slips under the symphysis bone, rest of baby easily slides out. Baby rotates slightly

Answer 7

1. Check for bleeding. Small or moderate amount is okay. If significant bleeding place trauma pad and transport 2. Transport once pts are stable. Don't wait for placenta 3. If placenta is delivered, massage uterus firmly to start contractions - King County Medic One BLS CBT Course 2020

Answer 8

1. position infant to facilitate flow of blood from placenta to baby 2. stimulate and dry infant 3. Wait for pulsations in cord to stop. place two clamps, two in apart and 6 in away from baby. cut between clamps 4. If uncomplicated delivery, encourage skin to skin. Check APGAR every 5 mins - King County Medic One BLS CBT Course 2020

Answer 9

Appearance: blue 0, blue extremities 1, pink 2 Pulse: <60 0, 60-100 1, >100 2 Grimace: no response 0, feeble cry 1, strong cry 2 Activity: no movement 0, some flexion 1, active movement 2 Respirations: absent 0, weak, irreg, slow 1, strong cry 2 totals: 0-3 critical, 4-6 low, 7-10 normal

Answer 10

Do not force the placenta, it could cause hemorrhage. Once delivered start uterine massage to prevent uterine atmophy (?) -King County Medic One BLS CBT Course 2020

Answer 11

1. Palpate Uterus to make sure it is firm and contracted. Keep massaging if needed 2. Monitor mother, she is most at risk for hemorrhage 3. Monitor infant - King County Medic One BLS CBT Course 2020

Answer 12

umbilical cord is wrapped around baby's neck Few maternal complications Fetal complications: reduced blood flow and oxygen, decreased HR, decreased movement If present, reduce the cord from around the neck. If too tight, clamp and cut cord, then continue with delivery. Actions: 1. request ALS if not already (imminent delivery is always ALS) 2. recognize and slip cord over head or cut between clamps 3. Notify ALS if not on scene - King County Medic One BLS CBT Course 2020

Answer 13

Cord presents first at birth. Cuts off oxygen and blood to baby, can lead to fetal demise Maternal Risks: Excessive bleeding and need C-section Actions: ALS Request and transport 1. Tell mother to stop pushing. Can position mother in knee-chest or all fours to relieve pressure 2. Elevate baby by pushing any presenting part back with two fingers to relieved pressure on cord inside vagina 3. Highflow O2 to mom, transport expedited - King County Medic One BLS CBT Course 2020

Answer 14

Anterior shoulder becomes obstructed by the pubic symphysis. Baby could loose O2, blood flow. damage to brachial plexus nerves, clavicular or humerus fracture. Maternal Risks: Risk increase w/ hx of obese and DM2. Excessive Bleeding and C-section Recognition: If shoulder does not deliver on next push (or about a minute) after head, suspect shoulder dystocia. If head retracts "turtle sign" Actions: ALS Request and Transport 1. Tell mother to stop pushing 2. Put mother in McRobert's position (raise legs w/flexion to open pelvic girdle; use two provider) 3. One provider pushes outside body to help push baby pass pubic girdle. "suprapubic pressure" 4. Use finger to slip shoulder past the pubic symphysis 5. High Flow O2, monitor and transport - King County Medic One BLS CBT Course 2020

Answer 15

Baby is born buttocks first. Complications include reduced blood flow and O2, prolapsed cord, head entrapment and fetal demise. Maternal complications: excessive bleeding and C-section Actions: ALS Request 1. Support buttocks and legs as it delivers. Reach and gently assist legs one at a time by pulling out laterally. 2. Assist delivering one shoulder anteriorly and then turn body 180 degrees so next shoulder is anterior. Pull arms across chest if needed. 3. Back should be anterior, use suprapubic pressure to assist head in delivery. Do not pull, if needed make a v-shape on chin of baby to assist in breathing 4. High Flow O2, monitor, and expedite transport If limb presents rather than buttocks, transport immediately and encourage mother to not push, put mother in knee-chest or all four position, ALS cannot surgically remove, so meet them in route or go straight to hospital. Call ER to give a head's up and get there. -King County Medic One BLS CBT Course 2020

Answer 16

Normally within 20 minutes of baby delivery. Emergency if: No placenta after 30 mins, significant bleeding. -King County Medic One BLS CBT Course 2020

Answer 17

the placenta covers the covering of the vagina. Typical presentation: bright red, painless third trimester bleeding. Can be intermittent Maternal Risk Factors: Hx of it, uterine scarring (ex:c-section), older, smoker, uses cocaine Maternal Complications: vaginal bleeding and preterm birth Fetal complications: hypoxia, brain damage, death, prematurity if delivered Actions: ALS Place trauma pad underneath mother, do not pack and do not throw away. Monitor, transport and notify hospital -King County Medic One BLS CBT Course 2020

Answer 18

Premature separation of the placenta from the uterine wall can occur spontaneously or with trauma. Happens suddenly and painfully in third trimester, dark red bleeding, pt may experience shock Types: concealed - blood accumulates behind the placenta revealed - blood tracks between the placenta and endometrium and escapes through the cervix to the vagina total - involves whole placenta and can result in fetal demise and major hemorrhage in mother Maternal Risk: abdominal trauma, older mother, hypertension, preeclampsia, smoker or cocaine user Baby Complications: hypoxia, brain damage, death, prematurity Actions: ALS Place trauma pad underneath mother, do not pack and do not throw away. Monitor, transport and notify hospital -King County Medic One BLS CBT Course 2020

Answer 19

Bleeding is normal during and after birth but bleeding is considered significant if more than 500ml (full kidney dish) Common Causes: uterine atony (uterus not contracting after birth), uterine inversion, bleeding disorder, lacerations, and retained placenta Maternal Risk: uterine over distention, prolonged or ra[id labor, uterine fibroids Complications: hysterectomy, shock, death Actions: ALS Place trauma pad underneath mother, do not pack and do not throw away. Monitor, transport and notify hospital. Preform uterine massage -King County Medic One BLS CBT Course 2020

Answer 20

cup uterus with both hands | firmly massage the uterine fundus through the abdominal wall

Answer 21

Condition of mother that involves HTN, proteinuria. Develops after 20 weeks gestation and up to 4 weeks postpartum Maternal Risk factors: nulliparity, previous HTN, gestational DM2, family history of preeclampsia, older Complications: causes vascular dysfunction with brain, liver, and kidneys. predisposes woman for placenta abruptio. Can lead to eclampsia if untreated. Fetal complications: growth restriction and death S/Sx: Edema, HTN(>140/90, 160/110 at risk for eclampsia), hyperreflexia, AMS, headache, epigastric pain, visual disturbances, respiratory distress Actions: 1. Recognition and call ALS if SBP over 140 and neurological s/sx accompanies. 2. Darken lights and make transport easy going 3. high flow o2, expedite and monitor vitals -King County Medic One BLS CBT Course 2020

Answer 22

Can occur if preeclampsia is not treated and even after birth. New onset of Grand Mal Seizure in a pregnant or postpartum woman. Risk factors: pre-eclampsia, nulliparity, pre-existing HTN, DM2, family history of, older Maternal Complications: placental abruptio, acute renal failure, death, PE and hypoxia Fetal complications: premature delivery and death Actions: 1. ALS, assume eclampsia if pregnant or recent postpartum 2. Highflow O2, monitor airways and vitals and expedite transport -King County Medic One BLS CBT Course 2020