OB/GYN Flashcards
Fallopian Tubes
transport the egg from the ovary to the uterus
Uterus
Hollow muscular organ located in the female pelvis between the rectum and bladder. Main function to nourish the developing fetus. AKA womb
-King County Medic One BLS CBT Course 2020
cervix
cylinder shaped neck of tissue that connects the vagina and uterus. Dilates during child birth up to 10 cm
-King County Medic One BLS CBT Course 2020
vagina
elastic, muscular canal with a soft, flexible lining that provides lubrication and sensation. Also called “birth canal” during birth.
-King County Medic One BLS CBT Course 2020
ovaries
produces eggs that travels through the fallopian tubes and to the uterus to implant if fertilized
-King County Medic One BLS CBT Course 2020
umbilical cord
connects the baby to the placenta
-King County Medic One BLS CBT Course 2020
placenta
large organ that develops during pregnancy to facilitate in exchange of nutrients, waste, and oxygen between the mother and baby.
-King County Medic One BLS CBT Course 2020
mucus plug
thick jelly-like fluid that seals the cervix
-King County Medic One BLS CBT Course 2020
pubic symphysis
cartilaginous joint that connects the two sides of the pelvis
-King County Medic One BLS CBT Course 2020
Gravidty
number of times pregnant. Includes miscarriages, abortions and fetal demise
Ex: G2P1 Pregnant twice, one child
-King County Medic One BLS CBT Course 2020
Parity
number of deliveries (twins count as one).
Ex:G2P1 pregnant twice, one child/delivery
-King County Medic One BLS CBT Course 2020
primip
first time pregnancy. Usually a long labor, plenty of time to transport. Has had one delivery
-King County Medic One BLS CBT Course 2020
mutlip
has had more children, labor may be short and delivery imminent
-King County Medic One BLS CBT Course 2020
nultip
never has delivered before
-King County Medic One BLS CBT Course 2020
What to consider in Assessment
Scene Size Up: Where the pt is located, who is present, is there any fluid present (blood, water break, vomit, etc)
Assessment: pt’s alertness (post-ictal, DLOC, AMS?), ABC
HISTORY: G/P, LMP (last menstral period)/Due date, prenatal care, any known issues with pregnancy
Second Assessment: contractions (time), abdominal pain (constant or severe), vaginal bleeding or fluid, seizures or tremors
-King County Medic One BLS CBT Course 2020
Physiological Changes to Body during Pregnancy
Blood volume increase, risk of bleeding out if abdominal trauma occurs
Clotting factors increase, risk of PE during and soon after pregnancy
After 20 weeks, the uterus can be large enough to cut the blood flow of the vena cava, can cause hypotension; can also cause reflux and vomiting by pushing on the stomach
As the woman becomes larger, it can throw her balance off and increase risk of falling
Growing baby can cause reduction in lung capacity and in women with previous respiratory issues can cause respiratory decomposition
-King County Medic One BLS CBT Course 2020
fundal height
distance from symphysis (pubic) bone to fundus (top of uterus. measured in cm. used to approximate gestation age after week 20.
-King County Medic One BLS CBT Course 2020
stages of delivery
1: pass of mucus plug (water breaking), full dilation of cervix and effacement
2: Dilation to birth of child (labor)
3: delivery of placenta
4: 1st hour after delivery of placenta (highest risk of hemorrhage)
effacement
thinning of cervical wall
onset of labor
the fetus starts to descend and mom feels pressure on her sacral nerve encouraging her to push
-King County Medic One BLS CBT Course 2020
flexion
as the baby descends, resistance from the pelvic floor causes the baby’s head to bend towards the chest
-King County Medic One BLS CBT Course 2020
internal rotation of head
head of the baby flexes as it touches the pelvic floor and rotates until it is superior or just below the symphysis
-King County Medic One BLS CBT Course 2020
Preparing for delivery (stage 1)
1) determine if there is time to transport
2) If mother is at risk for complications i.e. placenta previa, breech, twins. she should be transported immediately even with risk of delivery in transport
3) Any delay of ALS, BLS should consider meeting them in route
4) Contractions two minutes apart, seeing a bulge at the perineum, or mother’s urge to have a BM or has one, delivery may be imminent. or if mother has had kids and says baby is coming, she’s probably right
- King County Medic One BLS CBT Course 2020
PPE w/in “splash zone”
eye pro, gown, gloves, mask. towel beneath pt’s buttocks
OB Kit
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
positioning
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
Delivery (Stage 2)
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
crowning
resistance from the pelvic floor assists with extension of baby head as it pass under the symphysis pubis
extension of head
head extends further, head and chin are birth
restitution
anterior shoulder is delivered first as it slips under the symphysis bone, rest of baby easily slides out. Baby rotates slightly
after delivery, mother
- Check for bleeding. Small or moderate amount is okay. If significant bleeding place trauma pad and transport
- Transport once pts are stable. Don’t wait for placenta
- If placenta is delivered, massage uterus firmly to start contractions
- King County Medic One BLS CBT Course 2020
After delivery, baby
- position infant to facilitate flow of blood from placenta to baby
- stimulate and dry infant
- Wait for pulsations in cord to stop. place two clamps, two in apart and 6 in away from baby. cut between clamps
- If uncomplicated delivery, encourage skin to skin. Check APGAR every 5 mins
- King County Medic One BLS CBT Course 2020
APGAR
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
Delivery of placenta (stage 3)
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
Postpartum (stage 4)
- Palpate Uterus to make sure it is firm and contracted. Keep massaging if needed
- Monitor mother, she is most at risk for hemorrhage
- Monitor infant
- King County Medic One BLS CBT Course 2020
nuchal cord
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)
- recognize and slip cord over head or cut between clamps
- Notify ALS if not on scene
- King County Medic One BLS CBT Course 2020
Prolapsed Cord
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
- Tell mother to stop pushing. Can position mother in knee-chest or all fours to relieve pressure
- Elevate baby by pushing any presenting part back with two fingers to relieved pressure on cord inside vagina
- Highflow O2 to mom, transport expedited
- King County Medic One BLS CBT Course 2020
Shoulder Dystocia
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
- Tell mother to stop pushing
- Put mother in McRobert’s position (raise legs w/flexion to open pelvic girdle; use two provider)
- One provider pushes outside body to help push baby pass pubic girdle. “suprapubic pressure”
- Use finger to slip shoulder past the pubic symphysis
- High Flow O2, monitor and transport
- King County Medic One BLS CBT Course 2020
Breech Delivery
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
- Support buttocks and legs as it delivers. Reach and gently assist legs one at a time by pulling out laterally.
- Assist delivering one shoulder anteriorly and then turn body 180 degrees so next shoulder is anterior. Pull arms across chest if needed.
- 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
- 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
Placenta Delivery
Normally within 20 minutes of baby delivery.
Emergency if: No placenta after 30 mins, significant bleeding.
-King County Medic One BLS CBT Course 2020
Placenta Previa
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
Placental Abruption
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
postpartum hemorrhage
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
uterine massage
cup uterus with both hands
firmly massage the uterine fundus through the abdominal wall
preeclampsia
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:
- Recognition and call ALS if SBP over 140 and neurological s/sx accompanies.
- Darken lights and make transport easy going
- high flow o2, expedite and monitor vitals
-King County Medic One BLS CBT Course 2020
Eclampsia
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:
- ALS, assume eclampsia if pregnant or recent postpartum
- Highflow O2, monitor airways and vitals and expedite transport
-King County Medic One BLS CBT Course 2020
