OB/Peds Flashcards
Normal QRS size for a pediatric
less than 0.9
Premature rupture of membranes
Amniotic sac ruptures more than an hour before labor. Sac can self heal. Labor will begin within 48 hours. If pregnancy is term or near term there is no concern. If not near term there is risk for infection. Emotional support and transport.
Preterm Labor.
Labor after the 20th week but before the 37th week. Threat is premature birth.
Fetal distress
Difficult to assess in the field. Rely on information provided by the mother such as not as much movement. Best care is care for the mother and rapid transport.
Uterine rupture
Occurs during labor. Greatest risk in patients that are multi para with uterine scar tissue. Sign is woman in active labor reporting weakness, dizziness, and thirst. initial strong painful contractions and then contractions slacked and now there is a strong tearing pain. signs of shock. vaginal bleeding. Treat for shock and rapid transport.
Precipitous labor and birth
Potential for head trauma in the infant.
Post term pregnancy.
fetus is not born after 42 weeks gestation. Potential for fetus to become malnourished due to placenta becoming non functioning. Increased risk of muconium aspiration. Risk of complications during delivery due to larger fetus. Best to be delivered via c section
Meconium staining
The first bowel movement of the fetus after birth that consists of passively digested substances is called meconium. In cases of fetal distress or stress caused by labor and delivery, the fetus may may void the meconium into the amniotic fluid. May result in chemical pneumonia in the fetus. Amniotic fluid should be clear. If it is yellow tinged then meconium has been in the amniotic fluid for a while. if it is green/black color then the meconium is new and is a sign of danger. manage airway.
Fetal macrosomia
Big baby syndrome.
Multiple gestation
Babies can appear pre term. keep track of which is delivered first. call for assistance as it is possible for multiple resuscitation.
Intrauterine fetal death
Death of a fetus during the couse of normal pregnancy. Usually defined as death of the fetus after 20 weeks of gestation or when the fetus weighs 500 grams or more. before this the death is considered a miscarriage. Can be caused by Rh factor, uncontrolled diabetes, hypertension, eclampsia, preeclampsia, infections. do not attempt resuscitation.
Amniotic fluid embolism.
life threatening condition that is extremely rare and hardly ever seen. risk factors: maternal age older than 35, eclampsia, abruptio placenta, placenta previa, uterine rupture, fetal distress. Amniotic fluid and fetal cells enter the womans pulmonary and circulatory system via umbilical veins. S/S: sudden onset of respiratory distress and hypotension. Many of these patients are very cyanotic and have seizures. eventually go into cardiogenic shock. unresponsive, cardiac arrest. if survied they develop coagulopathies(no ability to clot)
Cephalic presentation
Head presentation but in an abnormal position such as face first.
Breech presentations
Anything other than the head presents first. Usually the butt first. Best place for delivery is in the hospital. If impossible to reach hospital then refer to book for delivery procedure.
Shoulder dystocia
“difficulty in delivering the shoulders. McRoberts maneuver: hyperflex the legs toward the abdomen.
Nuchal cord.
umbilical cord wrapped around the fetus’s neck. Attempt to slip the chord over the fetus’s head and shoulders. If unable, then clamp and cut the chord.
Prolapsed umbilical cord
The umbilical chord appears ahead of the fetus.
Position woman supine with hips elevated. administer 100% o2 via NRB, tell woman to pant with each contraction to prevent bearing down, push presenting part(not cord) back into vagina until no longer pressing on cord, while maintaining pressure on the presenting part have partner cover the exposed portion of the cord with moist dressings, maintain that position while urgently transporting.
Uterine inversion
placentia fails to detach from uterine wall when it is expelled, uterus turns inside out. Keep patient recumbent, administer 100% o2 via nrb, start two IV lines, do not attempt to remove placentia from uterus, monitor vitals, treat for shock, consider oxytocin, 10 units IM, make one attempt to replace the uterus. If attempt fails, cover exposed parts in moist dressing and rapid transport.
Postpartum Hemorrhage
average blood lose during third stage is 0.3 pints(150mL) when blood loss exceeds 500 mL during the first 24 hours after birth it is considered post partum hemorrhage. Treatment: continue uterine massage, encourage breastfeeding, 10 units of oxytocin to IV bag(1000mL) infused at 20 to 30mL/min, notify hospital, transport without delay, start another large bore iv, externally manage hemorrhage.
Pulmonary embolism
one of the most common causes of maternal death during childbirth. same as normal PE
Postpartum depression.
Most common in financial or other life hardships during or before pregnancy. can result in thoughts of harming self or fetus after birth or no interest in the fetus after birth.
Fluid resuscitation dosages for pediatrics and adults.
Neonates: 10mL/kg
Pediatrics: 20 mL/kg
Gynecological infections
PID
Pelvic inflammatory disease(PID): infection of a woman’s reproductive organs. Often caused by STD’s such as chlamydia or gonorrhea. organisms enter the vagina usually through sexual intercourse and migrate into the uterine cavity. purulent fluid drips out. May report pain that generally starts during or after normal menstruation. Usually diffuse pain in lower quadrants sometimes made worse by walking or sexual intercourse. Pain can move to the upper right quadrant later when the infection moves to the abdomen.
Gynecological infections Bartholin abscess
two mall ducts just inside the vagina lead to the bartholin glands. These secrete mucus that acts as lubricant. These can cor a cyst and become blocked and sweel bilaterally or unilaterally.
