Obstestrics & Gynecology Flashcards
Fetus
An offspring of a human or other mammal in the stages of prenatal development that follow the embryo stage.
NOTE: In humans taken perceived as the beginning 8 weeks after conception.
A fetus has a 9 month gestation period
Uterus
The muscular organ in the lower body of a woman or female mammal where offspring are conceived, and in which they gestate (grow) before birth.
Responsible for contractions during pregnancy.
Also known as the “womb”.
Cervix
The lower 1/3 narrow passage of the Uterus (neck of Uterus).
Contains a mucous plug that seals the Uterine opening.
Component of the Birthing Canal
Vagina
A muscular canal that extends from the Vulva to the neck of the Uterus (Cervix).
The vagina is where the lining of the Uterus is shed during menstruation, where penetration can occur during sex, and where a baby descends during childbirth.
Approximately 8-12 cm in length
Perineum
The area of skin between the Anus and the Scrotum or Vulva.
Placenta
An organ that develops in the uterus during pregnancy, and attached to the inner lining of the wall of the Uterus.
This structure provides oxygen and nutrients to a growing baby, and also removes waste products from the baby’s blood.
Baby's umbilical cord arises from Placenta
Umbilical Cord
A bundle of blood vessels that develops during the early stages of embryological development.
It is enclosed inside a tubular sheath of Amnion and consists of 2 paired Umbilical Arteries and 1 Umbilical Vein.
Amniotic Sac
The fluid-filled bag-like sac that contains and protects a fetus in the womb during gestation.
Protects and insulates the fetus, while providing lubrication and defensive septic measures for the Birthing Canal.
Contains 500-1000mL of Amniotic fluids
Stages of Labor
(Dilation & Effacement)
Time frame:
— 1st Stage of Labor — Begins with the onset of contractions — Ends with complete dilation – Averages 16 hours for a first delivery
Events:
— Release of mucous plug (bloody display) — Rupture of Amniotic Sac (water breaking) — Contractions will become more regular — Contractions increase in strength / length
Stages of Labor
(Expulsion of the Baby)
Time frame:
— 2nd Stage of Labor — Begins when Cervix is completely dilated — Ends with the birth of the infant
Events:
– Patient received urge to defecate – Bulging Perineum region – Vaginal Crowning
Stages of Labor
(Delivery of the Placenta)
Time frame:
— 3rd Stage of Labor — Begins after birth of the infant — Ends with delivery of the Placenta
Events:
— May take up to 30 minutes
Treatments:
— DO NOT PULL ON CORD TO ASSIST — Contact medical control about transport
Pre-eclampsia
A potentially dangerous pregnancy complication characterized by high Blood Pressure and protein in urine.
Pre-eclampsia usually begins after the 3rd Trimester (20 weeks of pregnancy) in a woman, whose blood pressure had been normal.
It can lead to serious, even fatal, complications for both mother and baby.
Assessment findings:
— 3rd Trimester — Headache — Seeing spots — Swelling (Edema) — Anxiety — Elevated Blood Pressure (140/90 BP)
Treatments:
— Supplemental 02 (as needed) — Place patient on her left side — Dim the lights in the ambulance — Rapid transport without lights / sirens
Eclampsia
Seizures that occur during a woman’s pregnancy or shortly after giving birth.
Eclampsia can follow a condition of high Blood Pressure, and excess protein in the urine during pregnancy (Pre-eclampsia).
Assessment findings:
— 3rd Trimester — Headache — Seeing spots — Swelling (Edema) — Anxiety — Elevated Blood Pressure (140/90 BP) — Seizure activity
Treatments:
— Supplemental 02 (as needed) — Aggressively manage airway — Place patient on her left side — Dim the lights in the ambulance — Rapid transport without lights / sirens
Supine Hypotensive Syndrome
Also referred to as Inferior Vena Cava Compression Syndrome (IVCCS), is caused when the Gravid Uterus compresses the Inferior Vena Cava when a pregnant woman is in a supine position, leading to decreased venous return centrally.
This syndrome causes a gradual decline in Blood Pressure of the patient, which results in chronic hypotension.
Assessment findings:
— Usually 3rd Trimester of pregnancy — Hypotension — Signs of shock (no underlying mechanism)
Treatments:
— Supplemental 02 (as needed) — Rule out volume depletion — Rule out decreased skin turgor — Rule out thirst / mechanism — Place patient on her left side — Monitor vitals frequently
Abortion
(Miscarriage)
The spontaneous loss of a woman’s pregnancy before the 20th week that can be both physically and emotionally painful.
The most common type of pregnancy loss; miscarriages often occur because the fetus isn’t developing normally.
Assessment Findings:
— Vaginal bleeding — Abdominal pain/cramping — Hypotension — Passing of tissue clots
Treatments:
— Supplemental 02 (as needed) — Treat patient for shock (as needed) — Place a sterile pad over vaginal opening — Transport all tissue and clots — Communication Therapy — Emotional support
Ectopic Pregnancy
(Extrauterine Pregnancy)
A pregnancy that develops outside of
the Uterus, usually in the Fallopian
Tubes. Patient may not know that they
are pregnant.
The fertilized egg can’t survive outside the Uterus, and if left to grow, it may damage nearby organs and cause life-threatening loss of blood.
Assessment Findings:
— 1st or 2nd Trimester — Missed menstrual cycle — Unilateral lower abdominal pain — Shoulder pain — Intermittent spotting — Morning sickness — History of PID / Tubal Ligations — Previous Ectopic Pregnancy
Treatments:
— Supplemental 02 (as needed) — Treat patient for shock (as needed) — Frequent vitals assessment — Place a sterile pad over vaginal area — Rapid transport
Abruptio Placentae
(Placental Abruption)
Premature separation of the Placenta from the Uterine wall.
Placental Abruption occurs when the Placenta detaches from the inner wall of the womb before delivery, which creates a condition which can deprive the baby of oxygen and nutrients.
Assessment Findings:
— 3rd Trimester — Constant / severe abdominal pain — Tearing quality of pain — Absent to heavy dark vaginal bleeding
Treatments:
— Supplemental 02 (as needed) — Position patient on her left side — Place a sterile pad over vaginal area — Rapid transport
Placenta Previa
The attachment of the Placenta very low in the Uterus so that it partially or completely covers the Cervical OS (opening).
Assessment Findings:
— 3rd Trimester — Painless bright red vaginal bleeding — History of PID / Tubal Ligations — Previous Ectopic Pregnancy
Treatments:
— Supplemental 02 (as needed) — Position patient on her left side — Place a sterile pad over vaginal area — Rapid transport
Trauma
(Hemorrhage)
The mother’s body will shunt blood from the baby back to the mother during a trauma.
Signs and symptoms of shock may not be visible until it’s too late for the baby.
Trauma in pregnancy can range from mild — for example, trauma associated with a single fall from standing height, or hitting the abdomen on an object such as an open desk drawer — to major — for example, trauma associated with penetrating injury or high force blunt motor vehicle accident.
NOTE: Save the baby by saving the mother
Para Grávida
Parity (para) is the number of times a patient has given birth to a viable (living) child.
Gravidity (grávida) is the number of times a patient has been pregnant, which includes a current pregnancy.
Abortus is the term used to describe a pregnancy that ended for any given reason, including both abortions and miscarriages.
Pelvic Inflammatory Disease
(PID)
An infection of the female reproductive organs.
It usually occurs when sexually transmitted bacteria spread from the Vagina to the womb (Uterus), Fallopian Tubes, or Ovaries.
Assessment Findings:
— Pain in Pelvis / Abdomen / Vagina — Pain in lower back — Chills / Fever / Fatigue — Cervical Motion Tenderness — Vaginal discharge / Odor — Nausea / Vomiting — Cramping / Painful menstruation
Treatments:
— Supplemental 02 (as needed) — Treat patient for shock (as needed) — Frequent vitals assessment — Place a sterile pad over vaginal area — Hospitalized Antibiotics / Penicillin — Rapid transport
Tubal Ligations
Tubal Ligation is a medical sterilization procedure for women who are sure they don’t want a future pregnancy.
Colloquially know as “tube tying”.
Preparing for Delivery
(Signs of Delivery)
When on-scene deliveries are required:
— Impossible to make it to hospital — Imminent delivery (crowning / urge to push) — Imminent delivery (mother says it’s time)
NOTE: the more pregnancies / live births, the shorter the Stages of Labor will be.
Assessment Findings:
— Length of pregnancy
— Patient’s due date
— Number of pregnancies / live births
• Para = number of live births
• Grávida = number of pregnancies
— Contractions
• How far apart are they
• Length / Strength
— History of previous C-section(s)
— Previous complications
— Complications with current pregnancy
— ETOH / Drug / Medical use
— Spotting / Bleeding
— Feeling of need to defecate
— Fluid from vagina (inspect around mother)
— Presence of multiple fetuses
— Inspect mother for crowning
• Check for crowning during contractions
Preparing for Delivery
(Patient Positioning)
Patient Position:
— Firm surface (not on a bed / couch) — Elevate patient’s hips 2-4” — Protect the patient’s modesty
Preparing Delivery Field:
— Place towels to control Amniotic fluid(s)
• Assess Amniotic fluids for greenish color
• Assess Amniotic fluids for foul odor
• Meconium Staining; sign of poor airway
— Maintain sterility of OB kit
— Placement of sterile sheets / towels:
• Under patient’s buttocks
• Over each of the patient’s legs
• Over patient’s abdomen
NOTE: the more pregnancies / live births, the shorter the Stages of Labor will be.
Deliver of the Baby
(Prior to Crowning)
Prior to Crowning:
— Maintain calm and reassure the mother
— Prevent abrupt delivery
• Precipitous Delivery
• Constantly watch for crowning
— Time the mother’s contractions
— Have patient take quick / short breaths
Delivery of the Baby
(Phase 1)
Events:
— Crowning until the delivery of the head — Contractions until the delivery of the head
Delivering the Head:
— Place hand over bony parts of the head — Exert gentle pressure to avoid expulsion — Tell mother not to push at this time — Assess for un-ruptured Amniotic Sac — Assess for Nuchal Cord findings
Delivering the Body:
— Support the head and upper body
— DO NOT PULL ON BODY
— Guide the head downward to assist delivery
• Assists with delivery of upper shoulder
— Guide the head upward to assist delivery
• Assists with delivery of lower shoulder
— Handle infant firmly but carefully
Delivery of the Baby
(Phase 2)
Events:
— Delivery of head to delivery of body
Delivering the Body:
— Support the head and upper body
— DO NOT PULL ON BODY
— Guide the head downward to assist delivery
• Assists with delivery of upper shoulder
— Guide the head upward to assist delivery
• Assists with delivery of lower shoulder
— Handle infant firmly but carefully
Post Delivery Care:
— Dry baby and wrap it; only expose the face
— Place baby on it’s side; lower baby’s head
— Wipe nose / mouth with sterile gauze
• Only suction if airway is poor
— Keep baby at vaginal level until cord is cut
Cutting Umbilical Cord:
— Clamp Umbilical cord
• 4 fingers width from baby
• Clamp 2-4” apart from one other
— Cut and tie cord with Umbilical tape
— Follow protocols in regards to post care
— Give baby to mother for breast feeding
— Give baby to partner for continued care
Deliver of the Baby
(Phase 3)
Events:
— Delivery of body to delivery of the Placenta
Delivering the Placenta:
— NEVER PULL ON UMBILICAL CORD
— Placenta will self-deliver in a few minutes
• May take as long as 30 minutes
• Transport emergent if it takes longer
— Wrap Placenta in moist towel and bio-bag it
— Bring all Placental material to hospital
Post Delivery of Placenta:
— Place sterile pad over vagina — Straighten mother’s legs outward — Massage the Fundus (promotes clotting) — Place baby on mother to breast feed — Record time of birth for records
Neonatal Evaluation & Resuscitation
(APGAR Score)
The Apgar Score is based on a total score of 1 to 10.
A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health.
Neonatal Evaluation & Resuscitation
(Pyramid / AHA)
AHA guidelines are to:
— Dry, Warm , Position, Suction, Stimulation
— Oxygen (blow by)
• Used if Central Cyanosis is present
• Use after 15-30 seconds of step 1
• 2-6 lpm with O2 tubing
— BVM / Positive Pressure Ventilation
• Heart rate <100 after 15-30 seconds
• In range of or less than 40-60 BPM
— Chest Compressions
• For heart rates <60
• 3:1 ratio (compressions to ventilations)
The AHA suggested ratio for neonatal resuscitation is 3 chest compressions synchronized to 1 inflation (with 30 inflations per minute and 90 compressions per minute) using the 2 thumb–encircling hands technique for chest compressions.
Un-ruptured Amniotic Sac
(En Caul Birth)
An un-ruptured Amniotic Sac (En Caul Birth), sometimes referred to as a “veiled birth”, occurs when a fetus is delivered still inside an intact Amniotic Sac.
This most often occurs during a Cesarean birth (C-Section).
Assessment Findings:
— Fluid filled sac emerging from the vagina
Treatments:
— Puncture sac away from baby’s face
— Do not disturb fetal crowning process
— Assess for Meconium Staining
• Signs of depressed newborn airways
• Greenish color with foul odor (waste)
— Rapid transport
Nuchal Cord
(Cord around Neck)
Nuchal Cord happens when the Umbilical Cord becomes wrapped around the baby’s neck during gestation or before delivery.
Assessment Findings:
— Assess for cord as soon as head is seen
Treatments:
— Run index finger around baby’s neck
— Gently sweep cord over baby’s head
— If unable to reposition cord:
• Place clamps approx. 2” apart and cut
• Continue delivery as normal
— Rapid transport
