Obstetrics Flashcards
1
Q
anatomy and physiology of the female reproductive
A
- cervix
- sacrum
- rectum
- vagina
- placenta
- uterus
- amniotic fluid
- bladder
- pubic symphysis
2
Q
placenta
A
- attaches to the inner lining of the wall of the uterus and connects to the fetus by the umbilical cord
- the placental barrier consists of two layers of cells
- after delivery, the placenta, or afterbirth separate from the uterus and delivers
- very vascular
- connects fetus and mother
- umbilical vein carries oxygenated blood*
- umbilical artery carries deoxygenated blood from baby to mom*
3
Q
umbilical cord
A
- lifeline of the fetus
- the umbilical vein carries oxygenated blood from the women to the fetus**
- there is one umbilical vein**
- the umbilical arteries carry deoxygenated blood from the fetus to the woman**
- there are two umbilical arteries **
4
Q
amniotic sac
A
- the fetus develops inside a fluid filled baglike membrane called the amniotic sac, or bag of waters
- contains about 500-1,000mL (ccs) of amniotic fluid
- fluid helps insulate and protect the fetus in development
- fluid increases as you get further along
- routinely check amniotic fluid levels
- fluid is released in a gush (sometimes) when the sac ruptures, usually at the beginning of labor
- you can break the water manually
- you can remove the baby with the sac present if premature
5
Q
stages of labor
A
- dilation of the cervix
- delivery of the infant
- delivery of the placenta
6
Q
first stage
A
- begins with the onset of contractions as the fetus enters the birth canal
- Braxton hicks- contractions prior to delivery (not always present)
- longer, more frequent, more painful, more regular, and short time in-between contractions before ***
- 0-1 cm dilation initially
- full cervical dilation is 10 cm dilated
- usually the longest stage, lasting an average of 16 hours
- quicker in lower weight children or previous pregnancy
- uterine contractions become more regular and last about 30-60 seconds each (60 seconds is usually peak)
- some women experience a premature rupture of the amniotic sac -> fetus not ready to be born -> provide supportive care and transport
- PROM- premature rupture of membrane
- toco monitor- assess baby heart beat
- ultrasound to check positioning
- head of the fetus descends into the women’s pelvic as it positions for delivery -> this is called lightening
7
Q
lightening
A
- head of the fetus descends into the womans pelvis as it positions for delivery
- this never occurs in some women -> then c-section
- usually give 2 hours of attempting to push to then decide for c-section (longer for women with epidural)
8
Q
second stage
A
- begins when the fetus begins to encounter the birth canal past the cervix
- ends when the infant is born (spontaneous birth) by vaginal delivery (or c-section)
- uterine contractions are usually closer together and last longer
- never let the mother sit on the toilet -> catheterized
- the perineum will bulge significantly (gets larger), and the top of the infants head will appear at the vaginal opening (or limb/butt -> breached) -> this is crowning
9
Q
crowning
A
- perineum will bulge significantly, and the top of the infants head will appear at the vaginal opening
- head only
- not limbs or butt
10
Q
third stage
A
- begins with the birth of the infant and ends with the delivery of the placenta
- the placenta must completely separate from the uterine wall -> not done forcefully, its done naturally (can cause hemorrhage)
- always follow standard precautions to protect yourself, the infant, and the mother from exposure to body fluids
11
Q
hypertensive disorders: preeclampsia (HDP)
A
- preeclampsia is a common complication
- pregnancy induced hypertension
- protein in the urine
- visual disturbances -> photophobia
- swelling in hands, feet, umbilical cavity
- 140/80/90 -> at risk for preeclampsia
- can continue for at least two weeks post-partum
- can develop after the 30th week of gestation (some as early as 20)
- signs and symptoms include headache, seeing of spots, swelling in the hands and feet, anxiety, and high blood pressure
- not sure what causes it but some women are more predisposed
12
Q
hypertensive disorders: eclampsia
A
- characterized by seizures that occur as a result of hypertension
- when does preeclampsia become eclampsia -> seizure*
- assume its a eclamptic seizure before anything else
- life threatening
- to treat:
- lie the patient on her side, preferably the left
- maintain an airway
- provide supplemental oxygen
- if vomiting occurs, suction the airway
- provide rapid transport and call for ALS
- IV magnesium in very high doses (4-6G) **- to stop seizures
13
Q
bleeding: ectopic pregnancy
A
internal bleeding may be the sign of an ectopic pregnancy
- a pregnancy that develops outside the uterus, most often in the fallopian tubes
- occurs about once in every 300 pregnancies
14
Q
bleeding
A
- the leading cause of maternal death in the first trimester is internal hemorrhage following rupture of an ectopic pregnancy
- hemorrhage from the vagina that occurs before labor begins may be very serious
- painless bleeding is most commonly caused by placenta previa - part of or all of placenta attaches on uterine wall and around cervix and vaginal opening -> as long as its not a lot and they arnt anemic its ok
15
Q
uterus
A
where baby develops
16
Q
amniotic fluid
A
surrounds amniotic sac
- amniotic fluid is fetal urine
- premature rupture of membranes - early breaking of water PROM
- you do not need amniotic fluid
17
Q
PDA (Patent Ductus Arteriosus?) and PFO (patent foramen ovale)
A
- fetal circulation
- dont need lungs to breath
- bypasses pulmonary circulation
- lungs are one of the last things to develop
- PDA and PFO exist in fetal circulation and then close
18
Q
30-34 weeks
A
lungs develop
-premature babies need support with breathing
19
Q
50%
A
- is are c sections
- we want to get it down to 30%
- higher potential for side effects
- longer hospital stay
- more expensive
- blood transfusion or support
- respiratory conditions are associated with c section (asthma, seasonal allergies)
20
Q
ectopic pregnancy
A
- development of zygote anywhere other than uterus
- most frequently the fallopian tube
- abdominal pain
- ruptured ectopic pregnancy is a surgical emergency
- you can bleed to death
- any abdominal pain from a female in child bearing age that is sexually active is an ectopic pregnancy until proven otherwise
21
Q
spontaneous abortion/miscarriage
A
- in abruptio placenta, the placenta separates (rips away) prematurely from the wall of the uterus -> leading cause is abdominal trauma (MVA or falls) -> surgical emergency
- in placenta previa, the placenta develops over and covers the cervix -> infrequently an emergency
22
Q
diabetes
A
- develops during pregnancy in many women who have not had it previously
- gestational diabetes will clear up after delivery (some can continue)
- treatment is the same as for any other patient with diabetes
- diet, exercise, or insulin injections
23
Q
special considerations for trauma and pregnancy
A
- with a trauma call involving a pregnant patients, you have 2 patients:
- the women
- the unborn fetus
- any trauma to the women has a direct effect on the fetus
24
Q
blood volume and heart rate
A
- pregnant women have an increased amount of overall total blood volume and a 20% increase in heart rate
- may have a significant amount of blood loss before you will see signs of shock
- uterus in vulnerable to penetrating trauma and blunt injuries
- larger than normal abdominal cavity -> hides blood
25
Q
assessment and management
A
- your focus is on the women
- suspect shock based on the MOI
- be prepared for vomiting and aspiration (medicine for pregnancy nausea is different for nonpregnant)
- attempt to determine the gestational period to assist you with determining the size of the fetus and the position of the uterus
- fetal depression the vena cava -> limited venous return -> obstructive shock -> never lay pregnant patient supine
- lay left lateral recumbent
- have you felt the baby move or kick or 2. use a fetal doppler ? -> no risk or demise**
26
Q
cavities you can bleed to death in
A
- retroperitoneal cavity
- both femurs
- head
- street
- chest
- abdomen
27
Q
history taking
A
- investigate the chief complaint
- ask questions that will help you identify the cause of her complain and the associated signs and symptoms
- obtain a thorough obstetric history:
- her expected due date
- any complications that she is aware of (high risk factors)
- if she has been receiving prenatal care
- her thorough medical history (past OB history -> have many pregnancy, how many delivered, how many delivered to term, how many vaginally, how many c-section, how many elective/spontaneous abortions)
- GNP- grava (times pregnant) and para (delivered)
28
Q
obtain SAMPLE history
A
- do not focus only on the pregnant history
- determine the due date, frequency of contractions, a history of previous pregnancies and deliveries, the possibility of twins, and if she has taken any drugs or medications
- if her water has broken, ask whether the fluid was green (what color and does it have an odor)
- green fluid is due to meconium (fetal stool)
- the presence of meconium can indicate newborn distress, and its possible for the fetus to aspirate meconium during delivery
29
Q
physical examinations
A
- fetal movement- sign of distress and viability
- assess the major body systems
- for a pregnant in labor, focus, on contractions and possible delivery
- if you suspect that delivery is imminent check for crowning (by eye)
30
Q
vital signs
A
-Include pulse; respirations; skin color,
temperature, and condition; and BP
-Pay attention to tachycardia and hypotension or hypertension.
-Hypertension, even mildly elevated BP, may indicate more serious problems
31
Q
breech delivery*
A
- the presentation is the position in which an infant is born or the body part that is delivered first
- frank breech- butt presentation
- most infants are born head first
- occasionally, the buttocks are delivered first
- can delivered breech if the practitioner knows how to
32
Q
presentation complications
A
- limb presentation- breech
- on rare occasions the presenting part of the infant is neither the head nor but but a single arm, leg, or foot
33
Q
prolapse of the umbilical cord
A
- must be treated in the hospital
- umbilical cord comes out of the vagina before the infant
- rupture can happen
- abruptio placentae- can cause
- fetus compress umbilical cord -> cuts off oxygen -> no nutrients, bradycardia, fetal demise,
34
Q
infants head will compress the cord and cut off circulation
A
- do not push the cord back into the vagina
- put in knee chest position
- Trendelenburg’s position
- insert your gloved hand into the vagina, and push the infants head away from the umbilical cord
35
Q
postterm pregnancy
A
- 37-42- term
- 36 and earlier- preterm
- 42 and greater- post term
- infants can be larger, sometimes weighing 10 ib or more
- 22-24 weeks - viability
- can lead to problems with the mother and infant: a more difficult labor and delivery
36
Q
postterm pregnancy problems
A
- increased chance of injury to the fetus
- most common injury is shoulder dystocia- as shoulders come up against pubic bones while being born -> uterine contraction pushes down on the child and brachial plexus -> developmental issues
- increased chance of cesarean section
- women is at risk for perineal tears and infection
- infants have increased risks of meconium aspirations, infection, and being stillborn
- infants may not have developed normally
37
Q
fetal demise
A
- you may deliver an infant who died in the mothers uterus before labor
- onset of labor may be premature, but labor will progress normally in most cases
- if an intrauterine infection caused the demise you may note a foul odor
- do not attempt to resuscitate an obviously dead infant
38
Q
postpartum complications
A
- bleeding that exceeds 500mL is considered excessive
- can be measured by the amount of pads bled through
- continue to massage the uterus after delivery
- check your technique and hand placement if bleeding continues
- excessive bleeding is usually caused by the uterine muscles not fully contracting
- oxytocin is administered externally to help
- uterine contraction can be most helpful way to control internal hemorrhage postpartum
- continue massaging the uterus and cover the vagina with a sterile pad
- change the pad as often as possible
- do not discard and blood soaked pads
- place the women in the shock position, administer oxygen, monitor vital signs, and transport her immediately
- hysterectomy might be necessary if bleeding out
39
Q
embolism- postpartum complication
A
- hypercoagulapathic
- most commonly and pulmonary embolism
- results from a clot that travels through the bloodstream and becomes lodged in the pulmonary circulation
- the obstruction will block blood flow to the lungs and is potentially life threatening
- DVT- deep vein thrombosis
- encourage to walk around
