OBSTETRICS Flashcards
Week 1
What are the 7 anatomical things that contribute to weight gain during pregnancy?
- The baby (7-8 lbs)
- Placenta (2-3 lbs)
- Amniotic fluid (2-3 lbs)
- Breast tissue (2-3 lbs)
- Blood supply (4 lbs)
- Stored fat (5-9 lbs)
- Large uterus (2-5 lbs)
What are the 5 systems that change during pregnancy?
- Circulatory system
- Respiratory system
- Genital tract
- GI system
- Metabolism
From the normal 4-5 L of blood volume, how much more does blood volume increase by during pregnancy? Why?
- It increases by 1.2-1.6 L
- To meet metabolic demands; RBC’s because of an increased need for iron; WBC’s during the 3rd trimester because of increased stress during pregnancy
What are some changes that occur in the Respiratory system during pregnancy?
- Diaphragm moves up into the chest
- Stuffy, runny nose, epistaxis
- Increase in various respiratory volumes (tidal, resp.rate, FRC)
What is the fundus?
The fundus is the top part of the uterus
How is fundal height measured?
Fundal height is measured in cm from the pubic symphysis to the top most portion of the uterus
What does the fundus estimate?
It helps estimate gestational age
At approximately 20 weeks, the fundus is located at the umbilicus… after that each week it grows ____ cm?
1 cm
Elevated progesterone causes what effects to the Gastrointestinal system during pregnancy?
Nausea/vomiting, relaxation of smooth muscle, gastric motility (constipation), heartburn (due to crowding of digestive system)
True or false: Metabolism decreases substantially during pregnancy?
False: Metabolism increases substantially during pregnancy
In early pregnancy, the ______ state in the mother with an increase in maternal fat stores and small increases in insulin sensitivity?
Anabolic
In late pregnancy, the ______ state with decreased insulin sensitivity (increased insulin resistance) causes an increase in maternal glucose and free fatty acid
Catabolic
Regarding Prenatal Development Stages, what is the Germinal development stage?
The division of cells and implantation of the blastocyst
Regarding Prenatal Development Stages, what is the Embryonic stage?
The development of neural tube and organs
Regarding Prenatal Development Stages, what is the Fetal stage?
Continued growth of organs and physical development in preparation of birth
What does Gravidity (Grava) mean?
Number of previous pregnancies
What does Multip (Multipara) mean?
Person having the second (or more) baby
What does Parity (Para) mean?
Number of previous live births
What does Primip (Primipara) mean?
Person having their 1st baby
What are a few questions that should be asked to the pregnant patient during assessment?
- How far a long are you?
- Is this your 1st pregnancy?
- Have you received any prenatal care?
- Do you have any medical problems/conditions
- Have you experienced any pain?
- Has there been any fluid/vaginal discharge?
- What is the timing of your contractions?
- Is there any fetal movement?
What are Braxton Hicks Contractions?
They are false labor pains that are contractions of the uterus that are typically not felt until the 2cd or 3rd trimester of the pregnancy
What are the 3 differences between Braxton Hicks vs. Labor?
- Contraction timing
- Gaining strength
- Changing it up
What are the 3 stages of labor?
Stage 1: Dilation and Effacement
Stage 2: Full Dilation -> Birth
Stage 3: Birth of the baby -> Delivery of the placenta
When does Stage 1 of labor begin?
It begins with uterine contractions
Outline Stage 1 of labor
- The fetus descends into the pelvis
- The cervix softens
- The cervix shortens (effaces)
- The cervix thins
- The cervix dilates (opens)
- The cervix reaches full dilation of 10 cm
What 2 parts is Stage 1 of labor broken down into?
Early labor and active labor
What are Paramedic observations seen during Early Labor?
- Far apart and irregular contractions
- Short, 20-30s long, contractions
- Mild strength contractions
- Patient will be walking and talking through contractions
What are Paramedic observations seen during Active Labor?
- 3-4 minute apart contractions
- Longer, 45-60s long, contractions
- Moderate to strong contractions
- Patient will have difficulty walking, talking through contractions, potential distress, possible vomiting/ shaking SROM/overwhelming emotions….often has bright red bloody show
What are Paramedic observations seen during Stage 2 of Labor?
- Approximately 2 minute apart contractions
- Longer, 60-90s long, contractions
- Strong contractions
- Patient will have the urge to push, pt. is actively bearing down, pt. is “crowing”, pt. experiences bloody show/stool, amniotic fluid drainage
What are Paramedic observations seen during Stage 3 of Labor?
- Lengthening of the cord
- Sudden gush or trickle of blood
- Uterine contraction(s)
When do you, as a Paramedic, assess a pregnant pt.’s vaginal area?
- Hx. is suggestive of ruptured membranes or umbilical cord prolapse
- The pt. is in labor and reports an urge to push, bear down, strain or move bowels with reports of “the baby is coming”
- The pt. is near term, LOC is decreased, and hx. is unavailable/inconclusive/or indicates that labor started prior to LOC decrease
- Vaginal bleeding is heavy and the pt. is hypotensive or in shock
What is Imminent Birth as per the ALS?
- Crowning or other parts is visible or;
- Primips (presenting part is visible between contractions, urge to push, contractions are less than 2 mins apart);
- Multips (contractions are less than 5 minutes apart & any other signs of 2cd stage labor present)
What are some general things, you as a Paramedic, can do to prepare for delivery?
- Ask for a 2cd crew
- Open an OB kit/prepare a delivery station
- Prepare a neonatal resuscitation station
- Make sure the environment is warm/towels & blankets
- Attempt to maintain patient privacy
What are the 7 stages of Normal Delivery?
- Decent (fetus moves down towards the pelvis & becomes engaged)
- Flexion (fetal chin to chest)
- Internal Rotation (fetal occiput turns toward the maternal pelvis)
- Extension (birth with the head facing down)
- Restitution (baby’s head rotates to the side)
- External Rotation (fetus turns to deliver shoulder)
- Expulsion (birth of the baby)
When should you clamp and cut the cord?
When it stops pulsating or the 2 minute mark
How should you clamp the cord?
Place the 1st clamp approximately 15 cm away from the neonate’s abdomen, place the 2cd clamp 5-7 cm (1 fist) away from the 1st clamp, and then cut the umbilical cord between the 2 clamps
True or false: you should stay on scene to deliver the placenta?
False, placental delivery should never delay transport time
How do we as Paramedics assist with Placental Delivery?
- Encourage delivery, ask the mother to push
- Apply gentle controlled cord traction (CCT) & guard the uterus with the other hand (only AFTER there is evidence of detachment)
What are the 4 things you should do following placental delivery?
- Inspect it for wholeness
- Place in a plastic bag from the OBS kit
- Label it with the maternal patient’s name and time of delivery
- Transport it with the maternal or neonatal patient
What are 6 things you should do to provide Post-Uncomplicated Delivery Care?
- Massage the uterus to help minimize bleeding; it should feel firm and central (only if needed, this is not a constant for every birth)
- Check for bleeding a minimum of every 5 mins for the first 15 mins
- Monitor vitals
- Encourage voiding to decrease the risk of postpartum hemorrhage
- Keep newborns warm, skin-to-skin, and encourage breastfeeding
- Continually monitor newborns using APGAR
What are the 5 categories of the APGAR Scoring System?
- Activity (muscle tone)
- Pulse
- Grimace (reflex irritability)
- Appearance (skin color)
- Respiration
What are the 3 points totaled classifications of the APGAR scoring system?
- Severely depressed
- Moderately depressed
- Excellent condition
Provide the following for the medication Oxytocin:
1. Class
2. Action
3. Onset
4. Half-life
5. Duration
6. Side effects
- Oxytocic Hormone
- To stimulate uterine contractions in labor and childbirth AND to stimulate contractions of breast tissue to aid in lactation after childbirth
- Uterine response occurs approximately 3-5 minutes after IM injection
- Approximately 1-6 mins, it decreases in late pregnancy and during late pregnancy and lactation
- Persists for approximately 2 hours
- Allergic reactions, heart rhythm changes, heavy vaginal bleeding, nausea/vomiting, more frequent contractions, seizures, respiratory difficulties
