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Paramedic > Obstetrics > Flashcards

Obstetrics Flashcards

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1
Q

Afterbirth

A

Placenta and membranes that are expelled from the uterus after the birth of the child

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2
Q

Umbilical cord

A

Extension of the placenta; 2 feet long; one vein (oxygenated blood to fetus) and two arteries- fetal lifeline

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3
Q

Amniotic sac

A

Protective sac; contains fetus and fluid

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4
Q

Amniotic fluid

A

Approx 500-1,000 mL from week 20 to 40; fluid for movement, protection, room for growth; fluid moves across placenta and is ‘changed’ constantly - should be CLEAR

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5
Q

Placenta

A

Organ of pregnancy- develops 14 days
1.) transfers heat
2.) exchange oxygen/carbon dioxide
3.) delivers nutrients
4.) carries away wastes
5.) endocrine gland- hormone production
A.) estrogen (prevents menses)
B.) progesterone (maintains pregnancy)
C.) human chorionic gonadotropin (hCG) (maintains progesterone production)
6.) barrier against most harmful substances (except narcotics, steroids, antibiotics)

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6
Q

Fetal Growth

End of 3rd month

A

12 weeks
Sex maybe distinguished
Heart is beating
Every structure found at birth is present

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7
Q

Fetal growth

End of 5th month

A

20 weeks
Fetal heart tones (FTH) can be detected - rate 120-160 bpm
Fetal movement my be felt by mother

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8
Q

Fetal growth

End of 6th month

A

24 weeks
Maybe capable of survival if born prematurely
Age of viability 22-24 weeks (varies)

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9
Q

Fetal growth

End of 9th month

A

Considered full term 37 weeks

Preterm before 37 weeks

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10
Q

Maternal changes

Reproductive system

A

Uterus increases in size

Vascular system

Formation of mucous plug in cervix

Estrogen causes vaginal mucosa to thicken

Breast enlargement

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11
Q

Maternal changes

Respiratory system

A

Bronchodilation

Increase in oxygen consumption

Increased tidal volume

Slight increase in respiratory rate

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12
Q

Maternal changes

Cardiovascular system

A

🔹Blood volume increases 40% - 50%
🔹Heart rate increases 10 - 15 bpm
🔹Blood pressure decreases by 2nd trimester = 10 - 15 mmHg systolic
▪️increase 3rd trimester to normal level
🔹Venous distention= risk for DVT and pulmonary embolism
🔹Supine hypotension- gravid uterus lies on inferior vena cava, decreasing venous return
▪️compression on abdominal aorta, pelvic and femoral vessels contribute to edema and varicose veins
▪️postural hypotension, syncope
▫️position left lateral recumbent during transport
🔹Cardiac output increases by 30% by week 34- cardiac pt’s have additional stress on heart
🔹Relative anemia- increase in RBC’s, need for more IRON- prenatal vitamins important
▪️risk for preterm labor or miscarriage
Volume loss of any kind➡️mother compensates ➡️ HR and BP little changes = FETUS in danger!

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13
Q

Maternal changes

Gastrointestinal system

A

Hormone levels- nausea/vomiting and peristalsis is slowed- bloating, constipation

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14
Q

Maternal changes

Musculoskeletal system

A

Loosened pelvic joints; prepares for delivery = Falls

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15
Q

Prenatal

A

Antepartum; existing or occurring before birth

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16
Q

Postpartum

A

Time after delivery

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17
Q

Gravidity

A

Number of pregnancies (including current)

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18
Q

Para

A

Number of deliveries (twins/triplets, multiples = para 1)

T- # of Term deliveries >=37 weeks
P- # of Premature deliveries >20 weeks; <37 weeks
A- # of Abortions <20 weeks
L- # of Living children

Primi- 1st time Multi- more than 1 Nulli- not, none

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19
Q

Gestation

A

Time of intrauterine fetal development

40 weeks

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20
Q

Trimesters

A

3 month intervals (3 trimesters in complete pregnancies)

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21
Q

Fetal death

A

No signs of life; obvious (err on the side of resuscitation efforts if in doubt)

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22
Q

Due date

A

Estimated date of confinement (EDC)
🔹figure first day of LMP plus 7 days➡️ minus 3 months (add the next year)

LMP= 8 May 2009
+1 year = 8 May 2010
-3 months = 8 February 2010
+7 days = 15 February 20010

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23
Q

Assess fundal height

A

Estimate gestation = 1cm per week
Between symphysis pubis and umbilicus= 12 weeks
At umbilicus = 20 weeks
Under xiphoid = full term**

24
Q

Braxton-Hicks Contractions

A

False labor that increases in intensity and frequency but does not cause cervical changes

25
Q

Stages of labor

Stage 1

A

Dilation
🔹onset of regular contractions to complete cervical dilation (opened) and effacement (muscle thins out)
🔹cervix is 10 cm dilated and paper-thin
🔹bloody show (mucus plug expels)
🔹primiparous-12.5 hr; multiparous- 7 hr
🔹contractions = beginning of one to beginning of next; duration = how long they last
▪️closer to stage 2 - contractions more frequent and duration longer

26
Q

Stages of labor

Stage 2

A

Expulsion- full dilation to expulsion of newborns
🔹infant moves down birth canal, mother urge to push
🔹primiparous- 80 min; multiparous - 30 min
🔹crowning- presentation

27
Q

Stages of labor

Stage 3

A

Placental- immediately after infant delivered to delivery of placenta
🔹do not delay transport during this stage
🔹approx 20-45 min

28
Q

Field delivery

A

🔹Set up delivery area. (Know contents of OB kit)
🔹Give oxygen to mother and start IV-NS TKO (if time permits)
🔹Position mother - Lithotomy
🔹Drape mother
🔹As head crowns, apply gentle pressure- control head; avoid explosive delivery
🔹Typically- crowning infant face down (vertex) ➡️ turns to side
🔹Observe/correct nuchal cord
🔹Suction the mouth and then nose (only when necessary)
🔹Guide head downward to deliver upper shoulder; guide body/head upward to deliver lower shoulder
🔹Dry infant at level of vagina until cord is cut
🔹Clamp and cut cord. 4” and 6” ➡️ re-clamp end if bleeding continues
🔹Deliver the placenta and save for transport with the mother

29
Q

Intact amniotic sac

A

During delivery ➡️ pinch and twist the amniotic sac to break it. Fluid will GUSH!

Prepare for rapid delivery!

30
Q

Prolapsed cord

A

🔹The umbilical cord precedes the fetal presenting part
🔹Knee-chest position coy in Trendelenberg
🔹High flow oxygen and keep warm
🔹Umbilical cord is seen in vagina
▪️Insert two gloved fingers to raise the fetus off the cord. Do not push back. Cord pulse.
🔹Wrap cord in sterile moist dressing
🔹Transport immediately; do not attempt delivery

31
Q

Neonate care

A

🔹Support the infant’s head and torso, using both hands (football carry)- slippery!
▪️Do not use axilla to hold infant! Brachial plexus injury =Erb’s Palsy
🔹Check airway - suction again only if necessary
🔹Dry, warm, position on side- dry blankets!
Stimulate- drying ➡️ flick feet, rub back
🔹Assess APGAR score- at 1 and 5 min; score 0, 1, 2

32
Q

Acrocyanosis

A

Pink body, blue extremities normal at delivery

33
Q

APGAR Score

A

A- Appearance (color)= blue 0; acrocyanosis 1; pink 2

P- Pulse (feel at umbilicus)=absent 0; <100 1; >100 2

G- Grimace (irritability)= none 0; grimace 1; cough, cry, sneeze 2 (when suctioning)

A- Activity (muscle tone)= limp 0; some flexion 1; active 2 (when straighten arm, leg)

R- Respiratory effort= absent 0; slow, irregular 1; strong cry 2

APGAR <6 requires resuscitation

34
Q

Care of mother

A

🔹May shiver or tremble, VERY tired- normal

🔹Monitor BP; keep warm, watch for shock

🔹Blood loss- post partum- rush of blood after delivery- slows to a trickle

35
Q

Postpartum hemorrhage

A

🔹Loss of >500 mL of blood following delivery
▪️Lack of uterine tone- soft (Tone)
▪️Vaginal or cervical tears (Trauma)
▪️Retained pieces of the placenta (Tissue)
▪️Clotting disorder (Thrombin)
🔹Large baby, placenta previa, abruptio placenta, prolonged labor
🔹ABC’s, O2 NRB
🔹Infant to breast
🔹Fundal massage- fingers flat against uterus above pubic bone; massage in circular motion = painful
🔹2 large-bore IV’s
🔹Administer oxytocin per physician’s order
🔹Do not pack Vagina- OB pads; Expedite transport

36
Q

Complicated delivery

Breech presentation

A

🔹Buttocks, feet present first
🔹If delivering (shoulders most difficult)
▪️Support infant on forearm- support legs, pelvis; don’t grasp around abdomen
▫️deliver to umbilicus; try to extract 4-6” of cord for slack
▪️rotate gently to anterior/posterior shoulder placement
▪️Guide upward; then downward as normal delivery
▪️Ease head out
🔹If head does not deliver:
▪️Mother in knee-chest position (on back, elevate torso with pillows; knees pulled to chest)
▪️Create an airway- form a “V” - 2 fingers
▪️Push the vaginal walk away from infant’s face
▪️Lift body upward to assist head delivery
▪️Fails- rapid transport!

37
Q

Complicated Delivery

Limb presentation

A

Place mother in knee-chest position, administer oxygen, and transport immediately. Do not attempt delivery.

38
Q

Complicated Delivery

Multiple Births

A

🔹Most mothers know; some may not!!

🔹Follow normal guidelines, but have additional personnel and supplies

🔹40% are premature; Babies typically smaller

🔹Prevent hypothermia; monitor for respiratory difficulties

39
Q

Complicated Delivery

Cephalopelvic Disproportion

A

🔹Infant’s head is too big to pass through pelvis easily

🔹Causes: oversized fetus, hydrocephalus, conjoined twins, or fetal tumors

🔹Unrecognized: can cause uterine rupture

🔹Usually requires cesarean section; Give oxygen to mother and start IV; rapid transport

40
Q

Complicated Delivery

Shoulder Dystocia

A

(Can cause Erb’s Palsy)
🔹Infant’s shoulders trapped under mother’s pelvic bone causing Turtle sign

🔹Do not pull on the infant’s head; If baby does not deliver, transport the pt immediately

🔹Mother in knee-chest position

41
Q

OB Complications

Hypertension Disorders

Chronic (Essential) Hypertension

A

Greater than 140/90 prior to pregnancy, before 20th week

Risk of stroke, miscarriage

42
Q

OB Complications

Hypertension Disorders

Gestational Hypertension

A

Pregnancy induced HTN- after 20th week; resolves after delivery

Early sign of preeclampsia

43
Q

OB Complications

Hypertension Disorders

Preeclampsia

A

(Toxemia of pregnancy)
🔹Gestational Hypertension ➡️ pregnancy induced HTN
🔹First birth, multigravida, excessive amniotic fluid; >35 y/o; HTN, twinning, diabetics, renal Dz
🔹Risk of Abruptio placenta (if progresses to eclampsia)
🔹Two of the following
▪️BP >140/90; or sudden rise Sys >20, rise Dias. >10
▪️Fluid retention/weight gain/edema
▪️Protein in urine= proteinuria
🔹H/A; N/V; visual disturbances (spots in vision); edema feet, face, hands; epigastric pain
🔹Hydralazine (Alpresoline) home medication
🔹**Symptoms may persist for up to 4-6 weeks after delivery

44
Q

OB Complications

Hypertension Disorders

Eclampsia

A

🔹HTN and seizures!!
🔹Assume pregnancy with seizures is eclampsia until proven otherwise (Assess pt’s history!)
▪️Left lateral recumbent
▪️Calm, lights dim, NO lights/sirens
▪️O2, IV NS
▪️Seizure or postictal
▫️Magnesium Sulfate 2-5 g in 50-100 mL NS; slow IVP
▫️Diazepam 5-10mg IV/IM refractory to magnesium
▪️Monitor for abruptio placenta or pulmonary edema
▪️Transport for immediate C-section and NICU
[Consider Calcium gluconate 5-8 mL slow IV for respiratory depression from high doses of magnesium]

45
Q

OB Complications

Gestational Diabetes

A

🔹Inability to process carbs during pregnancy; Mother ⬆️ resistance to insulin
▪️Polydipsia, polyphagia, polyuria
▪️Controlled- Diet, oral hypoglycemic, Insulin
▪️Resolves postpartum
▪️Field Tx- for hypo-, hyperglycemia
▪️Large infant at delivery ➡️ complications

46
Q

OB Complications

Supine Hypotensive Syndrome

A

(Vena caval syndrome)
🔹Fetus presses on inferior vena cava ➡️ Reduces cardiac output
▪️Treat - left lateral recumbent position, elevate right hip, tilt backboard 15-30 degrees to the left
▪️Monitor fetal heart tones & maternal vital signs
▪️If volume is depleted, consider 2 large bore IV NS
▫️Orthostatic VS, skin tenting

47
Q

OB Complications

Hyperemesis Gravidarum

A

Severe morning sickness
N/V, dehydration, electrolytes

Transport- ABC’s; IV fluids

48
Q

OB Complications

Infection

A

Rubella, varicella, STD➡️ harm mother or fetus

UIT➡️ streptococcus ➡️ migrate to amniotic sac ➡️ preterm labor

Premature rupture of membranes- ⬆️ risk infection

Transport- ABC’s, Tx septic shock prn

49
Q

Bleeding Pregnancy

Abortion

A

🔹Termination of pregnancy before the 20th week of gestation ➡️ ANY CAUSE
🔹Complete- all products of conception evacuated from the uterus
🔹Incomplete- fetus expelled, some tissues remain in uterus = complications
🔹Spontaneous (commonly called miscarriage)- Occur before 20th week; fetal or maternal defects
🔹Therapeutic- End pregnancy as thought necessary by a physician
🔹Septic- Presence of infection
🔹S/S- cramping, abdominal pain, backache, and vaginal bleeding
▪️Treat for shock; orthostatic vital signs
▪️Collect and transport passed tissue & Provide emotional support

50
Q

Bleeding Pregnancy

Ectopic Pregnancy

A

🔹Assume- female of childbearing age ➡️ sudden or severe lower abdominal pain
🔹Radiate to back, amenorrhea
🔹Bleeding ➡️ Absent, minimal
▪️Rupture = excessive bleed + shock
🔹Risk: adhesions, PID, tubal ligation, IUD use
🔹Ectopic Pregnancy is life threatening
🔹2 large bore IV’s, Trendelenburg, surgery

51
Q

Third Trimester Bleeding

Placenta Previa

A 
▪️Painless- without contractions 
   ▪️Bright red bleeding 
   ▪️Recurrent or spotting 
🔹Never attempt a vaginal exam 
🔹Treat for shock. Transport immediately 
🔹Risks: ⬆️ Age; multiparity; C-section; intercourse; preterm births
52
Q

Third Trimester Bleeding

Abruptio Placenta

A

🔹Premature separation of placenta from uterus
🔹Associated with hypertension, preeclampsia/eclampsia, trauma, ⬆️ Age, infection
🔹Complications: Fetal hypoxia and death
🔹Assessment:
▪️Painful uterine contraction with dark vag bleed
▪️Uterus becomes tender and board-like if hemorrhage retained (concealed)
▪️Shock inconsistent with minimal vag bleed
🔹Life threatening to mother and fetus
🔹Treat for shock; fluid resuscitation, FHT.
🔹Transport in left lateral recumbent position (right hip raised)

53
Q

Bleeding Pregnancy

Uterine Rupture

A

🔹Tearing, or rupture, of the uterus. MOST common after onset of labor
🔹Risks: Previous C-section or uterine surgery; prolonged, obstructed labor; fetal abnormality
▪️Severe, sudden, shearing pain during strong contraction
▪️Complete rupture- pain stops
▪️Shock- rapid onset
▪️Uterus palpated as a hard mass; separate from fetus
▪️Concealed bleeding
▪️Fetal heart tones are absent; lack of fetal movement
🔹Treat for shock
🔹Give high-flow, high-concentration oxygen and start 2 large bore IV’s of NS
🔹Expedite transport

54
Q

Preterm Labor

A

🔹Maternal factors
▪️CV disease, renal disease, diabetes, uterine/cervical abnormalities, maternal infection, trauma
🔹Placental Factors- Placenta Previa, abruptio placenta
🔹Fetal Factors- Multiple gestation, Excessive amniotic fluid, fetal infection

55
Q

Tocolysis

A

🔹Process of stopping labor
🔹Fluid bolus
▪️Stops ADH and oxytocin secretion from posterior pituitary gland
🔹Magnesium sulfate to inhibit smooth muscle contractions
🔹Terbutaline-relax smooth muscle- Beta 2 agonist

Paramedic (3 decks)

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