Obstetrics and Neonatal Care Flashcards
The female reproductive system includes ___
- Ovaries
- Fallopian tubes
- Uterus
- Cervix
- Vagina
- Breasts
Two glands located on either side of the uterus that are similar in function to the male testes
Ovaries
Each ovary contains ___, and ___
- Thousands of follicles
- Each follicle contains an egg
The maturing female body undergoes multiple physical and hormonal changes, ultimately leading to ___
Menarche
The first menstrual cycle or onset of the first menstrual bleeding in females
Menarche
Average duration between menstrual periods
28 days
During the typical menstrual cycle, how many follicles will mature and release an egg?
Only one, (10 to 20 will attempt to process, the remaining follicles will die and be reabsorbed in the body)
The process that the follicle goes through, and the actual release of the egg
Ovulation
Ovulation is stimulated by ___
The release of hormones
Ovulation occurs ___
About two weeks prior to menstruation
Immediately following ovulation, the ___
Endometrium begins to thicken in preparation for the potential implantation of a fertilized egg
The lining of the inside of the uterus
Endometrium
If the egg is not fertilized within ___ after it has been released from the follicle, it will ___, and the thickened endometrium will ___
- 36 to 48 hours
- Simply die
- Be shed because it is not needed
The fallopian tubes extend out ___ from the uterus
Laterally
Where does fertilization of the egg usually take place?
Fallopian tubes
The fertilized egg continues to ___, where ___
- The uterus
- If implantation occurs, the fertilized egg develops into an embryo
The stage from 0 to 10 weeks after fertilization
Embryo
The stage from 10 weeks until delivery
Fetus
How many weeks of gestation?
40 weeks
Muscular organ that encloses and protects the developing fetus
Uterus
During labor, produces contractions and ultimately helps to push the fetus through the birth canal
Uterus
The birth canal is made up of the ___
Vagina and the lower third, or neck, of the uterus
Lower third, or neck, of the uterus
Cervix
Contains a mucus plug that seals the uterine opening
Cervix
Purpose of the mucus plug in the cervix
Seals the uterine opening, preventing contamination from the outside
A small amount of blood in the vagina that appears at the beginning of labor and may include a plug of pink-tinged mucus that is discharged when the cervix begins to dilate
Bloody show
Outermost cavity of the female reproductive system
Vagina
Forms the lowest part of the birth canal
Vagina
Vagina length
3 to 5 inches
The area between the vagina and the anus
Perineum
Early signs of pregnancy in the breasts
Increased size and tenderness
Produce milk
Mammary glands
When do the mammary glands produce milk
Shortly after birth
Disk-shaped structure attached to the uterine wall that provides nourishment to the fetus through the umbilical cord
Placenta
What does the placenta separate?
Two layers of cells, keeping circulation of the woman and fetus separated, but allowing nutrients, oxygen, waste, and CO2 to pass between
Connects the woman and the fetus through the placenta
Umbilical cord
Oxygenation, nutrition, and waste removal for the fetus all rely on ___
The umbilical cord
Blood vessels in the umbilical cord
Two arteries and one vein
The fetus develops inside of a fluid-filled, bag-like membrane called ___
The amniotic sac (bag of waters)
mL of amniotic fluid
500 to 1000 mL
Purpose of amniotic sac and fluid
Helps insulate and protect the fetus
What does the amniotic fluid do at birth?
Breaks and lubricates the birth canal and remove any bacteria
Full term pregnancy time period
39 weeks by not more than 40 weeks
A pregnancy that has reached full term is referred to as ___
Term gestation
LMP
Last Menstrual Period
Four body systems that undergo major physiologic and anatomic changes during pregnancy
- Reproductive
- Respiratory
- Cardiovascular
- Musculoskeletal
The increased hormone levels during pregnancy put the woman at risk for complications from ___
Trauma, bleeding, and some medical conditions
By the 20th week of pregnancy, the top of the uterus is at or above the ___
Belly button
In the ___ of pregnancy, the rapid growth of the uterus leads to changes in the respiratory system
Second trimester
Affect of the uterus on the respiratory system
Pushes the diaphragm up and leads t reduced tidal volume. The respiratory rate increases to make up for this
Blood volume increase by the end of pregnancy
As much as 50%
The increase in blood, increases the woman’s need for ___
Iron
A condition in which a person has too few red blood cells
Anemic
Result of anemia
Decreased ability to transport oxygen throughout the body
Blood clotting factor change with pregnancy
Increases to protect against excessive bleeding during delivery
By the end of the pregnancy, the heart rate increases up to ___
20% (about 20 BPM)
Why does the pregnant woman’s heart rate increase?
To compensate for the increased blood volume
Women who are pregnant and have ___ may be more susceptible to cardiac compromise
Underlying medical conditions
Pregnant women are at increased risk for ___
- Gastroesophageal reflux
- Nausea
- Vomiting
- Potential aspiration
Why is a pregnant woman at a greater risk of vomiting and aspiration?
- The filling and emptying of the stomach into the small intestine is under the control of hormones and the nervous system that change with pregnancy
- Stomach is displaced upwards by the uterus
How does pregnancy affect the musculoskeletal system?
Hormones relax ligaments that stabilize bones and joints
Diabetes developed during the second half of pregnancy
Gestational diabetes
Hypertension in pregnancy generally manifests as one of three conditions
- Gestational hypertension
- Preeclampsia
- Eclampsia
The presence of high BP in the absence of other systemic effects
Gestational hypertension
Gestational hypertension high BP
140/90
Gestational hypertension severe BP
160/110
Condition that occurs in the second half of pregnancy (past 20 weeks), involves new-onset hypertension along with other systemic effects, such as protein in the urine
Preeclampsia
The risk of preeclampsia is 1.5 to 2 times higher in a woman’s ___ pregnancy
First
Signs and symptoms of preeclampsia
- Hypertension above 140/90
- Severe or persistent headache
- Visual abnormalities such as seeing spots, blurred vision, or persistent headache
- Swelling in the hands and feet (edema)
- Upper abdominal or epigastric pain
- Dyspnea and/or retrosternal chest pain
- Anxiety
- Altered mental status
Hypertension characterized by the presence of seizures
Eclampsia
Treatment for eclampsia
Lay the patient on the left side, maintain airway, and administer supplemental oxygen
Transporting the patient on their left side can prevent ___
Supine hypotensive syndrome
Timing of ectopic pregnancy
Early pregnancy (generally 6 to 8 weeks after last missed period)
Pain of ectopic pregnancy
Severe lower abdominal pain, typically unilateral. May radiate to one shoulder
Bleeding of ectopic pregnancy
Ranges from scant brown spotting to profuse bright red
Timing of abruptio placentae
Later pregnancy (usually after 20 weeks)
Pain of abruptio placentae
Lower abdominal and/or back pain. May be associated with contractions
Bleeding of abruptio placentae
Moderate vaginal bleeding. Most bleeding is internal
Timing of placenta previa
Later pregnancy (usually after 20 weeks)
Pain of placenta previa
Relatively painless
Bleeding of placenta previa
May present as moderate bleeding to life-threatening hemorrhage
When an embryo develops outside of the uterus, most often in a fallopian tube
Ectopic pregnancy
A patient with an ectopic pregnancy may present with signs of ___ when the fallopian tube ruptures
Internal bleeding
Sudden onset of ___ in the first trimester of pregnancy should be considered ectopic pregnancy until proven otherwise
Severe abdominal pain and vaginal bleeding
It is important to consider the possibility of an ectopic pregnancy in a woman who has missed a menstrual cycle and reports ___
Sudden, severe, usually unilateral pain in the lower abdomen
A history of ___ should heighten your suspicion of a possible ectopic pregnancy
Pelvic inflammatory disease, tubal litigation, or previous ectopic pregnancies
Vaginal bleeding in early pregnancy may be a sign of ___ (other than ectopic pregnancy)
Spontaneous abortion
The placenta separates prematurely from the wall of the uterus
Abruptio placentae
Most common causes of abruptio placentae
Hypertension and trauma
A patient with abruptio placentae will often report ___. May also present ___
- Severe pain
- Signs of shock, such as weak rapid pulse and pale, cool, diaphoretic skin
The placenta develops over and covers the cervix. When early labor begins and the cervix begins to dilate, the woman may experience heavy vaginal bleeding, often without significant pain
Placenta previa
Abruptio placentae and placenta previa are ___
Life-threatening conditions that require immediate rapid transport
The loss of a pregnancy prior to 20 weeks of gestation without any preceding surgical or medical intervention
Spontaneous abortion
A spontaneous abortion is also called ___
A miscarriage
The elective termination of a pregnancy prior to the time of viability
Induced abortion
Portions of the fetus or placenta remain inside the uterus
Incomplete abortion
If the story of how an injury happened does not make sense, suspect ___
Abuse
By 20 weeks of gestation, the top of the uterus has grown to the level of the ___
Belly button
The effects of addiction on the fetus
Prematurity, low birth weight, and severe respiratory depression
A condition caused by the consumption of alcohol by a pregnant woman; characterized by growth and physical problems, mental retardation, and a variety of congenital abnormalities in her child
Fetal alcohol syndrome
The newborn of an addicted woman will probably need ___
Immediate resuscitation
Women with severe injuries have a six-fold increase in the incidence of ___
Abruptio placentae
Guidelines for treating a pregnant trauma patient
- Maintain an open airway
- Administer high-flow oxygen
- Ensure adequate ventilation
- Assess circulation
- Transport considerations
Three stages of labor
- Dilation of the cervix
- Delivery of the fetus
- Delivery of the placenta
The first stage of labor begins with ___ and ends when ___
- The onset of contractions
- The cervix is fully dilated
The cervix is stretched thin by ___
Uterine contractions
Longest stage of labor
First stage
A woman who is experiencing her first pregnancy
Primigravida
A woman who has had previous pregnancies
Multigravida
In primigravida women, the first stage of labor lasts an average of ___
12 to 18 hours
In multigravida women, the first stage of labor lasts an average of ___
6.5 to 13 hours
Signs of the beginning of labor
- Contractions
- Bloody show
- Rupture of amniotic sac
In true labor, the frequency and intensity of contractions ___
Increase with time
Uterine contractions last for ___
30 to 60 seconds each
False labor
Braxton-Hicks Contractions
Care for a woman who’s water broke early
Provide supportive care and transport to the hospital
Toward the end of the third trimester, the head of the fetus normally ___
Descends into the woman’s pelvis as the fetus positions for delivery
The movement of the fetus down into the pelvis
Lightening
The second stage of labor begins when ___
The fetus enters the birth canal
The second stage of labor ends when ___
The newborn is delivered
Because the fetus goes through positional changes as it moves through the birth canal, the uterine contractions are usually ___
Closer together and last longer
When the top of the fetus’ head begins to appear at the vaginal opening
Crowning
During the second stage of labor, pressure on the ___ may make the woman feel as if she needs to make a bowel movement
Rectum
The third stage of labor begins with ___ and ends with ___
- The birth of the newborn
- Delivery of the placenta
The third stage of labor lasts up to ___
30 minutes
Purpose of contractions during the third stage of labor
Assist the separation of the placenta from the uterine wall, and clamping down and closing the blood vessels that connect the placenta to the uterine lining
Questions to ask to determine whether delivery is imminent
- How long have you been pregnant?
- When are you due?
- Is this your first pregnancy?
- Are you having contractions? How far apart are your contractions? How long do the contractions last?
- Have you had any spotting or bleeding?
- Has your water broken?
- Do you feel as though you need to have a bowel movement?
- Do you feel the need to push?
Questions to ask to help determine any potential complications with the birth
- Were any of your previous deliveries by c-section?
- Have you had any problems in this or any previous pregnancy?
- Do you use drugs, drink alcohol, or take any medications
- Is there a chance you are having more than one baby?
- Does you physician expect any complications?
If the patient says ___, immediately prepare for delivery and consider calling for additional resources
She is about to deliver, has to move her bowels, or feels the need to push
During birth, elevate the hips ___
2 - 4 inches
Precipitous
Fast
When the labor is too fast, the ___
Tissues do not have time to stretch, and the patient is at risk for tears in the perineal area
Wait how long to clamp the umbilical cord?
30 to 60 seconds for it to stop pulsing
How far apart to place clamps on the umbilical cord
2 to 3 inches
If the amniotic sac has not ruptured by the time the head is crowning, it will appear as ___
A fluid-filled sac emerging from the vagina
What do do if the amniotic sac has not ruptured by the time the head is crowning
Tear the sac away from the face. Push the ruptured sac away from the face. Wipe the mouth and nose with gauze
Greenish amniotic fluid indicates ___
Meconium staining
If the amniotic fluid is greenish or has a foul odor ___
Notify the receiving hospital
Normal amniotic fluid is ___
Clear
Meconium in the amniotic fluid may result in ___
Respiratory distress or an airway obstruction in the newborn
As soon as the head is delivered, ___
Use one finger to feel whether the umbilical cord is wrapped around the neck
Umbilical cord wrapped around the neck
Nuchal cord
What to do for nuchal cord
Gently slip the cord over the head
If you cannot slip the umbilical cord over the head for nuchal cord ___
- Place two clamps about 2” apart and cut the cord
- Attempt to speed up the delivery by encouraging the woman to push harder and possibly more often
Once the head has been delivered, it usually ___
Rotates to one side
White, cheesy substance called ___
Vernix caseosa
As soon as the newborn is delivered, ___
If the mother is able and willing, hand the newborn to the mother or place it on her chest or abdomen with skin to skin contact and cover with a blanket. Dry the newborn, and swaddle
Purpose of skin-to-skin contact contact
Keep the newborn warm and improve perfusion
If the mother cannot hold the newborn ___
Cradle the newborn in your arms. Keep the newborn at the same level as the vagina until the umbilical cord is cut
Postdelivery care of the umbilical cord is important because ___
Infection is easily transmitted through the cord to the newborn
How far from the newborn to clamp the cord
6”
If the cord is torn from the newborn ___
Fatal hemorrhage will result
Once the clamps are in place, there is ___
No need to rush
Cord cutting can be delayed for ___ in a healthy newborn
60 seconds
If the newborn requires immediate care for respiratory distress or other complication, ___
Prompt care takes priority over delayed cord clamping
Do not delay post delivery transport waiting for ___
The placenta to deliver
___ occurs before the placenta delivers
Gush of bloody fluid, usually less than 500 mL
Normal placenta size
7” diameter and 1” thick
Two sides of the placenta
- Smooth and covered in a shiny gray membrane
- Rough, divided into lobes, and is a dark reddish-brown, similar to raw liver
What to do with the delivered placenta and cord
Wrap in a towel, place into a plastic bag, and take to the hospital
If a piece of placenta has been retained inside the woman, it could cause ___
Persistent bleeding or infection
After delivery of the placenta and before transport ___
Place a sterile pad or sanitary pad over the vagina and straighten out the woman’s legs
You can help slow post birth bleeding by ___
Massaging the woman’s abdomen using a firm, circular, kneading motion with one hand cupped over the top of the fundus and the other over the pubic bone
The abdominal skin will be ___ post birth
Wrinkled and very soft
Firm, grapefruit-sized mass in the lower abdomen
Fundus
The fundus is ___
The upper end of the uterus
As you massage the fundus, ___
The uterus will contract and become firmer
Massaging the fundus may be ___
Uncomfortable for the woman. Reassure her and explain that it is necessary to help control the bleeding
Breastfeeding also stimulates the uterus to contract because, ___
It causes the production of oxytocin, a hormone that helps to contract the uterus and slow bleeding
Emergency situations after birthing
- Placenta not delivered after 30 minutes
- More than 500 mL of bleeding occurs before the deliver of the placenta
- Significant bleeding occurs after delivery of the placenta
The first minute after birth
The golden minute
Four initial steps of newborn care in the first minute of life
- Airway positioning and suctioning
- Drying
- Warming
- Tactile stimulation
If signs of good tone and adequate ventilation are not present after performing the initial steps for about 30 seconds, then ___
Positive-pressure ventilation with a bag-mask device may be necessary
Adequate respiration signs of newborn
- Good color
- Strong cry
- Spontaneous respirations
Vitals within 30 seconds of birth
Spontaneous breathing and a HR of 100 or higher
How to position the newborn
On the back with a towel or blanket under the shoulders so the neck is slightly extended in the neutral or sniffing position
What to use to suction a newborn
Bulb syringe or suction device with an 8 French or 10 French catheter
Deep suctioning of the mouth can cause ___
The heart rate to slow
Where to suction in a newborn’s mouth
Both sides of the mouth
In addition to vigorously drying the newborn’s head, back, and body with dry towels, you may ___
Rub the newborn’s back and gently flick or slap the soles of the feet
Many newborn’s require some form of stimulation that will encourage them to ___
Breath air and begin circulating blood through the lungs
Perform chest compressions on the newborn if ___
No pulse or less than 60/min after 30 seconds of ventilation
If chest compressions are required, use the ___ for two-person resuscitation
Hand-encircling technique
Perform bag mask ventilation during a pause after every ___ compression (newborn)
3rd
Cardiac arrest in neonates is nearly always the result of ___
Ventilation compromise
Neonate compression to ventilation ratio
3:1
Transport any newborn who requires more than routine resuscitation to a hospital with a ___
Level III neonatal intensive care unit
The risk of meconium-stained amniotic fluid generally increases with ___
Gestational age, and postterm newborns
If you see meconium and the newborn is not breathing adequately, consider quickly ___
Suctioning the mouth and then nose after delivery before providing rescue ventilations
The standard scoring system used to assess the status of a newborn
Apgar score
Apgar score number range
0-2 in 5 categories
Apgar score areas of activity
- Appearance
- Pulse
- Grimace or irritability
- Activity or muscle tone
- Respirations
Apgar score appearance
2 - Entire newborn is pink
1 - Body is pink, but hands and feet remain blue
0 - Entire newborn is blue or pale
Apgar score pulse
2 - More than 100 beats/min
1 - Fewer than 100 beats/min
0 - Absent pulse
Apgar score grimace or irritabilty
2 - Newborn cries and tries to move foot away from finger snapped against sole of foot
1 - Newborn gives a weak cry in response to stimulus
0 - Newborn does not cry or react to stimulus
Apgar score activity or muscle tone
2 - Newborn resists attempts to straighten hips and knees
1 - Newborn makes weak attempts to resist straightening
0 - Newborn is completely limp, with no muscle tone
Apgar score respiration
2 - Rapid respirations
1 - Slow respirations
0 - Absent respirations
Normally hips and knees are ___ at birth
Flexed
The Apgar score should be calculated ___
At 1 minute and again at 5 minutes after birth
Max Apgar score
10
Calculating the Apgar score is generally ___ when resuscitation is required
Delayed
An Apgar score of ___ is generally considered reassuring
7 or higher
If the pulse rate is less than 100/min in a newborn, ___
Begin ventilations with a bag-mask device
Reassess respirations and pulse rate at least every ___ when ventilating
30 seconds
Best place to take oxygen saturation on a newborn
The right wrist
Oxygen saturation does not usually reach the 85% to 95% range until ___
About 10 minutes after birth
If central cyanosis is present but breathing is adequate ___
Administer blow-by oxygen by holding a mask close to the newborn’s face at 5 L/min
In situations where assisted ventilation is required, you should ___
Use a newborn bag-mask device with high-flow oxygen at 40 to 60 breaths/min
The position in which an infant is born or the body part that is delivered first
Presentation
Born head first
Vertex presentation
Buttocks are delivered first
Breech presentation
If the woman does not deliver within ___ of the buttocks presentation, provide prompt transport
10 minutes
As the head is delivered in a breech presentation, you must ___
Make a “V” with your gloved fingers and position them in the vagina to keep the walls of the vagina from compressing the fetus’s airway
Only two reasons to put fingers into the vagina
- Breech presentation to protect airway
- Prolapsed cord
If a limb is delivered first ___
This is a life-threatening situation and prompt transport to the hospital for delivery is required
During transport, what to do with the limb protruding
Cover it with a sterile towel
The umbilical cord comes out of the vagina before the fetus
Prolapse of the umbilical cord
Why is a prolapsed umbilical cord dangerous?
The fetus’s head will compress the cord and cut off circulation
Prolapse of the umbilical cord usually occurs ___
Early in labor when the amniotic sac ruptures
Your job during a prolapsed umbilical cord
Try to keep the fetus’ head from compressing the cord
How to position the patient during a prolapsed umbilical cord
Foot end of the stretcher raised 6 to 12 inches higher than the head, with hips elevated on a pillow
Alternative position for the patient during a prolapsed umbilical cord
Knee-chest position
Knee-chest position
Kneeling and bent forward, face down
What to do with the exposed umbilical cord during a prolapsed umbilical cord
Wrap a sterile towel, moistened with saline around the cord. Administer oxygen, and transport rapidly
Development defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly outside of the body
Spina bifida
With spina bifida, when it protrudes outside of the body, the protrusion is seen ___
On the back, usually in the lumbar area
What to do with the open area of the spinal cord with spina bifida
Cover with a moist, sterile dressing and then an occlusive dressing
If you must use moist dressing on the neonate, ___
Have someone hold the newborn against their body to help keep warm
Consider the possibility of twins whenever ___
The newborn is small or the woman’s abdomen remains fairly large and firm after birth
When twins are born, they will usually be born within ___ of the first
45 minutes
When twins are born, the contractions for the second will begin again after ___
About 10 minutes after the first birth
ID the first newborn as ___
Baby A
Full-term gestation is considered to be between ___
39 weeks and 40 weeks, 6 days
Normal full-term birth weight
7 lbs
Premature newborn
Delivers before 8 months (36 weeks) or weighs less than 5 lbs
___ will be absent or minimal on a premature newborn
Vernix caseosa
Premature newborns will often require ___
Resuscitation
If intrauterine infection has caused the death of the fetus, you may note ___
An extremely foul odor
Do not attempt to resuscitate an ___ neonate
Obviously dead
You must attempt to resuscitate newborns if there is any ___
Question about viability
Bleeding that exceeds ___ is considered high risk for maternal mortality and morbidity
1000 mL
Postpartum patients are at an increased risk of a ___
Venous embolism
Most common embolism in postpartum women
Pulmonary embolism
If you deliver a baby and the woman begins to report difficulty breathing or shortness of breath, consider the possibility that ___
She has a pulmonary embolism
