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POC 27 Module 6 > Obstetrics Emergency > Flashcards

Obstetrics Emergency Flashcards

1
Q

Female reproductive organs

A

Ovaries, Fallopian tubes, vagina, uterus, mammary glands

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2
Q

Each ovary contains

A

200,000 follicles

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3
Q

Each follicle contains an ____

A

Oocyte (egg)

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4
Q

Each female is born with all the eggs that will ever release

A

Approximately 400,000 in a lifetime

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5
Q

FSH (follicle-stimulating hormone)

A

When the oocyte matures and responds to FSH which is released by anterior pituitary gland stimulated by the release of GnRF from the hypothalamus

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6
Q

Luteinizing Hormone

A

Which stimulates the process of ovulation

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7
Q

Release of an egg

A

Is called an ovum

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8
Q

At end of pregnancy the uterus and placenta prodcues

A

Prostaglandins that, along with oxytocin, will signal the uterus to contract and labor will begin

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9
Q

Corpus Luteum

A

What is last of follicle after egg has been released which in return secretes progesterone
Embryo to a fetus

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10
Q

Ovum if not fertilized

A

The ovum dies and degenerates

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11
Q

Fallopian tubes

A

Tubes in which the ovum passes through

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12
Q

Uterus

A

Muscular, inverted pearshaped organ that lies between the urinary bladder and the rectum

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13
Q

Cervix

A

Narrowest portion of the cervix that opens into vagina

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14
Q

Vagina cavity

A

Inside is acidic owing to the breakdown of glycogen ( in the vaginal mucosa ) which creates a low pH environment inhibiting growth of bacteria.
This acid harms sperm killing off many because sperm is alkaline in nature.

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15
Q

Episiotomy

A

Incision of the perineum

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16
Q

Heart begins to beat on..

A

The third week after conception

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17
Q

Placenta begins to form on the..

A

The fourth week after conception

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18
Q

Placenta

A 
Respiratory gas exchange
Transport nutrients
Excretion of wastes
Transfer of heat
Hormone production
Formation of a barrier
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19
Q

Umbilical cord

A

Contains Wharton jelly which keeps umbilical cord from becoming knotted
Contains one vein and two arteries

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20
Q

Umbilical vein

A

Carries oxygenated blood from placenta to fetus

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21
Q

Umbilical arteries

A

Carries arteriovenous blood to the placenta

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22
Q

Fetal lungs

A

Blood bypasses the lungs until birth because the baby receives oxygen from the placenta

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23
Q

Amniotic fluid

A

Reaches about 1liter by birth

Provides weightless environment

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24
Q

4th-8th week of embryonic development is

A

Critical for embryonic development
Major organs and body systems start to form
Where birth defects are made during the development phase (smoking, drugs, alcohol)

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25
Q

Gestational Period

A

Time it takes for fetus to form and develop which usually takes 38 weeks

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26
Q

Uterus changes after conception

A

From 10ml of fluid in uterus to 5,000ml before conception

Rarely returns to normal size after pregnancy

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27
Q

Measuring fundus

A

Length in centimeters corresponds to length of gestation

Measure from top of pubic bone to top of fundus

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28
Q

Uterus enlarges causing

A

Pressure on the lower end of the intestine and rectum causing constipation

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29
Q

Woman’s GI tract relaxes due to progesterone causing

A

Decrease in moving stomach contents causing heartburn and burping

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30
Q

Kidney size in woman..

A

Increase up to 30%

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31
Q

Linda Nigra

A

Dark line of pigment down middling of stomach is normal

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32
Q

Blood Volume

A

Before about 4-5L of blood

After increases 40-50% in blood

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33
Q

Gravid

A

Number of times pregnant

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34
Q

Para

A

Number of live births

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35
Q

Conception causes woman to lose _____ of blood

A

500-1000ml of fluid/blood

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36
Q

Prenatal vitamins

A

Body increases RBC’s by 33% which demands more iron and other nutrients

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37
Q

White blood cell during pregnancy

A

Triple in count

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38
Q

Heart of Mom

A

Displaced upward and to the left with a slight rotation in its long axis, which causes apex of the heart to shift laterally

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39
Q

Blood Pressure of mom

A

Usually decrease around 5-10mmHg around 12th week and returns normal around 36th week

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40
Q

Lithotomy Position

A

Mom laying supine with her knees spread apart, or feet in stirrups

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41
Q

Diaphragm of Mom

A

Displaces up about 1 and 1/2 inches

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42
Q

Postpartum

A

After delivery

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43
Q

Weight gain

A

Partly due to increased blood flow and increase in intra and extra cellular fluid, uterine growth, placental growth, and increased breast tissue (2-3lbs)

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44
Q

Hormone Relaxin

A

Causes collagenous tissue to soften and produce a generalized relaxing of the ligament out system, especially along the spine.
Helps lordosis of spine and increased flexion of the neck
Also loosens pelvic joints

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45
Q

Primigravida

A

Pregnant for the first time

46
Q

Primipara

A

Only one delivery

47
Q

Multigravida

A

Had two or more pregnancies

48
Q

Multipara

A

Two or more deliveries

49
Q

Nullipara

A

Has never delivered

50
Q

True Labor vs Flase Labor

A 
True: 
contractions regularly spaced
Interval between shortens
Intensity increases
Analgesics don't help
Progressive dilation
False: 
Opposite of above
51
Q

Imminent delivery

A

Vitals
Estimate gestational age
Listen for fetal heart tones (<120/min=distress)

52
Q

Supine Hypotensive Syndrome

A

When mom lays in supine position the uterus comprssses the inferior vena cava and can occur sitting.
Takes 3-7 minutes before symptoms become apparent
Nausea, dizzy, dyspnea, syncopated episode
Place in left lateral recumbant position

53
Q

Chronic Hypertension

A

BP > 140/90mmHg prior to pregnancy

54
Q

Pregnancy-induced Hypertension

A

Develops after 20th week gestation with normal BP before pregnant
May be early sign or preeclampsia

55
Q

Preeclampsia

A 
Occurs in 8% of women
Risk: <20y/o first pregnancy
Manifests after 20th week gestation
Symptoms leading to eclampsia:
Facial Edema, ankles and hands, gradual onset of hypertension, and protein in urine
56
Q

Eclampsia

A

When the patient experiences a seizure from result of hypertension

57
Q

Hypertension of

A

Greater than
Systolic of 160-180
Diastolic of 105
In prescence of other symptoms may require administration of emergency hypertension medications (lebatalol)

58
Q

Seizure with Mom

A

Two patients
Benzodiazepines cross the placental barrier and effects fetus
Magnesium sulfate is preferred, especially with eclampsia
High Flow supplemental oxygen needed for both patients to counteract hypoxia of seizure

59
Q

Diabetes in Mom

A

Gestational Diabetes is inability to process carbohydrates during pregnancy.
Pregnancy hormones can effect insulin production
Oral hypoglycemic agents can cross the placental barrier

60
Q

Respiratory Disorders in Mom

A

Usually dyspnea due to physical changes of pregnancy
Asthma, most common, may occur first time during pregnancy
Attacks render fetus and mother prone to hypoxia
Pneumonia, leading indirect causes of maternal death in USA because the immune system of Mom is already depressed

61
Q

Hyperemesis Gravidarum

A

Persistent nausea and vomiting during pregnancy
Leads to dehydration and malnutrition
Most common in first pregnancies, obese and multiple gestation

62
Q

Management of Hyperemsis Gravidarum

A

1) 100% oxygen NRB
2) Fluid bolus of 250ml
3) Diphenhydramine 10-50mg IV/IM
4) BGL
5) Orthostatic Vitals

63
Q

Renal Disorders

A

Urine increases by 25-50%

64
Q

Rh Sensitization

A

Rh is a protein found on RBC’s of most people.
When woman who is Rh neg becomes pregnant by a man that is Rh positive, and the fetus inherits the factor, the fetal blood can pass into the woman’s circulation and produce maternal antibody isoimmunization to the factor. (The fetus will and can be attacked by Mom)

65
Q

HIV in Mom

A

Fetus can contract from breastfeeding, during pregnancy, delivery.

66
Q

Cholestasis

A

The accumulation of bile can put stress on the fetus

67
Q

TORCH Syndrome

A 
Stands for 
Toxoplasmosis 
Other Agents
Rubella
Cytomegalovirus
Herpes Simplex
- refers to infections that occur in neonate as a result of organisms pass g through placenta barrier from woman to fetus
68
Q

Toxoplasmosis

A

Parasite from contaminated food the fetus gets causing an infection

69
Q

Rubella

A

“German measles” viral infection

70
Q

Cytomegalovirus

A

Member of herpesvirus family

Newborn succeptible to lung problems, blood, liver, and poor weight problems

71
Q

Herpes

A

Infection of genitals by herpes type 1 or type 2

72
Q

Abortion

A

Expulsion of the fetus before the 20th week of gestation

-Spontaneous (1in5pregnancies) and Elective Abortions

73
Q

Habitual Abortions

A

3 or more consecutive pregnancies that end in miscarriage

74
Q

Threatened Abortion

A

Abortion trying to take place characterized by bleeding

75
Q

Imminent Abortion

A

Spontaneous abortion that can not be prevented

76
Q

Incomplete Abortion

A

Part of fetus expelled but some remain inside

Can try fundus massage

77
Q

Complete Abortion

A

When all parts have been expelled

78
Q

Ectopic Pregnancy

A

Fertilized ovum becomes implanted somewhere other than the uterus
Normal symptoms of pregnancy with severe abdominal pain
All females with lower abdominal pain should be suspected of ectopic pregnancy

79
Q

Abruptio Placenta

A

Premature separation of placenta from uterine wall
Usually occurs during last trimester of pregnancy
Hypertension most common cause followed by trauma

80
Q

Abruptio Placenta Assesment

A

Vaginal bleeding, bright red blood, sudden abdominal pain
No longer feel fetus moving
Signs of shock
Abdominal wall tender and uterus ridged to palpation

81
Q

Placenta Previa

A

Placenta is implanted low in the uterus, and as it grows, it partially or fully obstructs cervical canal.
C/o painless vaginal bleeding of bright red blood
DO NOT PALPATE ABDOMEN DEEPLY in any woman with third trimester bleeding

82
Q

Placenta Previa Assessment

A

When did it start? What were you doing ? How much blood? Abdominal Pain?
Look for Grey Turner or Cullen Sign

83
Q

Placenta Previa Management

A

Left Lateral Recumbent
100% oxygen NRB 15lpm
Fluids
Place loose trauma pads over woman

84
Q

Labor

A

When fetus and placenta are expelled from vagina

85
Q

First Stage of Labor

A

Contractions early at 5-15 minutes apart
Later Phase the cervix begins to dialate
Last until cervix is fully dilated (10cm), usually between 8-12 hours

86
Q

Second Stage of Labor

A

Begins as head of fetus descends and enters birth canal
Then head rotates inside cervix to position properly
More intense contraction 2-3 minutes apart
Crowning begins to occur meaning delivery is imminent
Takes 30-60mins

87
Q

Third Stage of Labor

A

When the placenta separates from the uterine wall
Last from delivery until Placenta is expelled from vaginal canal
5-60 minutes

88
Q

Birthing positions

A

Standing Birth
Semi-Fowlers position
Kneeling Birth
Side Lying Position

89
Q

OB Kit Prep

A 
Maintain sterility
Gown and Mask up
Drape mother with towels
Emesis Basin and Portable suction
Oxygen if high risk pregnancy
Oxytocin available
ECG
IV Fluid if hypotensive
90
Q

Assisting Delivery

A
  • crowning, gentle pressure on newborns head
  • support head when head exiting, do not pull on newborn. If membrane is still covering, tear membrane with hands
  • slip finger down neck to check for Nuchal cord
  • if nuchal cord, gently slip over head, if can’t cut cord
  • clear airway with suction as soon as head exits
  • gently guide head upwards and downward for shoulders
  • delivered, maintain same level as vagina
  • wipe blood or mucus from newborn, suction mouth and nostrils,
  • dry newborn with towels, stimulate, suction and wrap with towels
  • record time of birth
91
Q

Delivery of Placenta

A

Bear down to expel placenta when following contractions occur
Place placenta in plastic bag
Examine perineum for lacerations and apply pressure to tears

92
Q

Postpartum Care

A

Massage fundus after delivery will help with bleeding

Cover Mom with blankets to prevent hypothermia

93
Q

Magnesium Sulfate

A

Management of eclampsia

Beta blockers used for BP if still hypertensive

94
Q

Calcium Chloride

A

Antigone to magnesium sulfate
Can cause bradycardia, syncope and dysrhythmias
May be repeated every ten minutes

95
Q

Terbutaline

A

Tocolyitc! Relaxes the uterus and can stop contractions, especially for cord prolapse
Also can treat pregnancy-induced asthma with bronchodilator effects.

96
Q

Valium

A

Eclamptic seizures when Mag Sulfate does not respond

Or anxiety in preeclampsia patients

97
Q

Duphenhydramine

A

Used to treat hyperemesis gravidarum

98
Q

Oxytocin

A

Postpartum hemmorage causing uterus to contract and shunt bleeding
3-10 units IM

99
Q

Preterm Labor

A

Labor, begins between 20-37th week of gestation

100
Q

Precipitous Labor and Birth

A

Baby delivered before EMS arrival

101
Q

Post-Term Pregnancy

A

If fetus hasn’t been born after 42 weeks

102
Q

Twins

A

Identical if share the same placenta

103
Q

Amniotic Fluid Embolism

A

When amniotic fluid and fetal cells enter woman’s pulmonary and circulatory system

104
Q

Hydraminos

A

Too much amniotic fluid

105
Q

Cephalopelvic Disproportion

A

Big Ass Head Baby

106
Q

Cephalon Presentation

A

Face first.

If cannot deliver, support mom and baby and transport!

107
Q

Breech Presentation

A

Butt first or limb first

  • flex knees of Mom
  • don’t pull, but let butt deliver
  • once legs are out, support body
  • lower newborn to hang legs so body weight pulls itself
  • grab legs when head is visible lift up and down of legs and head should exit easily
  • if no head after 3 minutes, newborn in danger of suffocation. Insert v shaped fingers of newborns nose and mouth pressing against the vaginal canal until head is delivered
  • do not pull. If still not delivered rapidly transport maintaining newborns airway
108
Q

Shoulder Dystocia

A

Difficulty in delivering shoulders
Fetus cant breath if compacted with shoulders
-Use McRoberts maneuver knees to the chest
-apply pubic pressure on lower abdominal wall and may need to gently pull on patients head

109
Q

Nuchal Cord

A

Slip finger under and over fetus head

Cut if too tight

110
Q

Prolapsed Umbilical Cord

A

Cord emerges first before fetus

  • supine mom with hips elevated
  • 100% oxygen
  • pant with each contraction decreasing bearing down
  • push presenting part (not cord) back into vagina until no longer presses on cord
  • cover exposed portion of cord with dressings moistened in saline
  • maintain position and transport fast
111
Q

Uterine Inversion

A

Placenta fails to detach and adheres to uterine wall when expelled resulting in prolapsed uterus
-keep recumbent
-100% oxygen
-two IV lines with saline and titration
-treat for shock
-oxytocin to help hemmorage
Attempt once to push uterus easily back inside.
If this fails, cover portruding uterus with saline wet dressing

112
Q

Pregnant Trauma

A

If trauma occurs and Mom is bleeding, blood will shunt from fetus and be used for Mom.
When signs of shock present, fetal mortality is 70-80%
Normal fetal heart rate is 120-180
If transported supine, elevate right hip 6 inches, if not recumbant position is necessary or elevate backboard underneath

POC 27 Module 6 (19 decks)

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