Obstetrics Emergency Flashcards
Female reproductive organs
Ovaries, Fallopian tubes, vagina, uterus, mammary glands
Each ovary contains
200,000 follicles
Each follicle contains an ____
Oocyte (egg)
Each female is born with all the eggs that will ever release
Approximately 400,000 in a lifetime
FSH (follicle-stimulating hormone)
When the oocyte matures and responds to FSH which is released by anterior pituitary gland stimulated by the release of GnRF from the hypothalamus
Luteinizing Hormone
Which stimulates the process of ovulation
Release of an egg
Is called an ovum
At end of pregnancy the uterus and placenta prodcues
Prostaglandins that, along with oxytocin, will signal the uterus to contract and labor will begin
Corpus Luteum
What is last of follicle after egg has been released which in return secretes progesterone
Embryo to a fetus
Ovum if not fertilized
The ovum dies and degenerates
Fallopian tubes
Tubes in which the ovum passes through
Uterus
Muscular, inverted pearshaped organ that lies between the urinary bladder and the rectum
Cervix
Narrowest portion of the cervix that opens into vagina
Vagina cavity
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.
Episiotomy
Incision of the perineum
Heart begins to beat on..
The third week after conception
Placenta begins to form on the..
The fourth week after conception
Placenta
Respiratory gas exchange Transport nutrients Excretion of wastes Transfer of heat Hormone production Formation of a barrier
Umbilical cord
Contains Wharton jelly which keeps umbilical cord from becoming knotted
Contains one vein and two arteries
Umbilical vein
Carries oxygenated blood from placenta to fetus
Umbilical arteries
Carries arteriovenous blood to the placenta
Fetal lungs
Blood bypasses the lungs until birth because the baby receives oxygen from the placenta
Amniotic fluid
Reaches about 1liter by birth
Provides weightless environment
4th-8th week of embryonic development is
Critical for embryonic development
Major organs and body systems start to form
Where birth defects are made during the development phase (smoking, drugs, alcohol)
Gestational Period
Time it takes for fetus to form and develop which usually takes 38 weeks
Uterus changes after conception
From 10ml of fluid in uterus to 5,000ml before conception
Rarely returns to normal size after pregnancy
Measuring fundus
Length in centimeters corresponds to length of gestation
Measure from top of pubic bone to top of fundus
Uterus enlarges causing
Pressure on the lower end of the intestine and rectum causing constipation
Woman’s GI tract relaxes due to progesterone causing
Decrease in moving stomach contents causing heartburn and burping
Kidney size in woman..
Increase up to 30%
Linda Nigra
Dark line of pigment down middling of stomach is normal
Blood Volume
Before about 4-5L of blood
After increases 40-50% in blood
Gravid
Number of times pregnant
Para
Number of live births
Conception causes woman to lose _____ of blood
500-1000ml of fluid/blood
Prenatal vitamins
Body increases RBC’s by 33% which demands more iron and other nutrients
White blood cell during pregnancy
Triple in count
Heart of Mom
Displaced upward and to the left with a slight rotation in its long axis, which causes apex of the heart to shift laterally
Blood Pressure of mom
Usually decrease around 5-10mmHg around 12th week and returns normal around 36th week
Lithotomy Position
Mom laying supine with her knees spread apart, or feet in stirrups
Diaphragm of Mom
Displaces up about 1 and 1/2 inches
Postpartum
After delivery
Weight gain
Partly due to increased blood flow and increase in intra and extra cellular fluid, uterine growth, placental growth, and increased breast tissue (2-3lbs)
Hormone Relaxin
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
Primigravida
Pregnant for the first time
Primipara
Only one delivery
Multigravida
Had two or more pregnancies
Multipara
Two or more deliveries
Nullipara
Has never delivered
True Labor vs Flase Labor
True: contractions regularly spaced Interval between shortens Intensity increases Analgesics don't help Progressive dilation False: Opposite of above
Imminent delivery
Vitals
Estimate gestational age
Listen for fetal heart tones (<120/min=distress)
Supine Hypotensive Syndrome
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
Chronic Hypertension
BP > 140/90mmHg prior to pregnancy
Pregnancy-induced Hypertension
Develops after 20th week gestation with normal BP before pregnant
May be early sign or preeclampsia
Preeclampsia
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
Eclampsia
When the patient experiences a seizure from result of hypertension
Hypertension of
Greater than
Systolic of 160-180
Diastolic of 105
In prescence of other symptoms may require administration of emergency hypertension medications (lebatalol)
Seizure with Mom
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
Diabetes in Mom
Gestational Diabetes is inability to process carbohydrates during pregnancy.
Pregnancy hormones can effect insulin production
Oral hypoglycemic agents can cross the placental barrier
Respiratory Disorders in Mom
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
Hyperemesis Gravidarum
Persistent nausea and vomiting during pregnancy
Leads to dehydration and malnutrition
Most common in first pregnancies, obese and multiple gestation
Management of Hyperemsis Gravidarum
1) 100% oxygen NRB
2) Fluid bolus of 250ml
3) Diphenhydramine 10-50mg IV/IM
4) BGL
5) Orthostatic Vitals
Renal Disorders
Urine increases by 25-50%
Rh Sensitization
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)
HIV in Mom
Fetus can contract from breastfeeding, during pregnancy, delivery.
Cholestasis
The accumulation of bile can put stress on the fetus
TORCH Syndrome
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
Toxoplasmosis
Parasite from contaminated food the fetus gets causing an infection
Rubella
“German measles” viral infection
Cytomegalovirus
Member of herpesvirus family
Newborn succeptible to lung problems, blood, liver, and poor weight problems
Herpes
Infection of genitals by herpes type 1 or type 2
Abortion
Expulsion of the fetus before the 20th week of gestation
-Spontaneous (1in5pregnancies) and Elective Abortions
Habitual Abortions
3 or more consecutive pregnancies that end in miscarriage
Threatened Abortion
Abortion trying to take place characterized by bleeding
Imminent Abortion
Spontaneous abortion that can not be prevented
Incomplete Abortion
Part of fetus expelled but some remain inside
Can try fundus massage
Complete Abortion
When all parts have been expelled
Ectopic Pregnancy
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
Abruptio Placenta
Premature separation of placenta from uterine wall
Usually occurs during last trimester of pregnancy
Hypertension most common cause followed by trauma
Abruptio Placenta Assesment
Vaginal bleeding, bright red blood, sudden abdominal pain
No longer feel fetus moving
Signs of shock
Abdominal wall tender and uterus ridged to palpation
Placenta Previa
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
Placenta Previa Assessment
When did it start? What were you doing ? How much blood? Abdominal Pain?
Look for Grey Turner or Cullen Sign
Placenta Previa Management
Left Lateral Recumbent
100% oxygen NRB 15lpm
Fluids
Place loose trauma pads over woman
Labor
When fetus and placenta are expelled from vagina
First Stage of Labor
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
Second Stage of Labor
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
Third Stage of Labor
When the placenta separates from the uterine wall
Last from delivery until Placenta is expelled from vaginal canal
5-60 minutes
Birthing positions
Standing Birth
Semi-Fowlers position
Kneeling Birth
Side Lying Position
OB Kit Prep
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
Assisting Delivery
- 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
Delivery of Placenta
Bear down to expel placenta when following contractions occur
Place placenta in plastic bag
Examine perineum for lacerations and apply pressure to tears
Postpartum Care
Massage fundus after delivery will help with bleeding
Cover Mom with blankets to prevent hypothermia
Magnesium Sulfate
Management of eclampsia
Beta blockers used for BP if still hypertensive
Calcium Chloride
Antigone to magnesium sulfate
Can cause bradycardia, syncope and dysrhythmias
May be repeated every ten minutes
Terbutaline
Tocolyitc! Relaxes the uterus and can stop contractions, especially for cord prolapse
Also can treat pregnancy-induced asthma with bronchodilator effects.
Valium
Eclamptic seizures when Mag Sulfate does not respond
Or anxiety in preeclampsia patients
Duphenhydramine
Used to treat hyperemesis gravidarum
Oxytocin
Postpartum hemmorage causing uterus to contract and shunt bleeding
3-10 units IM
Preterm Labor
Labor, begins between 20-37th week of gestation
Precipitous Labor and Birth
Baby delivered before EMS arrival
Post-Term Pregnancy
If fetus hasn’t been born after 42 weeks
Twins
Identical if share the same placenta
Amniotic Fluid Embolism
When amniotic fluid and fetal cells enter woman’s pulmonary and circulatory system
Hydraminos
Too much amniotic fluid
Cephalopelvic Disproportion
Big Ass Head Baby
Cephalon Presentation
Face first.
If cannot deliver, support mom and baby and transport!
Breech Presentation
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
Shoulder Dystocia
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
Nuchal Cord
Slip finger under and over fetus head
Cut if too tight
Prolapsed Umbilical Cord
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
Uterine Inversion
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
Pregnant Trauma
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
