Obstetrics part II Vega EMS

Question 1

Name all stages of labor.

Answer 1

1. Dilation
2. Expulsion
3. Placental delivery

Question 2

How long does dilation last for a 1st time mother vs a women who has had a child before?

Answer 2

1st time mother: 8-10 hours
Para I+ mothers: 5-7 hours

Question 3

At the end of stage 1 describe the frequency/duration/intensity of contractions.

Answer 3

contractions are at regular 3- to
4-minute intervals, last at least 60 seconds each, and feel very intense.

Question 4

describe what marks the first stage of labor.

Answer 4

The first stage of labor is from the beginning of true labor (contractions) to complete cervical dilation and 100 percent effacement (cervix stretches and gets thinner). During this first and longest stage, the cervix becomes fully dilated at 10cm.

Question 5

What are Braxton Hicks?

Answer 5

Contractions that feel like pregnancy contractions but do not indicate labor.

Question 6

Define frequency, duration, and intensity.

Answer 6

The frequency or interval is the time between the start of contractions.

The duration describes how long the contraction lasted.

The intensity or strength of the contraction describes the amount of pain associated with the contractile force.

Question 7

What occurs during stage two?

Answer 7

the infant moves through the
vagina and is born.

Question 8

What is the frequency and duration of contractions during expulsion?

Answer 8

Contractions are less than 2 minutes apart and last 60 to 90 seconds each.

Question 9

What does crowning/vertex presentation indicate?

Answer 9

The baby is coming, imminent birth.

Question 10

How long does the expulsion phase last for 1st time mothers? (para 0 soon to be para 1)

Answer 10

50-60 minutes

Question 11

How long does it take for the placenta to be delivered following birth?

Answer 11

5-20 minutes

Question 12

signs that the delivery of the placenta is imminent are…?

Answer 12

There is a sudden increase in bleeding from the vagina.

The uterus becomes smaller in size.

The umbilical cord begins to lengthen.

The mother has an urge to push.

Question 13

What should you NEVER do during placental delivery and why?

Answer 13

Pulling or tugging on the umbilical cord to deliver the placenta can cause the uterus to invert. If inverted, the uterus cannot contract and tone up effectively. The exposed uterine vessels continue to bleed and lead to serious hemorrhaging and hypovolemia.

Question 14

Gestational age by landmark?

Answer 14

Fundus at the umbilicus – 20 weeks

Fundus at the xiphoid – 38 weeks

At 40 weeks, the fundus drops to below the xiphoid as the fetus moves into position for delivery

Question 15

In which situations must you assist in the delivery of the baby?

Answer 15

There is no suitable transportation.

The hospital or physician cannot be reached due to bad
weather, a natural disaster, or catastrophe.

Delivery is imminent.

Question 16

What questions should you ask to determine if delivery is imminent?

Answer 16

Has crowning occurred?

Are contractions less than 2 minutes apart?

Do they last 60-90 seconds?

Does the patient have the urge to defecate?

Does the patient has a strong urge to push?

Question 17

What should you do to prevent an explosive delivery?

Answer 17

Apply gentle pressure to the head to prevent an explosive delivery. Avoid touching and exerting pressure on the baby’s face and on any soft spot
(fontanelle) on the head.

Question 18

After birth what do you do?

Answer 18

Dry the newborn with towels.

Clamp the cord and use sterile surgical scissors or a scalpel to cut it.

Take a Apgar score 1 minute and 5 minutes after birth.

Question 19

All criteria of Apgar?

Answer 19

Appearance
(skin color)

Blue, pale-0
Body pink; extremities blue-1
Completely pink-2

Pulse Rate

Absent-0
Below 100-1
Above 100-2

Grimace
(irritability)

No Response-0
Grimace-1
Cries-2

Activity
(muscle tone)

Limp-0
Some flexion extremities-1
Active motion-2

Respiratory
Effort

Absent-0
Slow and irregular-1
Strong cry-2

Question 20

What Apgar scores are considered normal, unusual, and which need medical attention?

Answer 20

A score of 7, 8, or 9 is normal

A score of 10 is very unusual, since almost all newborns lose 1 point for blue hands and feet.

Any score lower than 7 is a sign that the baby needs medical
attention.

Question 21

What is a prolapsed cord?

Answer 21

The umbilical cord is presenting itself with or before the baby during birth. The cord may be compressed, cutting off oxygen to the infant.

Question 22

What do you do when a prolapsed cord occurs?

Answer 22

Instruct the mother not to push.

Administer high-concentration oxygen.

Put patient in a knee-chest position.

Keep the mother warm

Do not push the cord back

wrap cord in sterile moist towel

transport mother to hospital, continuing pressure on baby’s head

Question 23

What is shoulder dystocia?

Answer 23

The fetal shoulders are larger than the fetal head. Sometimes The head delivers, but then retracts back into the vagina.

Question 24

Fetal complications for shoulder dystocia?

Answer 24

Asphyxia (suffocation),

Injury to the brachial plexus (group of nerves in the axillary region)

Humerus and clavicle
fractures.

Entrapment of umbilical cord

Inability of child’s chest to expand properly

Severe brain damage or death if baby is not delivered within minutes

Question 25

Materal complications for shoulder dystocia?

Answer 25

Trauma to the uterus, vagina, and perineum.

Question 26

Emergency care for shoulder dystocia?

Answer 26

Place the patient in the McRoberts position.

If the McRoberts position alone does not work, apply
suprapubic pressure.

If the McRoberts position and suprapubic pressure do
not allow the delivery of the shoulders, you might be
instructed by medical direction to attempt the Gaskin
maneuver.

Question 27

What is meconium?

Answer 27

First feces of newborn

Question 28

What is meconium staining and its colors?

Answer 28

Fetal distress can lead to the fetus passing a bowel
movement into the amniotic fluid. This causes normally
clear fluid to turn greenish or brownish yellow.

Question 29

What can happen if the meconium-stained fluid is inhaled?

Answer 29

Pneumonia

Question 30

In what type of births is meconiun-stain most common?

Answer 30

Breech births

Question 31

The thicker and darker the color of meconium….

Answer 31

the higher the risk for fetal problems.

Question 32

What happens when the fetus becomes hypoxic in regards to meconium?

Answer 32

The digestive tract increases movement (peristalsis) and the anal sphincter relaxes, causing the meconium to be released into the amniotic fluid

Question 33

Do you suction with meconium but the baby has a good cry or vigorous activity?

Answer 33

No

Question 34

With meconium in what cases do we suction?

Answer 34

If the baby is depressed or nonvigorous and the HR is less than 100 bpm or has inadequate respirations, quickly suction the nose and mouth with a bulb syringe and immediately begin PPV.

Question 35

What is Premature Rupture of Membranes (PROM)?

Answer 35

Spontaneous rupture of the amniotic sac prior to the
onset of true labor and before the end of the 37th week of
gestation

Question 36

Is Premature Rupture of Membranes considered a emergency?

Answer 36

Not an emergency but increases risk of infection of the uterus.

Question 37

Why is PROM bad?

Answer 37

Prevents adequate lubrication of the vaginal canal at the time of birth.

Question 38

What can place stress on the fetus regarding PROM?

Answer 38

Infection of the amniotic fluid or a dry delivery places stress on the fetus during labor and delivery. These babies often need additional resuscitation beyond normal newborn care after being delivered.

Question 39

Emergency medical care PPV for neonates

Answer 39

Clear the airway by suction with a bulb syringe.

Provide ventilations by bag-valve mask at the rate of 40–60 per minute.

Reassess every 30 seconds.

If breathing has not improved, continue ventilations.

Question 40

how to perform blow by oxygenation?

Answer 40

hold the tube 1 inch from the nose and mouth and direct the oxygen flow, at 5 lpm or greater, across the mouth and nose.

Question 41

What do you do if the amniotic sac is intact when the neonate is born?

Answer 41

Use your fingers to rupture the sac, and then tear it away from the baby’s head and face as they appear.

Question 42

How to manage a nuchal cord?

Answer 42

A nuchal cord is when the umbilical cord is around the baby’s neck. A nuchal cord must be managed immediately when it is found. Use two fingers to slip the cord over the baby’s shoulders or head. If you cannot move the cord, place two clamps 2 to 3 inches apart and cut between the clamps using scissors.

Question 43

When and how to suction

Answer 43

Suction the mouth first and nostrils second of the newborn immediately
following birth, only when secretions or other substances
are present that obstruct spontaneous breathing. A bulb syringe may be used.