Obstetrics part II Vega EMS Flashcards
Name all stages of labor.
- Dilation
- Expulsion
- Placental delivery
How long does dilation last for a 1st time mother vs a women who has had a child before?
1st time mother: 8-10 hours
Para I+ mothers: 5-7 hours
At the end of stage 1 describe the frequency/duration/intensity of contractions.
contractions are at regular 3- to 4-minute intervals, last at least 60 seconds each, and feel very intense.
describe what marks the first stage of labor.
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.
What are Braxton Hicks?
Contractions that feel like pregnancy contractions but do not indicate labor.
Define frequency, duration, and intensity.
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.
What occurs during stage two?
the infant moves through the vagina and is born.
What is the frequency and duration of contractions during expulsion?
Contractions are less than 2 minutes apart and last 60 to 90 seconds each.
What does crowning/vertex presentation indicate?
The baby is coming, imminent birth.
How long does the expulsion phase last for 1st time mothers? (para 0 soon to be para 1)
50-60 minutes
How long does it take for the placenta to be delivered following birth?
5-20 minutes
signs that the delivery of the placenta is imminent are…?
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.
What should you NEVER do during placental delivery and why?
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.
Gestational age by landmark?
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
In which situations must you assist in the delivery of the baby?
There is no suitable transportation.
The hospital or physician cannot be reached due to bad
weather, a natural disaster, or catastrophe.
Delivery is imminent.
What questions should you ask to determine if delivery is imminent?
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?
What should you do to prevent an explosive delivery?
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.
After birth what do you do?
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.
All criteria of Apgar?
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
What Apgar scores are considered normal, unusual, and which need medical attention?
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.
What is a prolapsed cord?
The umbilical cord is presenting itself with or before the baby during birth. The cord may be compressed, cutting off oxygen to the infant.
What do you do when a prolapsed cord occurs?
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
What is shoulder dystocia?
The fetal shoulders are larger than the fetal head. Sometimes The head delivers, but then retracts back into the vagina.
Fetal complications for shoulder dystocia?
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
Materal complications for shoulder dystocia?
Trauma to the uterus, vagina, and perineum.
Emergency care for shoulder dystocia?
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.
What is meconium?
First feces of newborn
What is meconium staining and its colors?
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.
What can happen if the meconium-stained fluid is inhaled?
Pneumonia
In what type of births is meconiun-stain most common?
Breech births
The thicker and darker the color of meconium….
the higher the risk for fetal problems.
What happens when the fetus becomes hypoxic in regards to meconium?
The digestive tract increases movement (peristalsis) and the anal sphincter relaxes, causing the meconium to be released into the amniotic fluid
Do you suction with meconium but the baby has a good cry or vigorous activity?
No
With meconium in what cases do we suction?
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.
What is Premature Rupture of Membranes (PROM)?
Spontaneous rupture of the amniotic sac prior to the
onset of true labor and before the end of the 37th week of
gestation
Is Premature Rupture of Membranes considered a emergency?
Not an emergency but increases risk of infection of the uterus.
Why is PROM bad?
Prevents adequate lubrication of the vaginal canal at the time of birth.
What can place stress on the fetus regarding PROM?
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.
Emergency medical care PPV for neonates
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.
how to perform blow by oxygenation?
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.
What do you do if the amniotic sac is intact when the neonate is born?
Use your fingers to rupture the sac, and then tear it away from the baby’s head and face as they appear.
How to manage a nuchal cord?
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.
When and how to suction
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.
