Obstetrics Quiz Flashcards
What is the definition of a ‘term baby’
37-42 weeks
What is a precipitate birth/delivery?
Usually a rapid labour and quick deliver (under 4 hours)
Where would you transport a pre-term baby?
- between 32-36 weeks gestation consult with PIPER
- 20-32 gestation RWH, monash medical centre, mercy heidelberg as these have NICU facilities
- Rural - closest regional base hospital
How much fluid would you administer to a pregnant woman with an antepartum haemorrhage?
- less than adequate perfusion (HR <50 or >100, BP <100) consider normal saline titrated to patient response
- max 40ml/kg
- if inadequate response, consult for a further 20ml/kg
What are the signs and symptoms of pre-eclampsia?
- HA
- Cerebral irritability
- Agitation
- Visual disturbances (flashing lights)
- nausea and vomiting
- hyperreflexia
- heartburn/gastric pain/abdo pain
- SBP >140 + >90 diastolic
What are the signs that the placenta is ready to be delivered?
- lengthening of the cord
- uterus becomes rounded, firmer, smaller
- trickle or gush of blood from the vagina
- cramping/contractions return
What do you need to do with the placenta once it has been delivered?
- note the time of delivery
- place placenta and if any clots in a container/wrap in the towel and transport with mother and baby
At what gestation would you apply a GTN patch if the mother was in labour?
- 20-34 weeks gestation
- consult for GTN patch to the abdomen
How much time do you have to deliver a baby with shoulder dystocia? Why?
- 5-7 mins
- Compression of the cord on the pelvic rim
When can a secondary PPH occur?
up to 6 weeks post partum
Would you deliverthe placenta in a female with primary PPH?
- NO
- the risk of uterine inversion - they will still bleed
What are the side effects of Misoprostol?
- hyper reflexia
- shivering
- abdo pain
- diarrhoea
When would you commence ventilations in the non-vigorous newborn? How?
- within the first 60 seconds. 40-60 bpm with BVM, air only, no supplemental oxygen, apply PEEP 5cm
- After 30 seconds (and HR 60-100) ensure adequate mask seal/ventlation pressure and ADD oxygen 5L/min
- If HR <60 (after 30 seconds) CPR with 100% FiO2
A baby who has a pink body and blue extremities, a pulse greater than 100, who is crying, flexing extremities has an APGAR score of what?
8
When resuscitating a newborn, whos heart rate is between 60-100 (after 30 seconds ventilation) what should the paramedic do next?
- ensure adequate mask and seal (BVM), correct airway position (neutral, padding under shoulders), if HR between 60-100 add O2 5L/min via BVM
What is restitution?
When the babies head rotates 90 degrees (to face the mothers thigh) indicating the the internal rotation of the shoulder is happening just before the birth of the body
Is a cord prolapse more common in a breech presentation?
Yes
How would you prevent hypothermia in the breech baby?
- maintain a warm environment
- use bubble wrap of the obstetric kit (dont rip it open) to wrap the baby if the body is exposed for an extended period of time
- cool air may stimulate the baby to breathe, which is not desirable if the head remains unborn
What would you use Lovesett’s manoeuvre?
- in a breech presentation when the buttocks presents first (and the arms do not birth spontaneously)
Define pre-term labour
- A woman who is in labour with a gestation between 24-<37 weeks
What is McRobert’s manoeuvre?
- The hyperflexion pf the maternal hips (knees to nipples)
- Place the mother in the recumbent position, hips to the edge of the bed for better access to gentle downward traction
- assist the mother to grasp her knees and pull her knees/thighs back as faras possible onto her abdomen ( you may need an assistant)
- Used in birth where there is prolonged time between birthing the head and the body (after 30-60 seconds) = shoulder dystocia
How long does a seizure last in the female with eclampsia? How would you manage this?
- typically no more than 90 seconds (provided not a history of epilepsy. Manage as per seizures)
