OMED 1401 - Advanced Patient Assessment (OBSTETRIC ASSESSMENT) Flashcards
What are the Red Flags of a Pregnant Patient?
- Miscarriage
- Ectopic Pregnancy
- Pre-Eclampsia
- Eclampsia
- Haemorrhage: Anti Partum
- Pulmonary Embolism
- Haemorrhage: Post Partum
- Mental Health/Post Natal Depression
- Maternal Sepsis
How to Assess the History, Vital Signs and Red Flags in a Pregnant Patient?
DRCABCDE/Primary Survey
- Environment: Prepare for Birth Imminent?
Introduce Self, Gain Consent, Ensure Dignity, Comfort, Privacy.
Take a General Patient History
- Medical Model
- Pain Assessment: SOCRATES/OPQRST
- MJTHREADS
Take a Maternal Patient History
- Parity, Gravida
- Risk Factors
- Previous Foetal or Birth Complications.
Gravida - How Many Pregnancies a Person has had?
Parity - How Many Live Births.
What to Consider the Following for Miscarriage?
Miscarriage is the Loss of your Baby before 24 Weeks. Early happens in the First 12 Weeks of Pregnancy. Late Miscarriages happen Between 12 & 24 Weeks.
Is there any Pain?
- Where is the Location of the Pain?
- Are you Certain this is Pregnancy Located?
- Consider Alternative Diagnoses.
- Complete a Pain Assessment Tool
- What Pain Relief should be Given/Avoided?
Is there any Bleeding?
What are the Characteristics of the Bleeding?
Estimate a Quantity
Are there any Other Potential Causes for Bleeding?
What to Consider in an Ectopic Pregnancy?
At what Gestation does Ectopic Pregnancy typically Occur?
Between the 4th & 12th Weeks
Is there any Pain?
- Where is the Location of the Pain?
- Consider Referred Pain
- Consider Alternative Diagnoses.
- Complete a Pain Assessment Tool.
- What Pain Relief should be Given/Avoided
Is there any Bleeding?
Usually Concealed - How can we Detect this?
Are there any Potential Causes for the Bleeding?
What is there to Consider for Pre-Eclampsia?
Usually Occurs in Second Half of Pregnancy OR Post Delivery.
What is Pre Eclampsia?
Condition that Causes High Blood Pressure during Pregnancy and After Labour. Early Signs include High Blood Pressure and Protein in your Pee.
What are the Typical Signs and Symptoms?
- Hypertension
- Proteinuria
- Oedema
- Headache
- Vision Problems
Assess for Pain and Consider Alternative Diagnoses.
- PAIN IS OFTEN LOCATED JUST BELOW RIBS.
What is there to Consider in Eclampsia?
Seizures that Occur in Pregnancy People with Preeclampsia. Symptoms of Eclampsia are High Blood Pressure, Headaches, Blurry Vision and Convulsions.
- Seizures Associated with Pre-Eclampsia
What are the Typical Signs and Symptoms (HELLP)?
Haemolysis - The Rupture of Red Blood Cells and Release of their Contents into Surrounding Fluid.
Can be Intravascular or Extravascular.
Abnormal Paleness, Dizziness, Confusion.
Elevated Liver Enzymes
Low Platelet Count.
Given an Anti-Convulsant Drug to Control the Eclamptic Fit and to Prevent Further Fits.
Diazepam can be Used after 2-3 Minutes.
What is HELLP Syndrome?
Often Considered to be a Variant of Preeclampsia. However, although HELLP Syndrome and Preeclampsia are Closely Linked. It’s Possible for an Expectant Mother to have HELLP Syndrome without High BP or Certain Aspects of Preeclampsia.
Characteristics of HELLP Include:
Hemolysis - Red Blood Cells are Broken Down too Quickly. This can Lead to Anaemia, a Problem Involving insufficient Transport of Oxygen throughout the Body.
Elevated Liver Enzymes - This can be Taken as a Sign that Liver Function is Compromised.
Low Platelet Count - Platelets help with Blood Clotting, so an Unusually Low Level of Platelets indicates that a Person is at Risk for Excessive Bleeding.
HELLP Syndrome - Symptoms
- Headaches
- Nausea and Vomiting: Continue to Worsen
- Upper Right Abdominal Pain
- Fatigue
- Pallor
What to Consider in a Anti-Partum Haemorrhage?
Placenta Previa - Placenta Overlaps and Implants on the Cervix: (23 Weeks)
- Bleeding Always Revealed.
- Blood is Bright Red.
- Painless
- Check for Signs of Shock
Placenta Abruption - Placenta becomes Separated from the Uterine Wall.
- Bleeding is Revealed or Concealed or a Mix of Both
- Dark Coloured
- Painful and Constant
- Pre-Eclampsia Symptoms can be Present.
What to Consider about Pulmonary Embolisms that are Pregnancy Related?
Pregnant Women are 5 Times more likely to Experience Blood Clots than those not Pregnancy.
At High Risk during Pregnancy, Child Birth and up to 3 Months Post Birth.
Why? Increased Clotting, Less Blood Flow to Legs, Immobility Increased, C-Section.
Reminder of the Signs, Symptoms:
DVT - Swelling of Limbs, Pain, Tenderness, Red, Warm to Touch.
Respiratory - Difficulty Breathing, Haemoptysis
Chest Pain (Worsens with Deep Breath)
Faster or Irregular Heart Beat.
What to Consider in a Post-Partum Haemorrhage?
How Much Blood has been Lost? What is a Significant Amount? (500ml)
What is the Cause of the Blood Loss?
Tone - Atonic Uterus (Soft and Weak Uterus after Childbirth, Uterine Muscles don’t Contract enough to Clamp the Placental Blood Vessels shut after Childbirth). Placenta Praevia (Problem During Pregnancy when the Placenta Completely or Partially Covers the Opening of the Uterus)
Trauma - Lacerations (Cervical, Vaginal, Perineal); Inverted Uterus (Aims Towards the Rectum instead of Towards the Belly). Uterine Rupture (Uterus Tears or Breaks Open). Pelvis Haematoma (Collections of Blood Located in the Pelvic Peritoneal Space). Caesarean (Operation to Deliver the Baby through a Cut Made in your Tummy and Womb).
Tissue - Retained Tissue, Invasive Placenta (Condition which the Placenta attaches too Strongly or Invades too Deeply into the Wall of the Uterus).
Thrombin - Coagulopathies (Affects how the Blood Clots, Resulting in increased Bleeding)
Clotting Disorders (Raises Risk of Clotting during Pregnancy. Especially True if History of Blood Clots)
- Syntometrin (Injection)
- Tranexamic Acid
- Misoprostol (Tablets)
Give Fluids before TXA
What to Consider in Mental Health and Post Natal Depression?
Timing - A Third of Women with PND have Symptoms during Pregnancy which Continue Post Birth. PND often starts within 1-2 Months of Giving Birth.
Signs/Symptoms - Depressed, Low, Unhappy, Tearful, Irritable, Tired, Sleepless, Change of Appetite, Negative and Guilty Thoughts, Anxiety, Hopelessness.
Incidence - Approx. 10-15 Women in every 100 who have a Baby.
Consider Maternal Suicide and Psychosis.
Baby - Consider Child Protection, Safeguarding, Non Accidental Injury, Welfare Concerns.
What are Common Causes of Maternal Sepsis?
Miscarriages (Particulary Non-Sterile)
Caesarean Section (Surgery Risk)
Prolonged Time - Rupture of Membranes to Birth
Infection Post Vaginal Delivery (esp. Outside of a Hospital Environment)
Mastitis (Breast Infection)
Any other Infection which can Occur in Non-Pregnant People.
What is the Endocrine System Responsible For in Pregnancy?
Hormones from the Ovary and Placenta are Responsible for Most of the Changed:
Oestrogen - Growth of the Uterus & Duct System of the Breast and Nipples.
Progesterone - Maintenance and Development of the Endometrium (Known as the Decidua during Pregnancy) & Growth of Breast Tissue.
Also Relaxes the Smooth Muscle.
What happens to the Cardiovascular System During Pregnancy?
Occur in the First 8 Week of Pregnancy with Maximum Changes around 28 Weeks. The Physiological Changes Influences the Management of Pregnant Patient.
—> Blood Volume (about 30-50%)
<— Hg Concentration (Physiologic Anaemia of Pregnancy)
—> HR by 15-20BPM.
Pregnant Patients can Tolerate Greater Blood Loss before Showing Signs of Hypovolaemia. Compensate at the Expense of Shunting Blood Away from the Uterus to the Vital Organs.
Pressure of the Growing Uterus may cause Vena Cava Compression, Reduced Venous Return, Lowers Cardiac Output in turn Reduced BP, thus making Resuscitation Difficult.
What Happens to the Respiratory System During Pregnancy?
The Diaphragm is Splinted (Pushed Upwards) and Transverse Diameter of the Chest Increases.
Total Volume Increases by 30-40%. Ventilation Increases by the Women Deepening her Respirations and Not by Breathing more to Increase the Amount of Oxygen Available for Maternal and Fetal Metabolism.
Oxygen Consumption Increased by about 16% and Alveoli Ventilation Increased by 50%.
In 3rd Trimester, Pregnant Patients may Experience Dyspnoea, Dizziness, Hyperventilation and Fainting Episodes.
