Pregnancy Flashcards
Define Antepartum
period before a baby is born (pregnancy)
Define Intrapartum
labour
Define Postpartum
period after baby is born (up to 6 weeks)
Define Primip
person giving birth for the first time
Define Multip
person who has given birth two or more times
What are the 2 types of abortions?
- spontaneous/miscarriage
- induced/therapeutic
How old does a fetus need to be to be considered Term?
37 weeks or greater
How old does a fetus need to be to be considered preterm
20+0 to 36+6
How is a due date calculated for fetus?
Its 40 weeks from conception
When is labour typically induced?
Babies are induced typically around 10 days post due date
Define Para
number of babies born
Define Gravida
Number of confirmed pregnancies
What does GTPAL stand for
G - Gravida
T - term babies
P - preterm babies
A - abortions
L - living
What are the questions you want to ask when doing a History Gathering on a pregnant pt?
- due date
- any problems with current pregnancy
- Abdominal pain/contractions present
- Bloody show (usually caused by cervical change)
- Amniotic fluid seen once spontaneous rupture of membranes (SROM) has occurred
- Para/Gravida or GTPAL
- position of fetus
- Hx of complications in pregnancy or birth including previous c-sections
- Duration of active labour in past pregnancies
How do you time contractions?
From the start of one contraction to the start of another
When is a birth imminent with a Primip? (contraction times)
2-3 min apart
When is a birth imminent with a multip? (contraction times)
5 minutes apart
How do you determine the strength of the contraction
palpate the fundus for intensity of contractions
When a contraction lasts this long, birth is imminent
60-90 seconds
True or False: A multip may present as a primip if this is their first time delivering a baby vaginally
True
What are some key assesments of an OB pt?
- uterine height
- fetal movement
- Timing and intensity of contractions
- Visualize perineum (if appropriate) - rule out cord prolapse and determine if birth is imminent
What are the 2 transport positions for transporting a pregnant pt?
- semi sitting
- left lateral position
When and why should you transport a pregnant pt in the left lateral position
- only after 20+ weeks gestation
- this position helps relieve pressure on the IVC
- tilt pt 30 degrees to the left
What are some pregnancy complications that can occur in the 1st trimester? (think hemorrhage)
- spontaneous abortion
- ectopic pregnancy
- gestational trophoblastic disease (GTD)
What are some pregnancy complications in the second and third trimester? (think hemorrhage)
- abrupto placenta
- placenta previa
- Ruptured Uterus
What is a spontaneous abortion?
loss of pregnancy before 14 weeks of gestation
If a pt has already had 1 miscarriage, are they likely to have another?
Yes
Signs and Sympotms of Spontaneous Abortion
- bleeding
- spotting
- abnormal abdominal cramping
Treatment for a spontaneous abortion
- sanitary pads
- treat for shock
Define Ectopic Pregnancy
fertillized egg implanted somewhere other than the uterus
Where could a fertilized egg implant other than the uterus
- fallopian tube
- outside uterus in abdo cavity
- cervix
What are the signs and symptoms if an ectopic pregnancy ruptures
- sudden onset of severe abdo pain (lower quadrant)
- Vaginal bleeding (sometimes)
- Shock (can go septic)
What is a Gestational Trophoblastic Disease (molar pregnancy)
- Normally, fertilized eggs divide and grow into a mass of cells called a blastocyst. Blastocyst contains early embryo and trophoblastic cells
- These pregnancies may lack an embryo and have abnormal growth of trophoblastic tissue (which would normally become the placenta)
Signs and Symptoms of Gestational Trophoblastic Disease
- vaginal bleeding
- uterine enlargement greater than expected for gestational age
- Absent fetal heart sounds
- hyperemesis gravidarum
Treatment for Gestational Trophoblastic Disease
- Dilation and Curettage
- Hysterectomy (if no longer want children)
Can there be pregnancy complications in the second trimester (hemorrhage)
Yes (spontaneous abortion up to 28 weeks gestation), but it is rare
Define Abrupto Placenta
Premature, spontaneous, partial or complete detachment of a normally implanted placenta in 3rd trimester
- can occur in trauma scenarios
True or False - Abrupto Placenta has a low fetal mortality
False - Abrupto placenta has a high mortality rate
Signs and Symptoms of Abrubtio Placenta
- Sudden Vaginal in 3rd trimester (bright red or dark with clots)
- Abdo pain or tenderness
- Rigid Uterus
Treatment for Abruptio placenta
- shcok
- high flow O2
- sanitary pads
True or False - Bleeding in Abruptio Placenta can be external or internal.
True - Depending on where the placenta is the bleeding could either be concealed behind the baby, or bleeding in front of the baby which would allow for blood to flow out of the vagina
Define Placenta Previa
- placental implantation in the lower uterine segment encroaching on or covering the cervical opening
In a pt with placenta previa, when the cervix starts to dilate, what will happen?
the placenta will tear
Signs and Symptoms of Placenta Previa
- Painless
- Bright red blood without uterine contraction
Define Uterine rupture
- spontaneous or traumatic rutpure of the uterine wall
- usually results from a weakened part of the uterine wall from previous c-section (scar), prolonged labour or direct trauma
Uterine Rupture has a high mortality rate
True - emergency c-section required - baby gets cut off from blood when mom needs blood
Signs and Symptoms of Uterine Rupture
- Sudden abdo pain described as steady or tearingock, vaginal active labour
- shock, vaginal bleeding may or may not be visible
- fetal parts may be easily palpated
At 12 weeks gestation, where is the fundus located?
Just above the pubic bone
Where is the fundus located at 20 weeks gestation?
Umbilicus
Where is the fundus located at 36-38 weeks gestation?
Right up under Sternum
General Treatment for pregnancy complications
- look after ABCs
- Place patient in left lateral position
- immediate transport
- place pads under perineum
Pre-eclampsia triad
- hypertension
- edema
- proteinuria
Difference between eclampsia and pre-eclampsia
Pre-eclampsia - HTN and bedbound
Eclampsia - occurrence of seizures in pre-eclamptic pt due to hypertension
Define Eclampsia
- Due to HTN may develop cerebral edema and/or cerebral hemorrhage
- during seizure, mom becomes hypoxic, but fetus becomes extremely hypoxic
Treatment for Eclampsia
- manage seizure
- high flow O2
- baby needs to be delivered
What does HELLP mean and what does it reference?
H - Hemolysis
EL - Elevated Liver enzymes
LP - Low platelet count
Variant of Pre-eclampsia
Signs and Symptoms of HELLP
- HA
- N/V
- swelling
- visual changes
- abdo pain
When is PIH developed?
over 20 weeks
What is the difference between PIH and Pre-eclampsia
PIH is only hypertension, none other of the pre-eclampsia triad
PIH does not reverse with birth of infant (True or False)
False
What causes PIH?
Increased blood volume from creating the baby. The pts still respond to other vasoactive treatment
What can cause an increased risk of pre-eclampsia and PIH
Gestational Diabetes
Treat mom to
treat baby
What is Supine Hypotension Syndrome?
When the developing fetus puts pressure on IVC which causes venous return and decreased CO. Pt may become symptomatic
What is one thing you ust do when running a maternal cardiac arrest
Lateral Uterine Displacement
Define Shoulder Dystocia
The inability of fetus’ shoulders to spontaneously deliver
What type of babies and pts are susceptible to shoulder dystocia
- big babies
- hx of gestation diabetes
- obese pts
- hx of shoulder dystocia
How to manage a pt with shoulder dystocia
Perform alarm twice then transport
What does ALARM stand for in the context of shoulder dystocia
A - Ask for help
L - Legs, McRoberts Manuever (push legs back with knees up to open the pelvis)
A - anterior should disempaction (push suprapubic to try and dislodge)
R - gaskins, pt goes on hands and knees
M - manual maneuver, attempt to deliver posterior arm
Signs and Symptoms of Shoulder Dystocia
- turtling sign
- possible cyanosis of the head
Define Breech birth
Position where baby buttocks or foot/feet is the presenting part
How to manage a breech birth
- Position pt at the end of the bed
- HANDS OFF the breech: may assist with gentle release of legs and arms
- time once baby is born to umbilicus is ideally 4 minutes
- help deliver head of baby with Mauriceau-Smelle-Veit Manouver
When delivering twins, when do you cut the the umbilical cord of twin A?
Immdiately
What are signs and symptoms of a cord prolapse?
cord seen out of vagina ahead of fetus
Define cord prolapse
cord lies alongside or in front of the presenting part.
What is the management for a pt with cord prolapse?
- move pt into hands and knees position
- Gently cradle cord and replace back in to vagina inserting fingers/hand in order to elevate fetus off the cord
- hold until arrival at hospital and care is transferred
How to manage a PPH when the placenta is undelivered
- attempt to deliver placenta
- external bimanual compression
Once the placenta has been delivered how can a paramedic manage a pt with PPH
- Uterine Massage
- External bimanual compression
Define Uncomplicated Childbirth
labour that progresses to a spontaneous vaginal birth between 37 and 42 weeks of gestation
Define Precipitous birth
birth that occurs within 3 hours from the onset of regular contractions
What occurs in stage 1 of labour?
- longest stage of the 3 stages
- baby descends in to pelvis
- cervix softens, effaces and dilates
- SROM may occur
- Uterine contractions gradually increase in frequency, strength and length over time
What occurs in stage 2 of labour? (Stages of imminent birth)
- Contractions every 2-3 min (5 min for multip, lasting 60-90 seconds
- Crowning (presenting part) or bulging membrane is visible at vaginal opening and/or perineum bulging with contraction
- contractions associated with urge to push or to move bowels
- Patient reports feeling pressure in their buttocks stretching or burning of perineum
What occurs in stage 3 of labour
Delivery of placenta
What are signs of separation of the placenta
- lengthening of cord
- contraction
- small gush of blood
What are things to rmember when delivering the placenta
- Guard Uterus
- Gentle cord traction on all umbilical cords
- bag placenta and bring to hospital
What does it mean to guard the uterus?
Press down suprapubicly
What are the 8 steps of the mechanisms of labour?
- Descent
- Engagement
- Neck Flexion
- Internal Rotation
- Crowning
- Extension of the presenting part
- Restitution
- Birth of newborwn
What occurs during the descent and engagement step in child labour
- the fetus descends into the pelvis
Descent is encouraged by - Increased abdo muscle tone and unterine contractions (fundal dominance) - Engagement is when the widest part of the fetal heads is in the the widest part of the pelvis
Define crowning
- when the widest diameter of the fetal head negotiates through the narrowest part of the maternal pelvis
- head is visible at the vulva and no longer retraccts between contractions
- Complete delivery of the head is imminent
Define Extension in the context of a step of childbirth
- extension is when the occiput slips beneath the suprapubic arch allowing the head to extend. The fetal head is now born and usually faces moms back
Define Restitution in the context of a step of childbirth
Restitution is when the head turns to align with the shoulders - either to the right or left medial thigh of the mother
After the babys head is delivered there will typically be a natural pause, what should you do during this natural pause
- assess for nuchal cord
- loosen and slide over babys head
- somesault baby during birth
- as a last resort you can clamp and cut a nuchal cord
What does bum,bum,bum,tum,tum,tum mean?
reminder for how to position the baby when delivering shoulders
What are some practical steps with the pt to prepare for imminent birth?
- assist pt to a firm, flat surface
- Patient supine, legs flexed and abducted, perineum
- provide warmth, ensure adequate lighting
- plastic bag or sheet, sterile drape under buttocks
If birth is progressing normally, do we intervene?
NO
What are some steps of immdiate postpartum care
- administer oxytocin
- preapre for and intiate transport after birth
- watch for signs of placental separation
- check fundus and monitor for vaginal bleeding
- monitor patients vitals
- consider external uterine massage only if placenta has been delivered and there is excessive bleeding
What does Oxytocin stimualte in the body during childbirth?
Uterine Contractions
- also associated with increasing lactation for breast-feeding
What is the goal of oxytocin administration?
to prevent and limit post-partum hemorhage
At what time do you cut the cord after birth?
2-3 minutes
How far is the first clamp located from the baby?
approx 15 cm from babys abdomen
What is meconium?
babys first bowel movement
When clamping the cord, how far above the 1st clamp is the 2nd clamp?
5-7 cm
Where do you cut the cord?
Between the first and second clamp
When do you assess APGAR
at 1 and 5 min
What can meconium stained amniotic fluid indicate
fetal distress
What does APGAR stand for
A - Appearance
P - pulse
G - Grimace
A - activity
R - respiration
