Pregnancy & Childbirth Flashcards
CPR compression/breath ratio infants
30:2 one person rescue
15:2 two ppl rescue
At how many weeks does the fetus become viable to survive outside the womb?
26 weeks
Gravida vs Para
Gravida (get it on): total number of pregnancies (inc current)
Para (parents): number of deliveries after 20 weeks of pregnacy
Gestation is typically how many weeks?
40
physiologic changes in pregnancy
inc HR
inc BV (can bleed out more before showing signs of shock)
BP could drop slightly (esp if supine)
slower GI motility (inc risk emesis)
factors that contribute to a high risk pregnancy
age
no prenatal care
diabetes
HTN
drug/etoh abuse
smoking
what is supine hypotensive syndrome? what are sx and tx?
the fetus on the inferior vena cava causes reduced blood flow back to the heart > dec BP
mother changes BP when laying on back, lightheadedness and syncope
tx: place motheron her side and push fetus off IVC
def of abortion and spontaneous vs induced
expulsion of fetal tissue before 20th week
spontaneous: miscarriage due to natural causes
induced: purposeful termination
sx abortion
vaginal bleeding
passing of tissue
cramping
shock
where do 95% of ectopic pregnancies occur?
fallopian tube
signs/sx and tx ectopic pregnancy
abdominal pain
vaginal bleeding
shock
CMT
palpable mass
RF: PID, STI, pelvic surgery, IUD use
workup: laparoscopy (definitive), US
tx: tx for shock
what is placenta previa? what are signs/sx?
the placenta grows over or near the cervical neck
total: completely covers internal os; partial, marginal (close but doesnt cover any part)
2nd and 3rd trimester bleeding (bright red)
painless
signs of shock
dx by US
what is abrupto placenta? what are signs/sx?
previously normally implanted placenta is detached from the uterine wall after 20 wks > bleeding into the uterus
severe abdominal pain/uterine tenderness
contractions
PAINFUL vaginal bleeding that is dark (not always present)
shock (that can be out of proportion to noticable bleeding)
RF: HTN, maternal trauma, smoking, alcohol, cocaine, >35
what is the most common disorder of pregnancy, what causes it, and when does it develop?
gestational HTN (>140/90 after 20 wks); vasoconstriction > higher BP
do NOT rx ACE, propanolol, diuretics
what is pre-eclampsia/toxemia?
when HTN continues along with organ damage (CNS, pulmonary, renal) due to vasospasm and leaky capillaries
kidney effect > issues with BP regulation/water retention
usu last trimester
signs/sx pre-eclampsia
HTN 140/90
edema (hands, face, ankles, feet, pulm edema)
neuro sx (HA, visual disturbances, confusion, hyperreflexia)
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) - can be seen without high BP too!
pre-eclampsia tx
ABCs
high flow O2
be ready for seizures
quiet transport
CCB, hydralazine
what is the difference between pre-eclampsia and eclampsia?
pre-eclampsia: dBP >90-109 + proteinuria
eclampsia: dBP > 90 with seizures
tx eclampsia
ABCs
high flow O2
protect pt from injury
rapid transport
ALS for seizure control
phenytoin
what is a uterine rupture? what could cause it?
rupture of uterus expelling all or part of fetus into abdomen
occurs during labor, at risk mothers (multiple births, previous c sections)
uterine rupture signs/sx and tx
labor pain considerably dec or stops
signs of shock
possible abnormal shaping of the abdomen
ABCs
high flow O2
tx for shock
MAST are probably harmful
rapid transport
changes at onset of labor
braxton hicks contractions change to regular contractions w dec interval
effacement: cervix thins to allow the delivery
mucus plug expelled
membrane rupture and amniotic fluid expelled
stages of labor
first stage: contractions > infant in birth canal
second: infant delivery
third: placenta delivery
fourth: post delivery contractions
signs of immanent childbirth
the need for a BM
urge to push
crowning
contractions 2 mins apart, 45 sec to 1 min in length
APGAR Score components
Appearance (blue / pink)
Pulse
Grimace
Activity
Respirations
done at 1 min, 5 min, every 5 min if score <7
what would be indications for bag valve mask or chest compressions?
bag valve mask: HR < 100, RR <30
CPR: HR < 60
normal APGAR
7-10
what is a breech presentation?
baby is positioned feet or butt first
deliverable baby unless head does not deliver quickly
what is a prolapsed cord? what is tx?
cord is sticking out of vagina before head; caused by gush of amniotic fluid
attempt to slow/stop birth, position mother prone with butt elevated (knee chest position), to reduce pressure ; wait for EMS
ddx lactation disorders
galactocele
lactating adenoma
pregnancy associated breast CA
what is contraindicated in placenta previa?
vaginal exam (inc risk hemorrhage)
what is postpartum hemorrhage defined as and how do you treat it?
> 500 mL blood loss within first 24 hour PP
tx: monitor vitals, IV oxytocin, raise legs, keep pt warm, oxygen, ER
what is precipitous birth? what complications can arise?
rapid labor <3 hrs from start of contractions
inc risk hemorrhage
at what gestational week is preterm labor?
20-36 weeks
at how long is a placenta considered retained? what could a retained placenta lead to?
within 30 mins; will lead to hemorrhage
tx for rh factor incompatibility
IM Rhogam
what is a threatened/spontaneous abortion? when is it considered an emergency?
naturally occurs >20 weeks, onset usually 8-12 weeks
due to placental insufficiency in producing progesterone
if pt soaking more than 2 pads w blood per hour > ER
what is the most common condition during pregnancy? tx?
UTI; amoxicillin
when does gestational diabetes occur and why?
24-28 weeks
placenta produced anti-insulin factors and high maternal cortisol levels
RF for gestational diabetes
> 25
fhx diabetes
PCOS
use of glucocorticoids
essential HTN
workup for gestational diabetes
1 hour oral glucose tolerance test (OGTT) > 140 mg / dL
newborn risks with gestational diabetes
RDS, macrosomia, inc risk open neural tube defects, neonatal hypoglycemia (give glucose at birth)
maternal complications gestational diabetes
diabetes later in life
tx gestational diabetes
insulin (cease after delivery)
f/u OGTT postpartum
what are maternal infections to be aware of during pregnancy?
strep B
toxoplasmosis
rubella
group B strep infxn during pregnancy; etiology and risks
normal strep flora in vagina
risk of vertical transmission leading to neonatal sepsis, meningitis, pneumonia, death of fetus
group B strep infxn during pregnancy; RF
previous infant with GBS infxn, preterm labor <37 weeks, prolonged rupture of membranes before delivery, intrapartum maternal temp >38 C
group B strep infxn during pregnancy; workup and tx
all preg pts screened at 35-37 weeks with vaginal/anorectal swabs for culture
abx for GBS prophylaxis; penicillin or clindamycin. if fever > broad spectrum abx
toxoplasmosis etiology
protozoa (toxoplasma gondii) transmitted to mother through raw meat, unpasteurized goat milk, cat feces/urine (no litterbox cleaning!!)
toxoplasmosis sx/workup
maternal: flu like sx
fetus: chorioretinitis/blindness, SN deafness, CNS calcification in basal ganglia, hydrocephalus, hepatosplenomegaly
serum IgM and IgG, PCR amniotic fluid
what is gestational trophoblastic disease?
proliferative abnormalities of trophoblast
complete mole or partial mole
what is a complete mole?
benign tumors of chorionic villus
46 XX or 46 YY where sperm fertilizes empty egg or duplication of 23 X sperm in ovum (lack of maternal chromosomes)
sx: painless bleeding in month 4/5, severe vomiting, preeclampsia, theca-lutein cysts, ovarian enlargement, no fetal HB
what is a partial (incomplete) mole?
hydropic villi and focal trophoblastic hyperplasia with fetus or fetal parts, often ovum is triloid (XXY, XYY, XXX) w chromos from both parents
similar sx to threatened, spontaneous, or missed abortion
PE/workup for complete (hydatidaform) mole
hCG > 100,000 IU/L
“snow storm” appearance on US (swelling of villa with no fetus)
no fetal heartbeat
pathogenesis rubella
contracted via respiratory droplets and transmitted transplacentally in first trimester
rubella sx
mother:
3 day rash face > trunk/extremities
low grade fever, joint pain, post auricular or occipital lymphadenopathy
fetus:
SN deafness, cataracts, thrombocytopenia
“blueberry muffin rash”
hepatomegaly
PDA
workup and tx rubella
ELISA IgM 4x IgG in acute infection
MMR vaccine AFTER pregnancy (NOT during, it is live attenuated)
toxoplasmosis tx
spiramycin
main screening testing done on neonates
metabolic screen (R/O PKU, hypothyroid)
ABO-Rh
Bilirubin (R/O hyperbilirubinemia)
when are ergonovine or methyl-ergonovine (ergot alkaloids) used?
ONLY in postpartum/postabortive hemorrhage tx + prevention NEVER in labor/delivery process
at what point do teratogens have inc risk birth defects
after 3 weeks
weeks 1 and 2 pregnancy is either lost or will continue with less risks
