SMOs- OB/GYN

Question 1

Emergency Childbirth Labor and Delivery (55)

Answer 1

Hx TD Cel

1. Obtain history and determine if there is time to transport
   - # of pregnancies
   - # of live births
   - Due date
   - How far contractions are
2. Teach slow breaths if hyperventilating with O2 NRB 12-15LPM
3. Delivery
   - Cord around neck= attempt to loosen/remove it. if unable, clamp twice and cut
   - Normal delivery= wrap in blanket and monitor airway
4. Post-partum care protocol and transport

Question 2

Obstetrical Complications (56) 
Third trimester bleeding (Placenta Previa, Abruptio Placenta, Trauma)

Answer 2

TO LINT

1. Transport immediately
2. 100% Oxygen
3. Place on left side
4. IV NS to keep SBP>90
5. Transport resumed

Question 3

Obstetrical Complications (56)
Pre-Eclampsia or Toxemia

Answer 3

TO L.S

1. Transport immediately
2. Oxygen 12-15LPM
3. Place on left side
4. Seizure precaution
   - Adult seizure protocol (44)

Question 4

Abnormal Deliveries (57)
Prolapsed Cord

Answer 4

1. Transport immediately
2. 100% Oxygen
3. Elevate mothers hips
4. Place gloved hand in vagina to remove pressure between cord and neck
   - Keep exposed cord moist and warm
   - Keep hand in position while enroute

Question 5

Abnormal Deliveries (57)
Breech Birth

Answer 5

TP

1. Transport immediately (Acc.)
2. If legs delivery, support body, wrapped in towel
3. After trunk, deliver head
   - If face down, elevate trunk and legs to help guide
   - If head doesnt deliver, placed gloved hand into vagina and find mouth (V with fingers). Apply gentle pressure to mother’s mid upper abdomen
4. Maintain position until delivery or arrival to hospital

Question 6

Resuscitation and Care of the Newborn (58)

Answer 6

Smooth delivery/Good APGAR score:

1. Place baby on mom’s belly
2. After 30-60 seconds, clamp and cut cords
3. Warm, dry, and stimulate
4. Suction if needed
5. Support and transport

Bad APGAR Score (Upside down pyramid):
1. Clamp and cut cord
2. Warm, dry, stimulate, suction
3. Oxygen 5-10LPM
4. Assist ventilations with BVM (40-60 bpm)
(If answer is no= support and transport)
HR <100bpm
5. Consider intubation and/or reposition airway 
HR <60bpm
6.  Intubate and Chest compressions
-ratio 3:1
-with 100% O2
HR <60bpm
7. Epi .01mg/kg 1:10,000 q 3-5 if HR remains <60

Question 7

Maternal Care (59)

Answer 7

1. Transport immediately
2. Allow placenta to deliver on own (20-30 minutes) (collect in bag and bring with)
3. If perineum is torn and bleeding, apply direct pressure with sterile dressing
4. If profuse bleeding= massage uterus and give NS bolus to keep SBP >90

Question 8

Review APGAR Score

Answer 8

Review