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Bachelor of Paramedic Science > SPOPs Obstetrics > Flashcards

SPOPs Obstetrics Flashcards

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1
Q

3 Types of Placental Abruption

A

Marginal - an edge has detached

Central - centre has detached

Complete - whole placenta has detached

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2
Q

4 Primary Causes of PPH (4 Ts)

A

Tone - poor uterine tone (70%)

Trauma - tears of the vulva, vagina or cervix, or uterine rupture (20%)

Tissue - retained products (10%)

Thrombin - coagulopathy disorders (1%)

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3
Q

9 Stages of the Golden Hour

(4th Stage of Labour)

A

birth cry

relax

awake

activity

rest

crawling
(finding boob)

familirisation

sucking

sleeping

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4
Q

Active Management of Third Stage of Labour

(preferred)

A

skin to skin with mother

rapid assessment of bleeding with delivery

1 min APGAR

warming of baby

consent of mother for oxytocin

administer oxytocin

clamping and cutting the cord

early application of SPO2 monitor

5 min APGAR

Continued observation of bleeding and mother

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5
Q

After initial assessment, if newborn is crying and breathing…

A

Immediate skin to skin contact with mother (increases oxytocin production)

Immediately warm and baby with blanket and beanie

APGAR 1 minute and 5 minutes after delivery

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6
Q

All Fours Running Start Position Procedure

A

Flip into Gaskins

Lift leg for runing start

rotate foetus to oblique

remove posterior arm

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7
Q

Antepartum Haemorrhage (APH)

A

Any bleeding from the genital tract after 20 weeks of pregnancy and before labour onset

affects approx 2-5% of all pregnancies

Primary causes are placenta abruption (30%) and placenta praevia (20%)

Any APH needs to be taken seriously as a potential time critical situation

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8
Q

APGAR Activity Scoring

A

Active movement - 2

Arms, legs flexed - 1

No movement - 0

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9
Q

APGAR Appearance Scoring

A

Pink - 2

Blue extremities - 1

Pale or blue - 0

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10
Q

APGAR Grimace Scoring

A

Cries and pulls away - 2

Grimaces or weak cry - 1

No response to stimulation - 0

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11
Q

APGAR Pulse Scoring

A

> 100 bpm - 2

< 100 bpm - 1

No pulse - 0

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12
Q

APGAR Respiration Scoring

A

Strong cry - 2

Slow, irregular - 1

No breathing - 0

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13
Q

Benefits of Delayed Cord Clamping

A

Increase in blood volume of 80-100 mls and up to 300mls

Optimum iron scores at birth and higher scores at 3-6 months

Supports transition from fetal to neonatal circulation

Less risk of brain haemorrhage and ischeamic gut premature babies

Reduced risk of anaemia

Optimum transfer of antibodies and stem cells, boosting immunity

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14
Q

Birth of the Head Procedure

A

pant and small pushes with contractions as the baby’s head delivers

to control birth of the head, place flats of fingers against baby’s head to keep it flexed and prevent explosive delivery

once baby’s head delivers and mother ceases pushing, encourage mother to continue pushing with each contraction to deliver the shoulders

allow the baby’s head to turn spontaneously

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15
Q

Birth of the Shoulders and Body Procedure

A

Place a hand on each side of the fetal head

Wait for the next contraction and ask the mother to push gently with the next contraction

Apply slight downward traction to deliver anterior shoulder

Provide slight upward traction to deliver the posterior shoulder

Make sure you have a good grip and support on baby throughout the delivery

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16
Q

Blood Flow Through the Foramen Ovale

A

2/3 blood volume goes from RA to LA then to LV then to aorta
1/3 foetal blood goes to RV

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17
Q

Braxton Hicks Signs and Symptoms

A

feels like tightening or very mild cramping

no regular pattern

goes away with rest, hydration, position changes, and time

do not feel stronger over time

localized in the lower abdomen and groin

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18
Q

Breech Delivery Complications

A

Foetal distress/hypoxia

Failure to deliver

Pain

Prolapsed cord

Shoulder dystocia

Head entrapment

Meconium aspiration

PPH

Soft tissue injuries

Foetal Spleen/liver damage

(premature inspiration before head birthed)

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19
Q

Breech Delivery Occurance

A

3-4% of term deliveries

common before 35 - 36 weeks gestation

more common in nulliparous women

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20
Q

Breech Delivery Procedure

A

rapid recognition and call for backup

Prepare early for neonatal resuscitation

Hands off - Delivery should proceed spontaneously through gravity, maternal effort and uterine action

perform manoeuvres if complications or failure to deliver

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21
Q

Breech Delivery Risk Factors

A

Multiparity

Uterine malformations

Fibroids

Placenta Praevia

Prematurity

Macrosomia

Twin pregnancy

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22
Q

What is breech delivery?

A

the foetus in the longitudinal lie with the buttocks or lower extremity entering the pelvis first

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23
Q

Clamp and Cutting of Umbilical Cord

A

one-third of baby’s circulating blood contained within the placenta and umbilical cord

blood contains essential nutrients and stem cells

wait 3-5 minutes after birth or until cord has stopped pulsating

It will appear drained, limp and white in colour once stopped pulsating

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24
Q

Classification of Miscarriage

A

missed

threatened

inevitable

incomplete

complete

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25
Q

Complete Miscarriage

A

vaginal bleeding

closed cervical os

products of conception completely expelled

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26
Q

Complications of cord prolapse

A

hypoxia

asphyxiation

death

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27
Q

Confirming Shoulder Dystocia

A

baby is not delivered on the next contraction

appropriate traction fails to assist

process of delivery of the shoulders takes longer than 60 seconds.

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28
Q

Cord Prolapse Risk Factors

A

Fetal mal-presentation (breech, transverse, oblique and unstable lie)

Multiparity

Low birth weight (<2.5 kg)

Pre-term labour (<37/40)

Long umbilical cord

Unengaged presenting part

Low-lying placenta

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29
Q

Cord Prolapse Tx

A

If cord is pulsating - modified SIMS, get pt to attempt to place cord back in vagina

If cord not pulsating - knees to chest position, attempts made to push the presenting part off the cord

rapid transport

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30
Q

Current Pregnancy Hx Questions

A

Confirmation of pregnancy (intrauterine)

Gestation of pregnancy (how many weeks)

Singleton or multiple pregnancy

Antenatal care – scans, bloods etc

Any complications or concerns THIS pregnancy

Foetal movements

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31
Q

Degrees of Uterine Inversion

A

1st Degree

2nd Degree (incomplete) - funus reaches cervix

3rd degree (complete) - fundus
passes through the cervix, but does not reach the vaginal opening

4th degree (prolapse) - fundus extends through the vaginal opening

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32
Q

What are the manoeuvres to deliver arms in breech delivery?

A

Loveset’s 1 Manouevre

Loveset’s 2 Manouevre

Loveset’s 3 Manouevre

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33
Q

Delivery of Legs in Breech Birth If Not Delivered Spontaneously

A

deliver one leg at a time

push behind knee to bend leg

grasp the ankle and deliver foot and leg

repeat for other leg

hold baby’s hip with thumbs on bums

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34
Q

Delivery of the Buttocks and Legs

A

tell mum she can push with contractions

let buttocks deliver until lower back and shoulders can be seen

gently hold buttocks in one hand (do not pull)

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35
Q

Delivery of the Placenta

A

assist mother to birth the placenta by her own efforts

encourage upright position, bearing down to expel the placenta OR

guard the uterus by placing one hand supra-pubically and apply steady controlled cord traction until the placenta is visible

support the birth of the placenta and membranes by gently twising to strengthen the placenta and limit the chance of retained products

do not apply increased traction if any resistanc is felt

place into clinical waste bag and take to hospital

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36
Q

Descent of the Placenta

A

After separation, the placenta moves down the birth canal and through the dilated cervix

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37
Q

Early Pregnancy PV Bleeding

A

20-40% will experience bleeding during first trimester

most bleeding in early pregnancy is benign and can be related to implantation

more sinister causes such as miscarriage (10–20% of clinical pregnancies) and ectopic pregnancy (1–2%) cannot be ruled out in the pre-hospital environment

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38
Q

Eclampsia

A

new onset of grand mal seizure activity and/or unexplained coma during pregnancy or post partum in a woman with signs or symptoms of preeclampsia

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39
Q

Eclampsia Management

A

Depending on the severity and gestation of the baby delivery may be considered

Manage symptomatically and take BP’s on every obstetric patient.

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40
Q

Eclampsia Risk Factors

A

Prior preeclampsia

Multiparity

Hypertension

Pre-existing diabetes

BMI >30

Pre-existing kidney disease

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41
Q

Ectopic Pregnancy

A

fertilised ovum implants at a site other than the endometrial lining of the uterus

most commonly in the fallopian tube

Estimated to occur in 1-2% of all pregnancies

as the embryo continues to grow it will rupture around 5-7 weeks when the fallopian tube cannot stretch to accommodate the growth

a ruptured ectopic pregnancy is a true obstetric emergency

95% in the fallopian tube but can also be seen in the ovary and abdominal cavity

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42
Q

Ectopic Pregnancy Management

A

treat symptoms

if ruptured - Pt has uncontolled haemorage so monitor fluids

consider analgesia

antiemetic

IV fluid

transport

If shocked - manage as per CPG: hypovalemic shock

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43
Q

3 objectives of shoulder dystocia emergency manoeuvres

A

Increase the functional size of the bony pelvis

Change the relationship of the bisoacromial diameter within the bony pelvis by rotating the foetus into the wider oblique diameter

Decrease the bisacromial diameter of the foetus

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44
Q

Expected SPO2 Values After Birth

A

1 minute - 68%

3 minutes - 1%

6 minutes - 94%

10 minutes - 97%

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45
Q

Expulsion of the placenta

A

The placenta is completely expelled from the birth canal

end of the third stage of labour

the muscles of the uterus continue to contract and compress the torn blood vessels to combine with blood clotting stops the postpartum bleeding

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46
Q

First Line External Manoeuvres for Shoulder Dystocia

A

McRoberts Manoeuvre

Supra-pubic pressure
(combine with McRoberts)

Gaskins Manoeuvre
(reposition to all fours)

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47
Q

First stage of labour established (active) phase process

A

When cervix dilates to at least 4cm

Regular contractions continue to dilate the cervix

3-4 contractions in 10minute period

Contractions longer in length, more intense
(oxytocin)

Mum more internally focused
(can’t talk - need to concentrate on body)

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48
Q

First stage of labour latent phase process

A

Begins when the cervix starts to soften up and thin out (effacement and dilation)

can last for hours/days

Minor discomfort and niggles

No regularity at this point

tends to be longer in the first pregnancy (6-10 hours to days)

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49
Q

First stage of labour transition phase:

A

Cervix dilates from 7-8cm through till 10cm

Contractions most powerful and intense

spontaneously releases noradrenaline triggering expulsive contractions

often the crisis point for a labouring woman
(feels out of control, can’t go on etc - triggered by noradrenaline)

Contractions at their longest (60-70 seconds), strongest and closest together (<2 minutes)

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50
Q

First Trimester

A

1st day of last menstrual period

cessation of menses

find out pregnant around 4-5 week mark after last menstrual period (LMP)

HCG building up and beginning to cause symptoms of:

breast changes
nausea and vomiting
fatigue

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51
Q

Foetal circulatory systems uses shunts for…

A

to direct blood that needs to be oxygenated

bypasses liver and lungs which are not fully developed

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52
Q

Foetal Complications of Shoulder Dystocia

A

brachial plexus injury (4-40%)

humerous and clavicle fractures (10%)

hypoxic brain injury (0.5-23%)

foetal death (0.4%)

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53
Q

Foetal Development First Trimester

Weeks 10-12

A

end of week 10 embryo is now called a foetus

arms and legs grow longer and start to move

face becomes well-formed

baby is 3 inches long

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54
Q

Foetal Development First Trimester

Weeks 1 - 2

A

not acutally pregnant - calculation date

body preparing for pregnancy

fertilisation occurs around 2 week mark

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55
Q

Foetal Development First Trimester

Weeks 3-4

A

Zygote divides to form a blastocyst ( hollow ball of cells)

cells arrange into 2 groups (inner - baby, outer - tissues to nourish and protect baby)

blastocyst moves into the uterus and hatches through the outer layer

inner layer implants into the uterine wall

water-tight sac forms around the embryo gradually filling with amniotic fluid to cushion growing embryo

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56
Q

Foetal Development First Trimester

Weeks 5-6

A

Embryonic period

Major organs start to grow (brain, spinal cord, heart)

heart begins to beat

placenta starts providing nutrients

bones and muscles begin to grow

embryo starts to look more human

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57
Q

Foetal Development Second Trimester

A

hair beginning to form

nervous system is starting to function

baby beginning to swallow and takes in small gulps of amniotic fluid

genitalia fully developed

fingers and toes are well developed

lanugo and vernix covering baby

baby is now moving freely and developing muscles

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58
Q

Foetal Development Third Trimester

A

foetus can now see and hear

all systems continue to mature

covered in vernix

fatten up

skull bones stay soft to make it easier to pass through birth canal

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59
Q

Foetal manoeuvring during labour

A

anteriposterior plane into the transverse plane

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60
Q

Fourth Stage of Labour

A

Beginning of the post partum period and the first hour after birth

The ‘golden hour’ where the female body stabilises and the baby is adjusting to life outside the womb

The tone of the uterus is re-established as the uterus contracts again assisting to expel any remaining contents

Encourage skin-to-skin contact and bonding

Encourage breast feeding

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61
Q

Gaskins Manoeuvre Procedure

A

reposition Pt to all fours

(can be time consuming and difficult)

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62
Q

GDM Management

A

50% require insulin

Oral hypoglycemics often used in conjunction with insulin if necessary

diet, lifestyle and regular glucose monitoring

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63
Q

GDM Risk Factors

A

Obesity

Family history

Aboriginal and Torres Straight Islander

Previous GDM

Maternal age >25 years

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64
Q

Gestational Diabetes

A

Defined as any degree of glucose intolerance with first recognition during pregnancy

affects 8-10% of pregnancies in Australia

50% will require treatment with insulin

mostly asymptomatic and diagnosed during routine GTT test between 24-28 weeks

generally self resolves once the pregnancy is completed, although 50% will develop TD2M in later life

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65
Q

Gestational Diabetes (GDM) Pathophysiology

A

pregnancy hormones affect the body’s uptake of glucose

Oestrogen and human placental lactogen can block insulin and/or make it less effective from being utilised by the cells (insulin resistance)

Usually begins around 20-24 weeks

pancreas does not make enough insulin to overcome the insulin resistance

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66
Q

Gestational Hypertension

A

Development of hypertension in the second half of pregnancy without other effects on kidneys or other organs

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67
Q

Gravida

A

number of pregnancies

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68
Q

Gravidity and Parity: 3 previous births and currently pregnant

A

G4 P3

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69
Q

Gravidity and Parity:

3 previous births and currently pregnant

A

G4 P3

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70
Q

Gravidity and Parity: currently pregnant and has previously delivered twins at term

A

G2 P1

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71
Q

Gravidity and Parity:

currently pregnant and has previously delivered twins at term

A

G2 P1

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72
Q

Gravidity and Parity: currently pregnant, has a 3 year old and has previously miscarried at 8 weeks

A

G3 P1

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73
Q

Gravidity and Parity:

currently pregnant, has a 3 year old and has previously miscarried at 8 weeks

A

G3 P1

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74
Q

Gravidity and Parity: first time pregnancy

A

G1 P0

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75
Q

Gravidity and Parity:

first time pregnancy

A

G1 P0

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76
Q

Gravidity and Parity:

Patient is not pregnant, had one previous delivery

A

G1:P1

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77
Q

Gravidity and Parity:A woman who has 2 living children and is currently pregnant

A

G3:P2

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78
Q

Gravidity and Parity Patient is currently pregnant and has had twins delivered in the previous pregnancy

A

G2:P1

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79
Q

Gravidity and Parity:

Patient is currently pregnant and has had twins delivered in the previous pregnancy

A

G2:P1

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80
Q

Gravidity and Parity Patient is currently pregnant, had one previous miscarriage and one previous delivery

A

G3:P1

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81
Q

HELLP Presentation

A

non-specific symptoms

general malaise

fatigue

right upper quadrant or epigastric pain

nausea and/or vomiting

jaundice

visual disturbance

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82
Q

HELLP Syndrome

A

rare, life-threatening liver disorder thought to be a type of severe preeclampsia

characterized by:

Haemolysis (destruction of RBC’s)

Elevated liver enzymes

Low platelet count

Occurs in the later part of pregnancy and sometimes after birth

Not all woman who develop preeclampsia develop HELLP

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83
Q

Hyperemesis Gravidarum Management

A

Positioning

Anti-emetic

IV fluids

Glucose (If hypoglycemic)

Emotional support and care

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84
Q

Hyperemesis Gravidarum Signs and Symptoms

A

Weight loss

dehydration

constipation

headache/migraines

food aversions

excessive salivation

exhaustion

low BP

tachycardic

dizziness

syncopal

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85
Q

How do we do tactile stimulation?

A

Using a soft towel place hands either side of newborn’s trunk and utilise a brief rubbing motion for a period of no more than 10 seconds

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86
Q

How do we assess HR in a newborn?

A

Determined via auscultation (prefered) or palpation of the umbilical cord if it is still pulsating

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87
Q

How long should shoulder dystocia manouvres be attempted for before moving on to next manoeuvre?

A

30 seconds

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88
Q

How much blood loss after delivery is normal?

A

<500 mL

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89
Q

How to Actively Control Newborn’s Temperature

A

Consider warm environment

Consider placing newborn into a plastic bag with head exposed

Use external heat sources to warm environment

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90
Q

How to Do Fundal Massage

A

Place one hand just above pubic symphysis and the other hand at the top of the fundas. With the top hand gentle massage in a circular motion until it firms up

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91
Q

Neonate Suctioning Notes

A

wipe face and nose area first

if suctioning required, suction mouth before nose with head in neutral position

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92
Q

Hx taking prior to delivery

A

Confirm gestation

How far apart are contractions? Length? Transport?

Where is the pain?

Have your membranes ruptured? If so, details.

How many babies? Chance of twins?

Antenatal care?

Complications so far? Previous pregnancies?

Head engaged? Normal cephalic or breech?

Parity / Gravidity?

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93
Q

If newborn’s HR is <60 bpm after 30 seconds of resuscitation…

A

Rapidly clamp and cut cord and move newborn to a flat, hard surface away from mum

Commence CPR at a rate of 3:1

(90 compressions:30 ventilations per minute)

Apply defibrillator pads

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94
Q

If newborn’s HR is >100 bpm after 30 seconds of resuscitation…

A

Manage as per normal cephalic delivery

Wrap and keep the newborn warm and encourage skin to skin contact

Ensure continued close management of newborn – HR, tone, breathing

If HR >100bpm but has central cyanosis at 10 minutes post birth commence oxygen 2 L/pm through nasal prongs until centrally pink

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95
Q

If newborn’s HR is between 60-100 bpm after 30 seconds of resuscitation…

A

Continue IPPV with supplementary O2 at 15 L/min

REASSESS after every 30 seconds and manage appropriately depending on HR range

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96
Q

If PPH not controlled…

A

Manage the cause(s) of the haemorrhage (4T’s)

prioritise interventions according to the likely aetiology and if possible should be performed simultaneously by different members of the paramedic team

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97
Q

If providing CPR to a newborn, when do we cut the cord?

A

When the heart rate is less than 60 bpm

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98
Q

If tactile stimulation and/or suctioning isn’t effective, immediately assess the newborn’s…

A

TONE – ability to flex and move limbs - floppy newborn with poor tone is more likely to need active resuscitation

BREATHING – crying and breathing? May initially pause breathing and then establish regular breaths. Chest recession or retraction, expiratory grunting and nasal flaring may indicate respiratory distress.

HEART RATE – should be 130bpm (110-160 range), anything above 100 initially acceptable

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99
Q

Implication of Immature Cilia in the Airways

A

poor secretion (bacteria and bugs) clearance

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100
Q

Incomplete Miscarriage

A

vaginal bleeding and cramping

dilated cervical os

some products of conception expelled

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101
Q

Inevitable Miscarriage

A

vaginal bleeding and cramping

rupture of membranes

dilated cervical os

products of cenception may seen or felt at or above cervical os

nothing can be done - make feel comfortable

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102
Q

Initial Bradycardia (<100 bpm) Management

A

IPPV with ROOM AIR at a rate of 40-60/min

Reassess after 30 seconds

Manage the baby at this point in between mums legs with placenta still pulsating

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103
Q

Key Investigations First Trimester

A

Dating scan approx. 7 – 8 weeks to confirm intrauterine implantation

12-week nuchal translucency scan and blood test (extremely accurate non-invasive screening test to identify fetuses at risk of down syndrome and other chromosomal and structural abnormalities) optional

harmony blood test – DNA blood based screening test for abnormalities optional

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104
Q

Key Investigations Second Trimester

A

Morphology scan (18-22 weeks) - complex in-depth scan of entire foetus, position of placenta, umbilical cord, amniotic fluid around baby, uterus and cervix

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105
Q

Key Investigations Third Trimester

A

often no scans during this period

further ultrasound if any growth or position concerns

antenatal visits will increase closer to term

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106
Q

Labour Room Tips

A

keep labour room nice, dark and quiet to help with delivery

makes it safe calm and quiet to help with melatonin production

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107
Q

List some pertinent information that we need to gather from our antenatal hx taking

A

gravidity and parity

gestation

antenatal care

complications

foetal movements (regular and similar to normal?)

previous pregnancies

previous losses

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108
Q

Loveset’s 1 Manoeuvre Procedure

A

hold baby by hips and turn 180o keeping the back uppermost and applying downward traction so that the posterior arm becomes anterior

place one or two fingers on upper part of the arm and draw arm down over the chest as the elbow is flexed and sweeping hand over face

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109
Q

Loveset’s 2 Manouevre Procedure

A

to deliver second arm, rotate baby back 180o, keeping the back uppermost and applying downard traction

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110
Q

Loveset’s 3 Manoeuvre Procedure

A

hold and lift baby up by the ankles

move baby’s chest towards mums inner leg, posterior shoulder should deliver

free the hand and arm

lay baby back down by the ankles, anterior shoulder should deliver

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111
Q

macrosomia

A

big baby due to gestational diabetes

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112
Q

Management of PPROM and PROM

A

Term patients: proceed to delivery with prophylactic antibiotics

Pre-term: antibiotics, corticosteroids and expectant management

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113
Q

Management of PV Bleed

A

Treat symptomatically: You may need to manage:

Hypovoleamia

Pain

Nausea

Hypotension

Reassurance

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114
Q

Management of Uterine Rupture

A

Position to avoid aortocaval compression (left lateral)

If trauma related, manage as per trauma in pregnancy

If evidence of shock, manage as per hypovolaemic shock

IV access

Analgesia

Assist patient to attain position of comfort

Transport and pre-notify as appropriate

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115
Q

Maternal Complications of Shoulder Dystocia

A

PPH

vaginal lacerations and tears

uterine rupture

psychological trauma

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116
Q

McRoberts Manoeuvre Procedure

A

knees to nipples position

primary officer - hand on head with gentle downward traction

second officer - assist with movement and/or apply supra pubic pressure

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117
Q

What is miscarriage?

A

spontaneous loss ofpregnancy before 20 weeks gestation and/or foetal weight less than 400g

Approx 1 in 4 pregnancies will end in miscarriage before 10 weeks

Any PV bleeding in 1st and 2nd trimester should be considered a threatened or actual miscarriage until proven otherwise

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118
Q

Miscarriage Management

A

Reassurance and emotional support

Estimate blood loss on scene

Retain any products of conception

Consider:

IV access and fluid

Positioning

Pain relief

Antiemetic

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119
Q

Miscarriage Pt Presentation

A

abdominal pain

PV bleeding (may not)

nausea

vomiting

hypotensive

tachycardic

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120
Q

missed miscarriage

A

no vaginal bleeding

closed cervical os

no foetal cardiac activity or emply sac

usually found at scan

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121
Q

Morning Sickness Management

A

empathy and reassurance

antiemetic

postural positioning

IV fluid replacement

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122
Q

MSV (adapted Mauriceau-Smellie-Veit) Manoeuvre Procedure

A

lay baby face down with length of body over your hand am arm and place first and second fingers either side of the nose

flex the head

use other hand to hood the baby’s shoulders with index and ring fingers with middle finger on baby’s occiput

gently flex baby’s head towards chest until the hairline is visible

pull gently to deliver head

raise baby until mouth and nose are free

place baby on mum’s abdomen

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123
Q

Neonatal Resuscitation Guidelines

A

<20 weeks gestation Resuscitation is futile

>23 weeks Newborn considered viable

Some pre-term infants <20 weeks may show signs of life but resuscitation is futile

If there is any uncertainty resuscitation measures should be commenced

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124
Q

Newborn Care Immediately After Delivery

A

Clean the newborn’s mouth and nose of visible blood and mucous with a clean cloth
- If airway obstruction identified, gentle suction the mouth followed by nares

Thoroughly dry the newborn

Within first 30 seconds assess the newborn’s:

  • Tone
  • Breathing status
  • HR
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125
Q

Newborn Chest Compressions

A

Compress over lower sternum

Two thumb technique

A half second pause after 3 compressions for ventilation

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126
Q

Newborn Ventilations

A

Head in neutral position

1 breath after every 3 compressions

Approx 30 breathes per minute

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127
Q

Non-Ruptured Ectopic Pregnancy Signs and Symptoms

A

Hx amenorrhoea (at least one missed period)

Abnormal vaginal bleeding

Pelvic and/or abdominal pain

Nausea

Pre-syncopal symptoms

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128
Q

Normal Cephalic Birth

A

Spontaneous in onset

Considered low risk at the start of labour

Remains low risk throughout labour and birth

The newborn is born sponataneously, in vertex position

37-42 weeks gestation

After delivery mother and baby are in good condition

129
Q

Normal pregnancy duration

A

37 - 42 weeks

130
Q

Nuchal Cord 3 Management Options

A

Cord Reduction
slip cord over baby’s head

Through Cord
slip over baby’s shoulder as baby is born

Somersault Manouvre
As shoulders are deliver flex baby’s head towards mothers thigh

As the baby’s body delivers gently flex the torso of the baby to ensure the cord remains intact

131
Q

Nuchal Cord Birth

A

15-34% of births and most will deliver without incident

Risk of hypoxia;

Avoid early clamping and cutting of the cord prior to delivery

132
Q

Obstetric Hx Questions

A

Number of past pregnancies (gravidity)

Number of past deliveries (parity)

Previous complications

Miscarriages/terminations

Previous pregnancies – length, delivery

133
Q

Obstetric Pt Hx Taking

A

determine quickly if presenting complaint is obstetric related

Per Vaginal Bleeding: How long, how much, what colour (frank blood or dark blood), presence of clots

Per Vaginal Discharge: Colour, consistency, odour, duration

Abdominal Pain: Location, duration, severity, radiation, exacerbation, score

Urinary symptoms: Frequency, dysuria, odour, colour.

Nausea and vomiting: Onset, frequency, contents, blood, current fluid status

Headache: visual disturbance, fast

134
Q

Once Delivery is Complete

A

Place baby directly on mother’s chest (postural drainage)

Observe for breathing, crying, tone
If sufficient – warm baby rapidly with blanket, beanie

Remember you now have 2 patients

135
Q

Paramedic Management of Pre-Term Labour

A

Manage symptoms

Be wary of pain relief, especially narcotics given the risk of delivering a premature baby

Position comfortably, reassurance, be calm

Rapid transport to hospital as tocolysis and steroids are definitive management

pre-notify birth suite

Prepare for neonatal delivery – premature babies have immature respiratory system development, so may require significant assistance if born pre-hospital

136
Q

Parity

A

number of babies born at or > 20 weeks, pre-term <37 weeks, post-term >42 weeks

137
Q

perinatal anxiety and depression risk factors

A

Hx of depression, anciety, OCD

pregnancy or delivery complications, infertility, mascarriage or infant loss

abrupt discontinuation of breastfeeding

thyroid imbalance, diabetes, endocrine disorders

PMS

Hx of abuse

lack of support form family and friends

financial stress or poverty

unwanted or unplanned pregnancy

138
Q

Pertinent questions for the pt in labour

A

confirm gestation

any complications

antenatal care

when did contractions start?

how often are they coming?

where is the pain with your contractions?

have your membranes ruptured? If so, what colour?

Previous deliveries

when was your last appointment and is the baby engaged?

139
Q

Pertinent questions relating to PV bleeding in pregnancy

A

How long have you had it?

How much is there?

How often do you have to change a pad

what colour is it?

what preceded it (coitus, nothing, strenuous exercise)?

Have you had bleeding like this before?

Does it have any odour?

Are there any clots in it?

140
Q

Physiologicial Management of the Third Stage

A

Women who don’t consent and/or prefer physiological management must birth the placenta unaided, by maternal force

Big focus on increasing the women’s natural oxytocin production

Skin to skin contact, encourage breast feeding

Continue to monitor for signs of placental delivery

141
Q

Placenta Previa Signs and Symptoms

A

Painless bleeding usually in third trimester (>28 weeks)

Bright red blood

No pain, other than that associated with contractions

A soft, non-tender uterus

Significant blood loss, which may lead to hypovolemic shock

142
Q

Placenta Previa Tx

A

left lateral positioning

IV access

antiemetic

analgesia

IV fluid as required

rapid transport

143
Q

Placental Abruption Tx

A

Left lateral positioning

IV access

antiemetic

analgesia

IV fluid as required

rapid transport

144
Q

Positive Hormonal Feedback Loop of Childbirth

A

head of baby pushes against cervix

nerve impulses from cervix transmitted to brain

brain stimulates pituitary gland to secrete oxytocin

oxytocin carried in bloodstream to uterus

oxytocin stimulates uterine contractons and pushes baby towards cervix

145
Q

PPH Management if Oxytocin Unsuccessful

A

Consider:

Tranexamic acid (TXA)

Sodium Chloride

Packed RBC’s

External aortic compression (Last resort)

Bimanual compression (Last resort)

146
Q

PPROM and PROM Causes

A

Previous PROM or PPROM

Short cervical length

Second and third trimester bleeding

Low socioeconomic status

Smoking and drug use

sometimes no cause identified

147
Q

PPROM and PROM Paramedic Considerations

A

Reassurance

Position left lateral – this allows for fluid to accumulate for hospital to get a sample and gives consideration to hind/fore water scenario

148
Q

Pre-Eclampsia

A

severe form of gestational hypertension

serious and only occurs after 20 weeks or up to 6 weeks after delivery

includes hypertension accompanied by one or more signs of organ dysfunctionon:

renal impairment

proteinuria

elevated liver enzymes

neurological complications

pulmonary oedema

foetal growth restriction (FGR)

haematological complications

149
Q

Pre-Eclampsia Signs and Symptoms

A

headache blurred vision flashing lights scotoma right upper quadrant pain (epigastric) oliguria

150
Q

Pre-Hospital Birth Preparation

A

early call for backup to get extra hands and resources on deck

set up maternity kit and get neonatal resuscitation gear primed and ready in case needed

let mum adopt a position of comfort

reassure and communicate with mother and partner

151
Q

Pre-Hospital Implications of RDS

A

More likely with premature delivery

Must be considered in any premature baby

Many have long-lasting effects and respiratory issues

Important to ask about RDS if bub born prematurely

152
Q

Pre-Term Labour

A

when regular contractions result in the opening of the cervix after 20 weeks gestation and before 37 weeks gestation

153
Q

Pre-Term Labour Sub Categories

A

Early preterm <34 weeks

Very preterm 28-32 weeks

Extremely preterm <28 weeks

earliest gestation survival age 24 weeks gestation

154
Q

Pregnancy Duration

A

37 - 42 weeks

approx 280 days in total

calculated from first day of last period

155
Q

Pregnancy Trimesters

A

first trimester = 1-13 weeks gestation

second trimester = 14-27 weeks gestation

third trimester = 28-40 weeks gestation

156
Q

Premature Rupture of Membranes (PROM)

A

rupture of gestational membranes prior to the onset of labour post 37 weeks gestation

157
Q

Preterm Premature Rupture of Membranes (PPROM)

A

membrane rupture before 37 weeks gestation

158
Q

PV Bleed 1st Trimester

A

postcoital

cervicitis

cervical polyps

infection

implantation

spontaneous abortion

ectopic pregnancy

159
Q

PV Bleed 2nd Trimester

A

infection

incompetent cervix

malfomation of the uterus

cysts

molar pregnancy

160
Q

PV Bleed 3rd Trimester

A

placenta praevia

placental abruption

preterm labour

bloody show

161
Q

First things to do when you recognise shoulder dystocia

A

stop maternal pushing effort

call for CCP backup

162
Q

Rapid initial newborn assessment of breathing consists of…

A

Is the baby crying and breathing?

Newborns may initially pause breathing and then establish regular breathes;

Respiratory distress is indicated by:

  • chest recession or retraction
  • expiratory grunting
  • nasal flaring
163
Q

Rapid initial newborn assessment of heart rate consists of…

A

the most important indicator for resuscitation

should be 130bpm (110-160 range)

164
Q

Rapid initial newborn assessment of tone consists of…

A

Assessing baby’s ability to flex and move limbs

A floppy newborn with poor tone is more likely to need active resuscitation

165
Q

Restitution

A

the baby’s head turning spontaneously

166
Q

Reverse Wood Screw (reverse posterior shoulder rotation) Procedure

A

one hand on posterior aspect of the posterior shoulder and attempt to rotate shoulder 180o in opposite direction

167
Q

Risk Factors for Primary PPH

A

Uterine atony

Increased maternal age (tone)

Obesity (tone)

History of previous PPH (tone)

Multiple pregnancy (tone)

Precipitate labour (trauma/tone)

Prolonged labour (tone)

168
Q

Risk Factors for Secondary PPH

A

infection

retained piece of placenta or membrane

169
Q

Risk Factors for Shoulder Dystocia

A

Macrosomia

Maternal obesity

Gestational diabetes

Prolonged second stage of labour

Previous hx of shoulder dystocia and/or large foetus

170
Q

Risk Factors for Uterine Atony

A

Overdistention of the uterus caused from:

Multiparity (tone)

Macrosomia (tone)

Polyhydraminos (tone)
(too much amniotic fluid around baby)

171
Q

Risk factors for uterine inversion

A

over-aggressive management of the third stage of labour (excessive fundal massage and cord traction prior to placental separation)

relaxed uterus

lower uterine segment and cervix

short umbilical cord

antepartum use of magnesium or oxytocin

172
Q

Risks Associated wit Pre-Term Labour

A

perinatal mortality

long term neurological disability

admission to NICU

prolonged hospital stays and readmission to hospitals

increased risk of chronic lung disease

Significant association between preterm birth and:

Social disadvantage

Previous preterm birth

Pre-existing GD

Cervix insufficiencies

Current urogenitial infections

Smoking and alcohol consumption

173
Q

Room Air Versus Oxygen for Newborns?

A

first 30 seconds of IPPV should be with room air only

excess oxygen can be toxic as it leads to free radical formation and issues with lungs, eyes, brain and other organs

quicker time to first breath compared with high flow oxygen

174
Q

Rubins II (internal anterior shoulder displacement) Procedure

A

apply pressure to the posterior aspect of the anterior shoulder

attempt to push the shoulder towards the chest of the fetus

175
Q

Ruptured Ectopic Pregnancy Signs and Symptoms

A

Syncope

Shock

Acute pelvic and/or abdominal pain

Shoulder tip pain (Kehr’s sign), caused by free blood irritating the diaphragm when supine

Abdominal distention

Rebound tenderness and/or guarding

176
Q

Scoring System for APGAR

A

0 – 3 - severe distress, immediate management is required

4 - 7 - moderate distress, baby may require some additional assistance

7 - 10 - little difficulty in adjusting to extrauterine life

177
Q

Second Line Manoeuvres for Shoulder Dystocia

A

Rubins II - internal anterior shoulder displacement

Wood Screw - internal anterior and posterior shoulder rotation

Reverse Wood Screw - reverse posterior shoulder rotation

All fours running start position - to deliver posterior arm

178
Q

Second Stage of Labour Process

A

Begins when the cervix is fully dilated (10cm)

Ends with the birth of the baby

During this stage the baby’s head navigates down the vagina and crowns

The mother will instinctively feel like bearing down

Encourage her to push with contractions

Monitor the perineum

179
Q

Second Trimester Maternal Changes

A

many woman start to feel energised

nausea often settles

uterus continues to grow

aches and pains from uterine ligaments stretching

weight gain

180
Q

Separation of the Placenta

A

The placenta separates from the wall of uterus

blood from the tiny vessels in the placental bed begins to clot between the placentaand the muscular wall of the uterus (the myometrium)

181
Q

Shoulder Dystocia Definition

A

vaginal cephalic delivery requiring additional obstetric manoeuvres to deliver foetus after head delivery and general downward traction has failed

182
Q

Shoulder Dystocia Description

A

the anterior shoulder becoming impacted behind the pubic symphysis after delivery of the head

less frequently, the posterior shoulder impacting against the sacral promontory

183
Q

Signs and Symptoms of Labour

A

Cramping

Dirrahoea
(rectum is pelvic muscle that loosens up prior to delivery)

Nesting

Lightening
(able to breathe easier as baby has shifted into pelvis)

Membrane rupture
(may/may not indicate labour, colour/stain can indicate baby stress)

184
Q

Signs and Symptoms of PPH

A

PV bleeding greater than 500 mls after vaginal delivery or 1000 mls after c section

Placenta may or may not have delivered

Poor fundal tone

Signs of shock may or may not be present

185
Q

Signs and symptoms of uterine rupture?

A

Loss of intrauterine pressure or cessation of contractions

Abnormal labour or failure to progress

Severe localised abdominal pain

Shoulder tip pain or suprapubic pain

Vaginal bleeding

Maternal hypovolaemic shock

Difficulty palpating the uterus

Easily palpable fetal parts

186
Q

Signs of Imminent Delivery

A

Strong pressure in the lower back or perineum

Bulging of the perineum

Crowning of fetal head

Need to bear down or defecate

Rupture of membranes

Increase in bloody show as capillary in cervix rupture

Nausea and vomiting

The mother may verbalise ‘I can’t do this anymore’ she feels like she has lost control

Contractions: 1-2 minutes apart, Regular, Lasting 45 to 60 seconds

187
Q

Six Key Hormones in Pregnancy

A

HCG

progesterone

oestrogen

prolactin

relaxin

oxytocin

188
Q

Step by step management of normal cephalic delivery

A

Early call for backup

early set up of equipment

Delivery of the head: use one or two fingers lightly touching the occiput to prevent rapid expulsion of the head

Hands off and let baby restitute naturally

Check for nuchal cord

Delivery of the body: One hand lightly holding either side of the head, apply slight downward traction to deliver the anterior shoulder and slight upward traction to deliver the posterior shoulder

Once the bay is delivered: quickly assess tone, crying and anything in the mouth or nose

Skin to Skin contact with mother

189
Q

Steps to success with Shoulder Dystocia manoeuvres

A

correct hand position

knowing sacral hollow

tuck thumb into palm

190
Q

Steps when breech is identified

A

Hands off - use gravity and encourage maternal effort
Deliver legs if they don’t deliver on their own
Lovesets 1
Lovesets 2
Lovesets 3
MSV

191
Q

Steps when shoulder dystocia is identified

A

tell mum to stop pushing
McRoberts manoeuvre (knees to chest) with suprapubic pressure
All fours in running start position with Rubins II
Wood Screw
Reverse Wood Screw

192
Q

Suction neonate only if…

A

obvious signs of obstruction and secretions stop spontaneous breathing (meconium, blood clots, mucous, vernix or if baby birthed through meconium stained amniotic fluid)

193
Q

Supra-Pubic Pressure Procedure

A

combine with McRoberts

place hands immediately superior to pubic symphysis

apply pressure to the posterior aspect of the impacted foetal shoulder in a rocking or continuous motion

194
Q

Symptoms of perinatal depression (postnatal depression) and anxiety

A

fellings of guilt, shame or hopelessness

feelings of anger, rage, irritability or scary and unwanted throughts

lack of interest in baby or difficulty bonding

loss of interest, joy or pleasure in things used to enjoy

disturbance of sleep and appetite

crying and sadness, constant worry or racing thoughts

physical symptoms like dizziness, hot flashes and nausea

possible thoughts of harming the baby or yourself

195
Q

Symptoms of Shoulder Dystocia

A

Prolonged or difficult birth of the face and chin

The head is birthed but remains tightly applied to the vulva

Turtle sign

No restitution of the head

The body is not delivered within 60 seconds of the head

196
Q

The 2 classifications of PPH

A

Primary – within the first 24 hours after birth with haemorrhage amount >500ml (vaginal), >1000ml (caesarean), or enough to cause deterioration of the mother’s condition

Secondary – after first 24 hours and up to 12 weeks after birth with haemorrhage amount >500ml or enough to cause deterioration of the mother’s condition

197
Q

The 4 Types of Breech Presentation

A

frank breech

complete breech

complete footling

incomplete footling

198
Q

Third Trimester Maternal Changes

A

fatigue

dyspnoea

increase in urine frequency

braxton Hicks

trouble Sleeping

starts to position itself ready for birth

199
Q

Threatened Miscarriage

A

vaginal bleeding and cramping

cervix closed and soft

foetal cardiac activity

pregnancy going on as normal

200
Q

To spontaneously deliver the placenta and featal membranes the…

A

cervix must remain open and there needs to be good uterine contraction

201
Q

Treatment of Poor Uterine Tone in PPH

A

fundal massage

Oxytocin (subsequent dosing and commencement of infusion)

202
Q

Treatment of PPH if Placenta Has Been Birthed

A

Commence fundal massage until firm and central

Encourage birthing parent to empty bladder

203
Q

Treatment of PPH if Placenta Has Not Been Birthed

A

Actively manage the third stage of labour:

oxytocin

skin to skin contact

breast feeding

urinate

204
Q

True Labour Signs and Contractions

A

Intense, stops you in your tracks

Regular, gets closer over time

Nothing makes them stop

Feel stronger and more painful over time

Starts at the back and moves to the abdomen

205
Q

Tx of Retained Products in PPH

A

Continue fundal masage to expel retained products

transport to nearest facility with surgical capabilities

206
Q

Tx of Trauma in PPH (perineum or vaginal lcerations)

A

control external haemorrhage

207
Q

Uterine Inversion Management

A

Protect any exposed uterus with a moist sterile drape

Assist the women to achieve a position of comfort

Analgesia

Consider if postpartum haemorrhage

IV access

IV fluids

Transport and pre-notify as appropriate

NOTE: high risk for infection, aseptic technique and infection control measures must be used

208
Q

Weight Gain During Pregnancy

A

can affect both maternal and fetal health and development

recommended weight gain depends on pre-pregnancy weight

11.5kg to 16kg is recommended for those in healthy weight range

209
Q

What are baby blues?

A

symptoms three to five days after birth, such as mood swings, teariness, feeling overwhelmed and/or anxious

generally subside after a few days to weeks

210
Q

What are the 3 foetal shunts?

A

Ductus Venosus - bypasses the liver and into inferior vena cava

Foramen Ovale - bypasses pulmonary circulation

Ductus Arteriorsus - shunts blood away from lungs into the aorta to feed lower extremities

211
Q

What are the 3 key assessments of the newborn that we need to complete immediately?

A

colour/tone

breathing/crying

heart rate

212
Q

What are the 3 stages of labour?

A

first stage
body preparing for birth
Gradual effacement and dilation of the cervix through regular contractions up to 10cm dilation

second stage
The period from full dilation of the cervix (10cm) until the birth of the baby

third stage
From the birth of the baby until the delivery of the placenta

213
Q

What are we assessing with each part of the APGAR?

A

Appearance - colour

Pulse - heart rate

Grimace - response to stimulus

Activity - tone and motion

Respiration - crying/breathing

214
Q

What are braxton hicks contractions

A

Normal, non dangerous practice contractions of the uterine muscles which happen in the weeks to months before birth

Most commonly in third trimester, but anytime after 20 weeks

Painless, yet uncomfortable

215
Q

perinatal anxiety and depression - What can we do to educate?

A

Share information about perinatal mental health issues and the effectiveness of early intervention

Speak about it, ask every patient antenatally and post-natally how they are?

216
Q

perinatal anxiety and depression - What can we do to empower (support them to seek help)?

A

Explore what has worked in the past

Speak about referral options and seek pts input

Encourage pts to be persistent and that there are numerous options

217
Q

What does APGAR stand for?

A

Appearance

Pulse

Grimace

Activity

Respiration

218
Q

What happens to foetal circulation after birth?

A

With the first breathes, the lungs begin to expand causing:

  • lung alveoli cleared of fluid
  • BP increases
  • significant reduction in pulmonary pressure

These changes reduce the pressure and stimulate shunts to close

Transition to newborn circulation completed

219
Q

what is the foramen ovale?

A

a small hole located in the septum of the atria that closes shortly after birth

220
Q

What is cord prolapse?

A

the umbilical cord presents in front of the foetus resulting in the cord prolapsing through the cervix into the vagina

occurs in 0.6% (approx 1 in 200)

221
Q

What is effacement:

A

The shortening and ‘thinning out’ or ‘ripening’ of the cervix

The cervix shortens from approx 3.5 - 4cm during pregnancy

Measured by percentage

222
Q

What is external aortic compression?

A

The manual compression of the abdominal aorta against the vertebral column to restrict uterine blood flow

223
Q

What is fundal massage?

A

external manual stimulation of a boggy postpartum uterus to increase uterine tone, express clots and reduce haemorrhage

224
Q

What is gravidity?

A

the number of times a female has been pregnant (regardless of the outcome)

225
Q

What is grief?

A

a reaction to different types of loss

226
Q

What is labour?

A

Regular and coordinated muscular contractions of the uterus

Gradual effacement and dilation of the cervix

227
Q

What is our focus in the initial stages of breech management?

A

hands off - let gravity do the work

228
Q

What is our initial management if the newborn presents flat?

A

tactile stimulation (often all that is needed)

229
Q

What is parity?

A

the total number of times a female has given birth to a child greater than 24 weeks or more gestation, regardless of whether the child was born alive or not.

230
Q

What is Patent Formaen Ovale?

A

when the foramen ovale doesn’t close after birth

231
Q

What is perinatal depression (postnatal depression) and anxiety?

A

any mental health condition affecting the mood, behaviour, wellbeing and or daily function of an expecting or new parent

232
Q

What is perinatal OCD?

A

an anxiety disorder characterized by recurrent, unwelcomed thoughts, images, ideas and doubts

233
Q

What is placenta previa?

A

an abnormally implanted placenta in the lower part of the uterus that is either partially or fully covering the cervical os making vaginal delivery difficult

234
Q

What is placental abruption?

A

bleeding as a result of premature separation of a normally situated placenta from the uterine wall before the birth of the baby

235
Q

What is placental abruption?

A

bleeding as a result of premature separation of a normally situated placenta from the uterine wall before the birth of the baby

236
Q

What is post partum haemorrhage?

A

Excessive bleeding from or into the genital tract after the birth of a baby/ies

237
Q

What is post partum phychosis?

A

rare mental illness that starts soon after childbirth. of loss of reality, delusions, hallucinations, disorientation, agitation, insomnia

238
Q

What is the key indicator of resuscitation in neonates?

A

heart rate

239
Q

What is the main reason that newbons will require resuscitation?

A

hypoxia - they haven’t initiated their breathing mechanics

240
Q

What is the management of a newborn if tactile stimulation is not successful and heart rate is less than 100?

A

IPPV room air for 30 seconds - 40-60 breaths per minute for 30 seconds

IPPV with oxygen for 30 seconds - 40-60 breaths per minute for 30 seconds

241
Q

What is the management of newborn heart rate greater than 100 breaths per minute?

A

manage as per normal cephalic delivery

242
Q

What is the management of newborn heart rate between 60 - 100 breaths per minute?

A

IPPV with oxygen (46-60 breathe per minute) for 30 seconds then reassess

243
Q

What is the management of newborn heart rate between 60 - 100 breaths per minute after initial IPPV on room air?

A

IPPV with oxygen (46-60 breathe per minute) for 30 seconds then reassess

244
Q

What is the most common cause of uterine rupture?

A

Dehiscence (splitting or bursting) of a caesarean section scar, with rupture more frequent in obstructed labour

245
Q

What is the most common form of obstetric haemorrhage and leading cause of maternal morbidity and mortality?

A

PPH

246
Q

What is the procedure to deliver the head in a breech birth?

A

MSV (adapted Mauriceau-Smellie-Veit) Manoeuvre

247
Q

What is the ratio for CPR in a newborn?

A

3:1

248
Q

What is the structure of antenatal hx taking?

A

presenting complaint

current pregnancy

obstetric history

249
Q

What is uterine atony?

A

a failure of the uterine myometrial fibres to contract and retract for any reason causing continuation of bleeding

250
Q

What is uterine inversion?

A

rare, but potentially life-threatening obstetric condition where the uterus collapses in on itself

251
Q

What is uterine rupture?

A

the tearing of the uterine wall during pregnancy or birth

(very rare but one of the most lifethreatening obstetric emergencies)

252
Q

What is Dilation

A

The opening up of the cervix

measured in cms

253
Q

What percentage of babies required some form of active resuscitation?

A

5%

254
Q

What should we communicate with the mother instantly when we identify shoulder dystocia?

A

Stop pushing as this may further impact the baby

255
Q

What time do we have to safely deliver the baby if breech presentation occurs?

A

4 minutes

256
Q

When cord is not pulsating during cord prolapse.

A

Ask the mum to assume the knee-chest position

Carefully attempt to push the presenting part off the cord

257
Q

When do foetus start producing surfactant?

A

around 28 weeks

258
Q

When pulsting cord is evident during cord prolapse

A

Assist the mother into exaggerated SIMS position (left lateral tilt)

Ask mother to gently push the cord back into the vagina (using a dry pad)

259
Q

When do we initiate newborn resuscitation?

A

if the newborn has poor tone and/or is floppy

260
Q

Where do defibrillation pads go on the newborn?

A

anterior and posterior

261
Q

Where do we hold the baby to assist during a breech delivery?

A

thumbs on bums (to avoid the abdominal organs)

262
Q

Where does blood collect in a placental abruption?

A

rapidly passes through the placental implantation site and either collects inside the reproductive tract or expelled vaginally

263
Q

Where to Clamp and Cut Cord

A

Clamp - 10, 15 and 20 cm

Cut - between 15 and 20 cm

264
Q

Why de we do tactile stimulation?

A

to initiate breathing on the 15% of newborns who don’t spontaneously breathe on their own - successful in 5-10%

265
Q

Why does SD occur?

A

biasacromial diameter of the foetus is too wide for the pelvic inlet and they don’t enter in the transverse diameter

266
Q

Why is oxytocin given post delivery?

A

to speed up the delivery of the placenta and reduce the risk of post partum haemorrhage (PPH)

267
Q

Wood Screw (internal anterior and posterior shoulder rotation) Procedure

A

apply pressure to the posterior aspect of the anterior shoulder

second hand locates anterior aspect of posterior shoulder and applies pressures

268
Q

What are we more likely to see in pregnant patients due to cardiovascular changes during pregnancy?

A

dizziness

lightheadedness

syncopal episodes

palpitations

mumurs

patient positioning after 20 weeks gestation

269
Q

What are we more likely to see in pregnant patients due to respiratory changes during pregnancy?

A

increased RR

increased WOB

oedmatous airways lead to more difficult airway management and intubation

270
Q

What are we more likely to see in pregnant patients due to haematological changes during pregnancy?

A

Pts can loose considerable amount of blood prior to displaying classic signs of shock

low RBC can contribute to SOB

fatigue

271
Q

What are we more likely to see in pregnant patients due to muskuloskeletal changes during pregnancy?

A

changes in gait

pelvic girdle disease

sprains and strains

niggling pelvic girdle pain

272
Q

What are we more likely to see in pregnant patients due to gastrointestinal changes during pregnancy?

A

constipation

reflux

heartburn

273
Q

What are we more likely to see in pregnant patients due to renal changes during pregnancy?

A

Increased risk of pyelonephritis

UTI’s

increased frequency of urine

274
Q

What should we do regarding the normal physiological changes in a pregnant patient?

A

have an awareness of the normal changes

275
Q

How can grief affect people?

A

Emotionally

In our cognition or thoughts

Physically

Behaviourally

Socially

Professsionally

Spiritually

Philosophically

276
Q

Pre-Eclampsia Statistics

A

affects 5-7% of all pregnant woman

responsible for 70,000 maternal deaths and 500,000 fetal deaths
worldwide every year

277
Q

Pre-hospital birth is more likely in…

A

precipitate labour (<3 hrs)

younger mothers (<18)

multiparous mothers

mothers from low socioeconomic areas (less likely for antenatal cares)

278
Q

Statisitcs on Shoulder Dystocia

A

1-3% of deliveries

Likelihood increases with fetal size:

  • 1% for babies <4kg
  • 5% for babies between 4-4.5kg
  • 10% for babies >4.5kg
279
Q

What is the average foetal bisacromial angle?

A

12-15 cm

280
Q

What is the transverse width of the pelvis?

A

13.5 cm

281
Q

What is the oblique width of the pelvis?

A

12.75 cm

282
Q

What is the anteroposterior width of the pelvis?

A

11 cm

283
Q

How to Build Trust

A

Be kind and warm

Compassion and empathy

Acknowledge the change that comes with new parenthood

Listen

Let them know they can be honest and open

284
Q

What can we say to build trust?

A

How are you going with it all?

Becoming a parent is a big change, how are you going with it all?

Are you getting enough sleep?

285
Q

perinatal anxiety and depression - How to Validate

A

Active listening

Reflect back in your own words

Avoid reassurance before validation

Be ok with silence (let them gather their thoughts)

286
Q

perinatal anxiety and depression - What can we say to validate?

A

It sounds like things are really tough

You’re dealing with a lot of worry and I can see it’s making it really hard to sleep

287
Q

perinatal anxiety and depression - How can we explore (assess the risk)?

A

Ask open ended questions

Non judgemental

Be curious about their journey

Stop and listen

288
Q

perinatal anxiety and depression - What can we say to explore (assess the risk)?

A

When you say it’s all too much, have you thought about harming yourself?

What goes through your mind when your baby is constantly crying and won’t settle?

289
Q

perinatal anxiety and depression - What can we say to empower (support them to seek help)?

A

What do you think will be most helpful to you right now?

Have you ever spoken to anyone about this before?

Do you have a good GP you can chat to about your mental health?

290
Q

perinatal anxiety and depression - What can we say to educate?

A

It is commonplace to be experiencing these feelings with the stage you are at.

This can happen to anyone, and there is lots of support and help available.

291
Q

perinatal anxiety and depression - What does PANDA do?

A

provide risk assessment, telecounselling, peer support, service navigation and care coordination to people affected by perinatal mental health concerns during the transition to parenthood.

Provide secondary consultations to health professionals supporting individuals and families during the perinatal period

292
Q

What is culture?

A

values and way of life that they have grown up with that guide decisions and actions

293
Q

Examples of Cultural Approaches to Pregnancy and Labour

A

say yes in order to please HCPs, even if they do not understand

prefer all female attendance at birth

a period of confinement after delivery

294
Q

Australia’s culture challenges include:

A

Indigenous mothers suffer three times mortality rate

Premature and low birthweight babies doubled

factors affecting babies in utero and in early life have an effect on long-term health

295
Q

Key aims of the National Maternity Services Plan 2010

A

Develop and expand culturally competent maternity care for ATSI people

Research international evidence-based examples of Birthing on Country programs to inform the development and implementation of a national Birthing on Country service delivery model

improve health outcomes for ATSI mothers and babies.

296
Q

What is birthing on country?

A

an Aboriginal mother giving birth to her child on the lands of ancestors, ensuring a spiritual connection to the land for her baby

297
Q

Cultural Considerations for Paramedics

A

try and respect cultural needs and provide a positive health care experience

lack of awareness and understanding of culturally competent care can affect future medical decisions of women and their families

298
Q

Body Language Tips for Paediatric Patients

A

Get down to their level

Always make eye contact when talking to the patient.

Smile. Small mannerisms go a long way.

299
Q

Emotional development at 3 months

A

Stops crying when picked up

300
Q

Emotional development at 6 months

A

enjoys being played with and laughs

301
Q

Emotional development at 9 months

A

Stiffens body when annoyed and shows fear of strangers

302
Q

Emotional development at 12 months

A

Egocentric and very dependent on familiar adults

303
Q

Emotional development at 2 years

A

Consistently demands attention and has tantrums when frustrated

304
Q

Emotional development at 3 years

A

Becomes less egocentric and shows feeling and concern for others

305
Q

Emotional development at 4 years

A

Very affectionate to people they see often

306
Q

Emotional development at 5 years

A

Comforts playmates in distress and will respond to reasoning

307
Q

Pain managment and cultureal considerations

A

differences exist between interpretation and experience of pain across different cultures

have an understanding of cultural differences and practices in response to pain

there is no one right way to deal with the pain of labour, and that pain is a personal experience

308
Q

How to build rapport with paediatric patients

A

Make conversation about topics other than their condition.

Simple questions:
how old they are
what school they go to
teddy's name
something in their room

Get down on their level

Make eye contact

309
Q

Physical development during infancy

A

3 months - child begins sitting without support

6 months - begins crawling and standing with assistance

9 months - begins standing on own and walking with assistance

310
Q

Physical development during early childhood

A

12 months - can stand and may start to take first steps

15 months - begin to walk unassisted

18 months - able to begin stacking bricks

311
Q

Physical development during childhood

A

2 years - can run and walk down steps 2 feet at a time

3 years - able to catch objects and hold a pencil to draw

4-5 years - can clib, skip, hop and colour in neatly

312
Q

Pain Definition

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

313
Q

Types of play at different paediatric ages

A

Unoccupied - 0-3 months

Solitary 0-2

Spectator/onlooker behaviour - 2 years

Parallel play - 2+ years

Associate play - 3-4 years

Cooperative play - 4+ years

314
Q

What is solitary play?

A

child plays alone and not interest in playing with others yet

315
Q

What is spectator/onlooker behaviour?

A

child watches and observes other children playing but will not play with them

316
Q

What is parallel play?

A

child plays alongside or near to others, but not with them

317
Q

What is associate play?

A

child starts to interect with others during play, without much cooperation being required

318
Q

What is cooperative play?

A

child plays with others and has interests in both the activity and other children

319
Q

What is unoccupied play?

A

baby making movements with their arms, legs, hands, feet, learning about and discovering “” how their body moves

Bachelor of Paramedic Science (19 decks)

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