Week 1- Obstetrics Flashcards
What is considered a full term pregnancy?
Full term is between 37-42 weeks
At how many weeks should gestation resuscitation efforts occur?
20 weeks, as this is considered viable except in the cause of obvious death
1st Trimester
- 1, 2, 3 months
- 1-4, 5-8, 9-13 weeks
2nd Trimester
- 4, 5, 6 months
- 14-17, 18-22, 23-27 weeks
3rd Trimester
- 7, 8, 9 months
- 28-31, 32-35, 36-40 weeks
Uncomplicated: Pregnancy, Labour and Birth will likely include:
- A healthy pt without medical conditions
- uncomplicated pregnancy
- term gestation
- singleton pregnancy
- vertex presentation
- spontaneous labour
- Clear amniotic fluid
What are the 3 stages?
- Germinal stage 0-2 weeks
- Embryonic stage lasts about 3-8 weeks
- Fetal stage from week 9 till birth
Maternal changes- what systems change:
- circulatory system
- respiratory system
- genital tract
- GI system
- Metabolism
What are the circulatory system changes?
- Normal blood volume is 4-5L and INCREASE 1.2-1.6L
- INCREASE to meet metabolic demands
- INCREASE red blood cells b/c of increase need for iron
- WBC 3rd trimester b/c of increase stress due to pregnancy
Cardiac output during pregnancy
40-50% increase
HR during pregnancy
20-25% increase 10-20 bpm
Stroke volume during pregnancy
30% increase
Intravascular volume during pregnancy
45% increase
Systolic BP during pregnancy
Minimal change
Diastolic BP during pregnancy
20% decrease mid pregnancy
What is supine hypotension syndrome?
- After 20 weeks when a pregnant women lays supine there is the potential for compression of the inferior vena cava by the uterus
- A decrease in preload, causes the decrease in cardiac output leading to hypotension or syncope
CPR on a pregnant women
- When preforming CPR on a pregnant pt >20 weeks gestation have a second paramedic manually displace the abdo to the left
Respiratory system changes during pregnancy
- Diaphragm moves up into the chest
- Stuffy, runny nose and epistaxis
02 Consumption during pregnancy
30-40% increase
Resp rate during pregnancy
slight increase
Tidal volume during pregnancy
30-35% increase
Functional residual capacity during pregnancy
25% decrease
What is the fundus?
- Top part of the uterus
- It is important to identify because it helps estimate gestational age
- At approx 20 weeks it will be located at the umbilicus
- After that eah week is 1 cm
- The increasing size outs weight on the bladder causing frequent urination
Elevated progesterone causes:
- nausea/ vomiting most common in first 6-14 weeks
- also causes relaxation of smooth muscle- causes decrease gastric motility= constipation
Crowdin of the digestive system causes
heartburn
Early pregnancy
- anabolic state in the mother with an increase in maternal fat stores and small increases in insulin sensitivity
- nutrients are stored to meet the demands of mother and fetus and prep for lactation
Late Pregnancy
- Catabolic state with decrease insulin sensitivity (increased insulin resistance)
- Increase maternal glucose and free fatty acid
- Helps with fetal growth
Gravida
How many times pregnant, this includes miscarriages/ abortions
Para
of pregnancies a woman carried past 28 wks live or dead (twin/ triplets count as 1)
Amniotic sac
The fluid filled, bag like membrane where the fetus grows
Abortion
Expulsion of the fetus, from any cause before the 20th week
Ectopic pregnancy
any egg that attaches outside the uterus, usually the fallopian tube
Primipara
(Primip)- the pt has only had one birth/ delivery
Multipata
(Multip) the pt has had 2 or more deliveres
How to time contractions
Frequency
- measured as the interval between (between the start of one contraction and that start of the next)
Duration
- How long one contraction lasts
How many stages of labour are there?
3
What are Braxton Hicks Contractions?
- false labour pains, are contractions of the uterus that typically aren’t felt until the 2nd or 3rd trimester of pregnancy
What is stage 1 of labour?
- Dilation and effacement of the cervix
- The longest stage
What does stage 1 of labour consist of?
- Uterine contractions begin that gradually increase in (frequency, strength, length)
- Fetus descends into pelvis
- Cervix softens
- Shorten (effaces)
- Thins
- Dilates (open)
- Until full dilation of 10 cm
What two parts is stage 1 of labour broken into?
- Early Labour and Active Labour
What is early labour?
Beginning of labour
- Contractions are mild and irregular
- Length is unpredictable and can occur over a few days
- Initial cervical changes occur including: (effacement and dilation)
What should you look for in early labour?
- For bloody show- pink, red or brown discharge
- Spontaneous rupture of the membrane may occur (SRO)
What are the paramedic observations during Early Labour?
- Frequency: far apart and irregular
- Length: short 20-30 sec long
- Strength: mild
Pt Presentation: will be walking and talking through contractions
What is active labour?
- Regular strong contractions
- Progressive dilation to 10 cm
- Contractions are continuous and will not stop until birth occurs
- Often accompanied by bright red bloody show
SROM may or may not occur
What are the paramedic observations during Active Labour?
- Frequency: every 3-4 min
- Length: 45-60 sec
- Strength: mod to strong
Pt Presentation: difficulty walking and talking through contractions, Pt may distressed
Can have: vomiting, shaking, SROM, overwhelming emotions
What is stage 2 of labour?
- Starts when cervix is fully dilated to 10cm
- Pt feels when the urge to push
- Ends once the baby is born
What are paramedic observations during stage 2?
- Frequency: less than 2 min
- Length: 60-90 secs
- Strength: strong
What happens stage 2 of labour?
- The uterus will rise up and change shape
- Urge to push occurs when the presenting part reaches the pelvic floor
- Pt is actively bearing down
- Bloody show, stool amniotic fluid drainage
- Pain and perineal pressure with distention
- Bulging perineum until presenting part is visible
What are clinical considerations for labour?
- From a clinical perspective, labour starts when dilation begins. Since the assessment of dilation is not possible in the prehospital setting other objective findings can help identify active labour or when to inspect perineum.
When should I look?
- History is suggestive of ruptured membranes or umbilical cord prolapse
- The patient is in labour and reports an urge to push, bear down, strain or move the bowels with contraction or reports that “the baby is coming”
- The patient is near term, LOC is decreased and history is unavailable, inconclusive or indicates that labour was on-going prior to decrease in LOC
- Vaginal bleeding is heavy and the pt is hypotensive or in shock
Imminent Birth as per ALS
- Crowning or other presenting part is visible or;
- Primips: presenting part is visible during and between contraction, maternal urge to push or bear down, Contractions are less than 2mins apart
- Multips: Contractions 5 mins apart or less and any other signs of second stage labour present
What is stage 3 of labour?
- Last from birth of the baby to delivery of the placenta
- Usually occurs 5-30 min after birth
Paramedic Observations during stage 3?
- Lengthening of the cord
- Sudden gush o trickle of blood
- Uterine contraction
What happens during placenta delivery?
- Placenta will separate from the uterine wall and this occurs with a gush of blood. You may notice lengthening of the cord or contractions.
- Apply gentle controlled cord traction (CCT) & guard the uterus with other hand (only after there is evidence of detachment)
- Encourage delivery- you can ask the mother to push
When the placenta is delivered, what should you do?
- Inspect it for wholeness
- Place in a plastic bag for the OBS kit
- Label it with the maternal pts name and time of delivery
- Transport it with the maternal or neonatal pt
What is the highest risk stage?
- Stage 3- Delivery of the placenta because of the increased risk of bleeding
How should we prepare to deliver a baby?
- Maintain pt privacy
- Prepare a delivery station
- Open up the OB kit
- Update dispatch and ask for a 2nd crew
- Get the pt of a form surface
- If they don’t want to move the baby will deliver in any position, there’s no stopping it
- Prepare a neonatal resus station
- Make sure the environment is warm
- Have towels and blankets
- Use sterile gloves
Normal Labour and Delivery Process
- Decent-fetus moves down toward the pelvis and becomes engaged
- Flexion- fetal chin to chest
- Internal rotation- fetal occiput turns toward maternal pelvis
- Extension- birth with head facing down
- Restitution- baby’s head rotates to the side
- External rotation- Fetus turns to deliver shoulder
- Expulsion- birth of baby
What does delayed cord clamping do?
- It suggests that delaying cord clamping and holding the baby below the level of placenta will increase blood volume to baby as well as decrease portability of aemia
When should you clamp and cut the cord?
- Clamp and cut the cord when it stops pulsating up to 2 min mark
Where should you clamp the cord?
- Clamp the umbilical cord in two places using the OBS clamps, approx 15 cm from the neonates abdomen and approx 5-7 cm from the first clamp. Cut the umbilical cord between the camps using the OBS scissors
What is the uncomplicated delivery care?
- Massage uterus to help minimize bleeding
- Check for bleeding every 5 mins for first 15 mins
- Monitor vitals
- Encourage voiding due to decreasing the risk of PPH
- Keep newborn warm, skin to skin, encourage breastfeeding
- Continually monitor newborn using APGAR
What does APGAR stand for?
A= Appearance
P= Pulse
G= Grimace
A= Activity
R= Respiration
Appearance
0= blue and pale
1= body pink, limbs blue
2= all pink
Pulse
0= Absent
1= Less than <100
2= More than >100
Grimace
0= no response
1= Grimace
2= Coughing and crying
Activity
0= limp
1= weak
2= strong
Respiration
0= Absent
1= Irregular, slow
2= Good, crying
