WEEK 2 Flashcards
what is the Handover/pre-alert acronym for pregnant women?
ASHHIE A- age S - Signs and symmtoms H - History of current problem/presentation H - History of current pregnancy I - interventions E- ETA
What are the 5 things to check for if you see blood on the floor?
- Check vagina for bleeding at the introitus
- Check thoracic area (any sign of internal bleeding)
- Check abdo area (internal bleeding - firm or woody)
- Check pelvis - trauma specific
- Check femurs - trauma specific
how long is full term labour?
37-42 weeks
what is labour?
normal process by which the foetus, placenta and membranes are expelled through the birth canal
what does gestation mean?
how long they have been pregnant for
what happens in the first stage of labour?
painful contractions resulting in cervicle dilatation to 10cm or fully dilated.
three phases - latent, active & transition
What are the three phases in the 1st stage of labour?
three phases - latent, active & transition
What happens in the 2nd stage of labour?
full dilation to arrival of baby
2 phases - lull, expulsive
What are the three phases in the 2nd stage of labour?
2 phases - lull, expulsive
WHat happens in the 3rd stage of labour?
Time from birth of baby to delivery of placenta
WHat are the timeframes for the 1st stage of labour?
Primigravida - 12-16 hours
multigravida - 4-10 hours
WHat are the timeframes for the 2nd stage of labour?
Primigravida - 30-90 min
multigravida - 5-60 min
WHat are the timeframes for the 3rd stage of labour?
Primigravida - 5-60 min
multigravida - 5-30 min
WHat does gravida mean?
number of times a woman has been pregnant
what does parity mean?
the number of pregnancies carried to viability (past 24 weeks)
What is antepartum?
the period prior to childbirth
what is postpartum?
the period after childbirth
what is antenatal?
the period prior to childbirth
what is postnatal?
the period post-childbirth
what is the Importance of a structured assessment
- Provides context of for the signs and symptoms
- Assist with clinical judgement
- Allows paramedics to prioritise for treatment and management
- Assists with transportation decisions
- Assist with clearer handovers
WHat is the acronym used to assess maternity patients?
EPOMS
What does the EPOMS acronym stand for?
Event – this event – current presentation???
• Labour, Baby, Bleeding, Pain, Trauma,
Pregnancy – this pregnancy –
• Gestation; G’sP’s; problems; last check-up; carer
Obstetric – previous history
• Outcomes & complications- previous pregnancy
Medical – current & previous history
• Medical conditions affecting decision making
Social – current & previous
• Social conditions that may affect treatment/decisions
what are the presumptive signs of potential pregnancy?
Amenorrhoea (lack of mentral bleeding)
Nausea & Vomiting
Fatigue
WHat are probably signs of pregnancy?
- Uterine enlargement;
- breast enlargement
- Softening of cervix;
- Colour changes of mucous membrane from pink to bluish pink
What are positive signs of pregnancy?
Pregnancy test +ve HCG
Foetal heart beat
Ultrasound
WHat is Naegeles rule?
Estimation of delivery date:
• First date last menstrual period
• Add 9 months & Add 7 days
• Based on 28 day cycle
What is RH Factor?
those who are RH + have the D antigen
those who are RH - do not have the D antigen
Mother and child need to be the same or the woman’s body will attack the baby
How can the expected date of delivery be determined by fundal height?
Fundal height • 12 weeks symphysis pubis • 20 weeks belly button • 40 weeks 2-3 cms ↓ Xyphi. • 38 weeks xyphi sternum
Fundal measurements ↑’s 1cm/week
• From symphis pubis
What is a mutagen?
a mutagen is a physical or chemical agent that causes genetic material (DNA) to undergo a detectable and heritable structural change. All mutagens are teratogens but not all teratogens are mutagens’.
What is a carcinogen?
‘a carcinogen is any agent that by either direct or indirect actions causes a normal cell to become a neoplastic cell’.
What is a tetrogen?
EXAMMM
“A substance that causes a transient or permanent physical or functional disorder in the foetus without causing toxicity to the mother.”
when can teratogens be particularly dangerous for the foetus?
during organogenesis
What are some of the altered pharmacokinetics of absorption during pregnanacy?
Absorption
• May be increased or decreased from the GIT by delayed gastric emptying and motility
• Drug absorption from the lungs may be increased due to increased ventilation rates
• Drug absorption from the skin may be increased due to increased skin surface area
What are some of the altered pharmacokinetics of distribution during pregnanacy?
Distribution
• Altered body composition (increased proportion of fat stores up to 25%)
• Altered fluid distribution (30-50% increase in plasma volume).
What are some of the altered pharmacokinetics of metabolism during pregnanacy?
Metabolism
• Hepatic enzyme activity (CYP450) can be either increased or decreased
• (metabolism of caffeine is reduced whilst metabolism of some anticonvulsants are increased)
What are some of the altered pharmacokinetics of excretion during pregnanacy?
Excretion
• Maternal renal blood flow and GFR increase during the first 8 months of gestation
By week 12-14, how developed is the foetus liver?
approx 30% adult function
when does the foetal liver achieve full function?
at 1 year of age
How can drug metabolism affect foetus?
underdeveloped metabolisim process, drugs can circulate and remain for longer periods of time and have dramatic effects
What are category A drugs?
Drugs which have been taken by a large number of pregnant women and women of childbearing age
without any proven increase in the frequency of malformations or other direct or indirect harmful
effects on the foetus having been observed.
What are category B1 drugs?
Drugs which have been taken by only a limited number of pregnant women and women of
childbearing age, without an increase in the frequency of malformation or other direct or indirect
harmful effects on the human fetus having been observed. Studies in animals have not shown
evidence of an increased occurrence of fetal damage.
What are category B2 drugs?
Drugs which have been taken by only a limited number of pregnant women and women of
childbearing age, without an increase in the frequency of malformation or other direct or indirect
harmful effects on the human foetus having been observed. Studies in animals are inadequate or may
be lacking, but available data show no evidence of an increased occurrence of foetal damage.
WHat are category B3 drugs?
Drugs which have been taken by only a limited number of pregnant women and women of
childbearing age, without an increase in the frequency of malformation or other direct or indirect
harmful effects on the human foetus having been observed. Studies in animals have shown evidence of
an increased occurrence of foetal damage, the significance of which is considered uncertain in
humans.
What are category C drugs?
Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing,
harmful effects on the human foetus or neonate without causing malformations. These effects may be
reversible. Accompanying texts should be consulted for further details.
What are category D drugs?
Drugs which have caused, are suspected to have caused or may be expected to cause, an increased
incidence of human foetal malformations or irreversible damage. These drugs may also have adverse
pharmacological effects. Accompanying texts should be consulted for further details`
What are category X drugs?
Drugs which have such a high risk of causing permanent damage to the foetus that they should not be
used in pregnancy or when there is a possibility of pregnancy
what types of drugs are easily transferred in breast milk?
•Highly lipid soluble and low plasma bound drugs
WHat does the risk of drug exposure depend on when referring to breastmilk?
•The risk of exposure depends on the maternal drug plasma concentration, concentration in the breast
milk and the amount of milk consumed
What are the key drugs that are passed through breastmilk?
- Nicotine (3x higher concentration in breastmilk)
- Alcohol
- Cannabis
- basically all medications to a degree
what are some Changes in pharmacokinetics in children?
- liver and drug metabolism enzymes are increased in children
- renel excretion is decreased in neonates (reaches adult level by 3-6 months)
- altered distribution of drugs
