Week 2- Complications in Deliveries Flashcards
What are risk factors that affect pregnancy?
older than 35
younger than 20
smoking/drinking
pregnant w twins/triplets
hx of miscarriage
obese
anorexia
Health conditions that can complicate pregnancy:
diabetes
cancer
high BP
STIs
kidney problems
epilepsy
anemia
What are three 1st trimester complications?
- Ectopic pregnancy
- Miscarriage
- Hyperemesis
What is an ectopic pregnancy?
a condition where the fertilized egg implants outside of your uterus
Where does the egg usually plant itself when its not in the uterus?
the fallopian tube
- 90% of the time
When would an ectopic pregnancy be diagnosed? (how many weeks)
12 weeks
What is the clinical triad of an ectopic pregnancy?
pain
missed periods (amenorrhea)
vaginal bleeding
S/S of ectopics pregnancy?
- when ruptured will present with hypotension and shock
- maybe shoulder pain due to irritation and this can also cause bradycardia or lack of tachycardia
What is one of the most dangerous complications in the first trimester?
Ectopic pregnancy
How do you treat a ectopic pregnancy pt?
treat them for shock and give them IV fluids
What is a miscarriage? (spontaneous abortion)
the loss of a pregnancy naturally before 20 weeks
What is the intervention needed to be done after a miscarriage happens?
surgical interventions!!
How does a miscarriage pt present?
- bleeding (light with clots, tissue and cramping)
- occurring for approx. 1 week
- can also be massive bleeds w hypovolemia
What is hyperemesis gravidarum?
severe nausea and vomiting during pregnancy
vomiting over 3 times a day
What are we worried about in hyperemesis gravidarum pt’s?
dehydration
vertigo
weight loss
pre term labour
What causes Hyperemesis Gravidarum?
high levels of pregnancy hormone
What are the 5 second and third trimester complications?
Preeclampsia
Eclampsia
Gestational diabetes
Placenta previa
Abruptio placenta
What is preeclampsia?
is a hypertensive disorder that occurs after 20 weeks
can also develop up to 10 weeks after delivery
What are s/s of preeclampsia?
high BP> 140/90
severe headache
blurred vision
upper abdo pain
n/v
proteinuria
edema
What is eclampsia?
the person with preeclampsia goes into seizure
How do we treat preeclampsia and eclapmsia pts?
pre- bring them to the hospital and monitor vital signs
ec- seizure pt, L&G, CTAS 1
What is gestational diabetes?
diabetes caused by pregnancy due to carbohydrate metabolism
mother is not able to produced and use all the insulin required
Can you give oral hypoglycaemic drugs to a pregnant person?
NO contradindicated
What is the result to the baby in a lady with gestational diabetes?
HUGE BABYYYYYYY
What are s/s of gestational diabetes?
- increased thirst
- frequent urination
- nausea
- fatigue
- sugar in the urine
- frequent bladder and skin infections
- yeast infections
- blurred vision
- dry mouth
What is placenta previa?
when the placenta partially or fully covers over the cervix
Will the fetus be able deliver vaginally if placenta is fully covering the cervix?
NOPE
What are s/s of a pt with placenta previa?
asymptomatic
painless bleeding
bright red
What is abruptio placenta?
partial/full detachment of placenta at 20 weeks
What is the worry of abruptio placenta patients?
massive hemorrhage!!!
What are s/s of a pt with a detached placenta?
+/- vaginal bleeding
contractions that do not relax (tight uterus)
rigid abdo
abdo pain
How would the pt describe the abdo pain in abruptio placenta?
tearing severe abdo pain!!
What is an amniotic fluid embolism? (AFE)
the most catastrophic complication in pregnancy
when amniotic fluid, fetal cells, hair or other debris enters into the maternal pulmonary circulation causing cardiovascular collapse–> they just DIE
How would a pt with an AFE present?
like they have a massive PE
Increases WOB, Hypoxia, Hypotension, Possibly cardiac arrest
Are minor injuries a concern in a pregnant lady?
YES.
What should we always ask a pregnant pt in an MVC?
If she was wearing her seatbelt properly
What is vertex presentation?
the proper way a baby should be positioned, the path of least resistance
40%-50% of twins will be delivered _____ (when in wks)???
<37 weeks
After first delivery of twin should the medic wait to clamp the cord???
NO!!! we will not know if placentas are joined/shared
What should we remember to do with umbilical cord after we clamp it?
LABEL!!!
If mom doesn’t know… it might be twins IFFF…..
- smaller than anticipated birth weight
- fundal height remains high
- fetal parts are felt through abdomen
What is considered a pre mature birth?
<37 weeks
What are risks for premature babies?
- always a risk of HYPOTHERMIA
- usually requires resus
- poor lung compliance
- no surfactant, alveoli not fully formed
What is surfactant?
produces by cells in the lungs and is essential for gas exchange in the alveoli
When does the surfactant start being produced in babies?
~26-28 wks by the alveolar cells
What is a nuchal cord?
when it is tighten over the babies neck
What do we do if the umbilical cord is suffocating the baby?
clamp/cut cord and deliver infant QUICKLY
What is a precipitous labour?
extremely rapid delivery
- delivery within 3 hrs of regular contractions
What is uterine atony?
the failure of the uterus to contract sufficiently
What are concerns with rapid labour?
increase risk of perineal laceration and postpartum hemorrhage due to uterine atony
How do we manage a precipitous labour?
Same as delivery
Setting up faster!!!!
Reassure mom
Encourage panting vs pushing to slow it down
Place mom in a position where gravity isn’t working against you
Guard perineum
Control delivery of head- apply gentle “ counter pressure” to vertex when crowning occurs
What is occiput anterior?
normal presentation
- vertex presentation is what we HOPE for, path of least resistance
What is occiput posterior?
fetal occiput is posterior in relation to the maternal pelvis “sunny side up”
What are the mal-presentations that will not deliver?
transverse lie- head and breech can be felt with exam of abdomen
shoulder presentation- shoulder is presenting part
oblique lie- fetus lies on a diagonal
When there is a limb presentation what do we do?
DO NOT PUSH IT BACK IN
tell her NOT to push
wrap the limb, keep it warm
L&G
What is brow presentation?
caused by partial extension of the fetal head so that the occiput is higher than the sinciput (the front of the skull from the forehead to the crown)
What is a frank breech?
hips flexed and legs extended over the anterior surface of the body
BUTTOCKS viewed from the cervix
What is a complete breech? (FULL)
occurs when both hips and knees are flexed, therefore buttocks and feet enter cervix first
What is a footling breech?
one hip and knees flexes, while the other remains straight and enters the birth canal first
risks of cord prolapse is HIGH!!
What is the best approach when delivering a FRANK BREECH’s!!?
HANDS OFF
you do not want to stimulate premature breathing
Management of complete breeches?
transport immediately!!!
How should we position the pt during a feet first breech??
place pt into gravity position (side of bed, upright or supported squat position)
an assistant should applying gentle fundal pressure to keep the fetal head flexed
When presenting part is visible, what should we encourage pt to do?
PUSH!!
and hands off to reduce the stimulation for neonate to breath!!
What is marcieau smellie veit (SMV)?
when most of the baby is delivered except for the head…..
lay neonate along ONE forearm with palm support neonates chest and two fingers exerting gentle pressure on the face to increase flexion
Place other hand on the neonates back and with two fingers hooked over the shoulders and the middle finger pushing up on the occiput to aid flexion
When the hairline becomes visible, lift the body in an arc to assist the fetal head to pivot around the symphysis pubis and allow the face to be born slowly. If a second paramedic is available, have him or her apply surprapubic pressure
Lift body in “arc” to assist head delivery “bum to mum”
When do we use Marcieau- Smellie- Veit technique??
During a breech delivery
What else can we do during a breech delivery to allow for a smoother delivery?
SQUAT position
Pt on all 4’s
What is a cord prolapse?
When the umbilical cord proceeds neonate thru the cervix (cord presents first) the umbilical cord will become compressed by the following neonate
What is a big risk with cord prolapse?
Can lead to fetal hypoxia or death!
What is the only treatment for a cord prolapse?
C-SECTION!!
Steps 1-4 in cord prolapse management:
- explain the situation!!
- assist pt into knee-chest position
- apply sterile gloves
- gently assess cord for pulse
What do we do with a prolapsed cord if we find a strong pulse in it?
replace cord into vagina (ask mom to, if not, we do it)
minimum cord handling to reduce vasospasm
What do we do if we find a weak pulse in the cord?
explain to mom whats happened!!
gently cradle cord in hand
replace cord into vagina while inserting fingers into vagina and apply manual digital pressure on the presenting part
lift the fetal part of the cord to relieve compression
cord pulse will become stronger if elevating the presenting part
Do we hold the presenting part the entire time we transport???
YES.
What is shoulder dystocia??
occurs when fetal shoulders are unable to born either spontaneously or with gentle flexion of head
Once the head is born, what is the time until critical irreversible hypoxic injury occurs?
FOUR MINUTES!!!!!
During shoulder dysotica what is the pneumonic we must peform twice before transporting???
ALARM!!!!!!
what does the A mean in ALARM?
ask for help!!! get a second crew if not here already
what does the L mean in ALARM?
lift legs!! hyperflex the thighs!!
mcroberts manuever, hyperflex maternal hips, knees to chest position and tell pt to stop pushing
What does the mc roberts maneuver accomplish?
This widens the pelvic outlet by flattening the sacral promontory and increasing the lumbosacral angle
what does the second A in ALARM stand for?
Apply suprpubic pressure
- use palm or fist to press down on your abdomen just above the pubic bone
the pressure is applied downward assist to dislodge the impacted shoulder
Why is McRoberts maneuver and suprpubic pressure done together?
because it increases the effectiveness or dislodging the baby shoulders
what does the R in ALARM mean?
Roll OVER
Gaskins maneuver- with the pt on her hands and knees (all fours position)
Gentle downward traction is applied to the posterior shoulder (the shoulder against the maternal sacrum)
Upward traction is applied on the anterior shoulder
What does the M mean in ALARM?
Manual Delivery of Posterior Arm!!
insert hand into vagina behind the posterior fetal shoulder to grasp the fetal elbow and bend it into the fetal chest
with gentle traction, the fetal elbow is delivered followed by the delivery of the posterior shoulder
What are the FOUR main causes of POST partum hemorrhage??
Tone- exhausted uterus and cannot contract
Tissue- parts of placenta still retained and clotting compromised
Trauma- uterine rupture/lac during delivery
Thrombin- coagulation abnormalities
POST PARTUM Hemorrhage with placenta delivered already….. what next???
Fundal Massage!!
if this doesn’t work….. then bimanual compressioN!!
What is a bimanual compression?
one hand above the symphysis pubis and other on top of the fundus
squeeze together for 5- 10 mins until bleeding stops
When to perform bimanual compression??
placenta delivered and fundal massage fails
placenta not delivered and PPH is present!!
What is meconium??
the newborn first stool/ bowel movement
sticky, thick, dark green poop made up of cells, protein, fats and intestinal secretions like bile
What does oxytocin do??
stimulates urine contraction, increases tone
