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EMRG 1302- Skill Labs > Week 2- Delivery and complications > Flashcards

Week 2- Delivery and complications Flashcards

1
Q

Childbirth: Uncomplicated

A
  1. Position pt supine on a firm surface with head and shoulder’s slightly raised, legs flexed and abducted at hips and knees
  2. Place plastic sheet/ bag/ towel/ drape under pt
  3. Observe for water break ( if not already ruptured) and note colour of fluid
  4. With non-dominat hand guard the perineum w 4x4
  5. Deliver the head in a control manner
  6. Apply gentle pressure to vertex (neonate’s head) to control delivery of the head
  7. Allow for restitution of head to occur naturally
  8. Observe for nuchal cord (if cord present and loose, slip over baby’s head/ if nuchal cord tight & can’t be slipped, clamp and cut cord)
  9. Encourage pt to push on next contraction
  10. Provide gentle lateral flexion, followed by gentle upward flexion to deliver shoulders and body (Note time of delivery)
  11. Place baby directly on Mom’s abdomen, prone with head to side allowing airway to drain
  12. Dry, stimulate newborn, and assess tone, breathing, crying
  13. Cover newborn with a new blanket/ towel to maintain warmth
  14. Allow cord to pulse before clamp & cut (2 mins) unless nenonatal resus or multiples
  15. Clamp 15cm from infant’s abdo and approx 5cm apart. Cut the cord
  16. Assess for placental detachment
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2
Q

How to deliver the placenta?

A
  1. Guard the uterus: place a hand on lower abdo
  2. With other hand apply gentle controlled cord traction (work w pt contraction) using up and downward motion, until completely delivered
  3. When membrane trail is seen; ask pt to cough or laugh and gently tease out in up & down motion
  4. Observe wholeness of placenta. Preform external uterine massage
  5. Place placenta into provided plastic bag and transport. Label with pt’s name and document time of delivery
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3
Q

What are some complications of childbirth?

A
  • Nuchal cord
  • Prolapsed cord
  • Malpresentation
  • Breech delivery
  • Shoulder dystocia
  • PPH
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4
Q

Childbirth complication: prolapsed cord

A
  1. Gain consent to inspect pernieum for prolapsed cord
  2. Explain procedure and expected outcome
  3. Consider extrication
  4. Assist into knee-chest position or exaggerated sims
  5. Encourage pt to breathe through contractions
  6. Keep pt informed
  7. Gently cradle the cord in hand and replace into vagina, insert fingers to lift fetal part of the cord
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5
Q

Childbrith complications: Breech Delivery

A
  1. Assess for signs of imminent breech birth
  2. Position pt to allow gravity to birth the baby (upright or supported squat position OR bring buttocks to edge of bed, place feet on chair)
  3. Hands off breech
  4. Consider manual delivery of legs (apply pressure to popliteal fossa once visible, sweep foot down & out)
  5. Hands off breech
  6. Note time of delivered umbilicus (you have 4 mins to deliver head)
  7. Consider manual delivery of arms (if hand or elbow visible on fetal chest)
  8. Allow baby to descent with gravity
  9. Another medic may apply gentle suprapubic pressure to maintain flexion of head
  10. Initiate MSV when hairline/nape or head does not deliver within 3 mins after the umbilicus is visible
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6
Q

During breech, what to do if head doesn’t deliver within 3 mins?

A
  1. Maintain MSV and transport
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7
Q

How to do the MSV manoeuvre?

A
  1. Discourage pt from pushing during the manoeuvre
  2. Support baby with forearm, palm supporting chest. Place fingers on cheekbones
  3. Place other hand on baby’s back
  4. Ensure controlled delivery of baby’s head
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8
Q

What to do if limb presentation?

A
  • Cover limb with dry sheet to maintain warmth and discourage from pushing
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9
Q

Childbirth complication: Shoulder Dystocia

A
  1. Assess signs of imminent shoulder dystocia birth
  2. Inform pt, support person(s) and partner of the emergency situation
  3. Explain procedure and expected outcome, obtain consent
  4. Position pt supine on the edge of a firm surface
  5. Note time of baby’s head delivered (you have 8 mins to complete delivery)
  6. Preform ALARM Manoeuvers
  7. If first ALARM unsuccessful (paramedic partner tries)
  8. If second ALARM unsuccessful (transport immediately, preform ALARM en route)
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10
Q

What is the first A and what do we do?

A

Ask for assistance

  • ask pt to lay flat, on a firm surface
  • Ask for help to assist during ALARM
  • Ask partner to help
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11
Q

What does L stand for and what do we do?

A

Legs Abduction (McRobert’s manoeuver)

  • Hyperflex hips by lifting legs & knees
  • Aim to: bring knees to ear, form a squatting position
  • Best preformed by 2 people holding legs
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12
Q

What is the second A and what do we do?

A

Adduct shoulder (suprapubic pressure)

  • Apply pressure before the next contraction (preformed by partner)
  • Maintain throughout entire contraction
  • Instruct pt to push in this position
  • Apply gentle downward lateral flexion of the head
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13
Q

What does the R stand for and what do we do?

A

Roll over (Gaskin Manoeuver)

  • If steps 1, 2, 3 are unsuccessful: (preform hands and knees)
  • Ask pt to roll over onto hands-and-knees position
  • Apply upward lateral flexion of the baby’s head to facilitate delivery of the body
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14
Q

What does the M stand for and mean?

A

Manually Release Posterior Arm

If hand visible:
- Follow humorous
- Sweep arm across fetal chest and out
- Deliver the posterior arm

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15
Q

After delivery of the baby, what should you encourage Mom to do?

A
  • Encourage infant latching/nipple simulation
  • Encourage pt to void her bladder
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16
Q

External Bi Manual Compression- Placenta In

A
  1. Attempt to deliver placenta; guard uterus use gentle controlled cord traction during contraction with pt pushing
  2. If delivery is unsuccessful & pts is exhibiting signs of PPH; preform bimanual compression
17
Q

How do you do bimanual compression?

A
  1. Place one hand on lower abdo; cup hand supporting the lower portion
  2. Place other hand at the top of the uterine fundus
  3. Compress the uterus between each hand continuously compressing the uterus (preform as long as possible; may require rotation) until PPH stops
18
Q

What to do if Placenta is out and PPH occurs?

A
  1. Preform uterine massage
  2. If EUM is unsuccessful, preform external bi-manual compression
19
Q

How to do external uterine massage?

A

Conduct eum one placenta has been delivered if the fundus remains soft/”boggy” or PPH

  1. Place one hand on the lower portion of the abdo in a cupped position supporting the lower portion of the uterus
  2. Place one hand at the top of the uterine fundus
  3. Begin massaging with the upper hand using circular motion. The lower hand should remain still, supporting the lower portion of uterus
  4. If PPH doesn’t stop switch to bimanual compressions
20
Q

What are some complications/ considerations of uterine massage?

A
  • Should not be conducted until after placenta delivery
21
Q

What are some complications/ considerations of Shoulder Dystocia?

A
  • Baby’s head emerges slowly and chin may have difficulty sliding over perineum
  • Turtling sign
  • Cyanosis to baby’s head
  • Failure of spontaneous restitution
  • Preform a Max of 2 ALARMS on scene
22
Q

What should be documented with shoulder dystocia?

A
  • Color of fluid
  • Time of birth of head
  • Turtle sign, if present
  • Time each manoeuvre and attempt to deliver baby
  • Time partner attempted ALARM and time of each manoeuvre
  • Time of birth of baby
  • Time of delivery of placenta
  • Amount of bleeding- minimal/ moderate/ large amounts/ clots
23
Q

What are some complications/ considerations with breech delivery?

A
  • Nuchal cord
  • Cord prolapse
  • Hypoxic damage and asphyxia
  • Damage to internal organs
  • Limb presentation
  • Death (neonate resus)
24
Q

What are some signs of imminent breech birth?

A
  • Fresh dark meconium at perineum
  • Breech, foot/ leg visibly protruding from vagina
25
Q

What should you document during breech delivery?

A
  • Breech visible on the perineum
  • Time umbilicus is visible
  • Manual release of legs and arms
  • Time hairline is visible
  • MSV manoeuvre
  • Time of birth of baby
  • Time of placenta delivery
  • Amount of bleeding

EMRG 1302- Skill Labs (3 decks)

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