EMRG 1305 - Complicated OB

Question 1

What’s an Ectopic Pregnancy?

Answer 1

Fertilized egg implants outside the uterus (usually on Fallopian tubes)
Usually happens around 6 week marks

Question 2

Signs and symptoms of an Ectopic pregnancy

Answer 2

pain
amenorrhea (missed periods)
A lot of vag bleeding
Complaints of shoulder pain (due to irritation)
- can cause Bradycardia or lack of tachycardia in hypovolemic pt
syncope
hypotension
SHOCK

Question 3

Treatment for ectopic pregnancy

Answer 3

Treat for shock
give IV fluids (they will be hypotensive, it meets the conditions)
load and go

Question 4

Miscarriage

Answer 4

loss of pregnancy naturally before 20 weeks
commonly in the first trimester
chromosomal problems cause most misscarriages
massive bleeds with hypolvolemia

Question 5

Treatment for miscarriage

Answer 5

Give fluids i.e. IV
Oxygenate if sat go low
treat symptoms found

Question 6

Hyperemesis Gravidarum (morning sickness) s/s

Answer 6

Severe nausea and vomiting during pregnancy
Vomiting > 3 times per day
vertigo
weight loss
dehydration
shock (from dehydration and loss of volume)

Question 7

Treatment for morning sickness

Answer 7

Treat based on symptoms

Question 8

Preeclampsia

Answer 8

Hypertensive disorder that occurs after 20 weeks
can occur unto 10 weeks after delivery

Question 9

Signs and symptoms for Preeclampsia

Answer 9

BP higher 140/90
severe headache
blurred vision
upper abdo pain (RUQ)
SOB
edema (due to hypertension)
Proteinuria (elevated protein in the urine)

Question 10

Eclampsia

Answer 10

Someone with preeclampsia goes into seizure

Question 11

Treatment Eclampsia

Answer 11

Bring to hospital
Vitals
Treat for seizure
Load and Go

Question 12

Gestational Diabetes

Answer 12

Mother is not able to produce and use all the insulin required
Excess glucose is transferred to fetus and stored as fat (transfers to baby= big baby)

Question 13

Signs and Symptoms of gestational diabetes

Answer 13

Frequent urination
nausea
fatigue
increased thirst
yeast infection
sugar in urine
frequent infections
dry mouths
blurred vision

Question 14

Treatment for gestational diabetes

Answer 14

load and go
can’t deliver easily

Question 15

Placenta Previa

Answer 15

Placenta partially or fully covers the cervix, this is easy to detect on ultrasound, so mother should be aware
Detached from where its suppose to be, sometimes it comes off and covers the cervix

Question 16

S/S of Placenta Previa

Answer 16

Asymptomatic
painless bleeding bright red
Blood transfusion may be needed

Question 17

Abruptio Placenta

Answer 17

Partial/full detachment of placenta at 20 weeks
Blood behind the placenta

Question 18

S/S abruptio placenta

Answer 18

severe abdominal pain, described as tearing

Question 19

Risk Factors of abruptio placenta

Answer 19

Trauma
multiple fetuses
short umbilical cord previous c-section
pre-eclampsia/eclampsia

Question 20

S/S abruptio placenta

Answer 20

Vag bleeding
Contractions that do not relax
abdo pain (rigid abdomen)

Question 21

Amniotic Fluid Embolism (AFE)

Answer 21

amniotic fluid, fetal cells, hair or other debris enters into the maternal pulmonary circulation causing cardiovascular collapse (you just die)
Typically 30 minutes after delivery

Question 22

Pt presentation of AFE

Answer 22

rapid and/or abnormal HR
Low blood pressure
chills
vomiting
severe anxiety

Question 23

Trauma in pregnant pt

Answer 23

most common cause MVC’s, assaults and falls
60-70% of fetal loss is reported from minor injuries
call another ambulance 2 pt
mortality of the infant relies on the mother, prehospital treatment should be maximized for maternal survival

Question 24

Vertex presentation

Answer 24

path of least resistance, crowning

Question 25

Twin complications

Answer 25

40-50% are preterm (<37wks)
2nd twin is usually malpresentation due to room once the 1st is delivered

Question 26

Postpartum Hemorrhage

Answer 26

Overdistention of uterus may result in uterine atony. Higher incidence of mean blood loss with twins

Question 27

Delivering a Twins

Answer 27

clamp right away and label the placenta, you don’t know if they are shared or separate and you need to keep the placentas to right pt
you may be able to transport between the twins after delivering the first twin, may be 17-20 minutes in between
if you are on route you will need to stop and deliver the second baby

Question 28

Fraternal Twins

Answer 28

TWO eggs are released from ovaries
each egg fertilized by SEPERATE sperm
seperate placenta and are separately implanted in the wombs

Question 29

Maternal Twins

Answer 29

ONE egg released from ovary and fertilized by ONE sperm

Question 30

When is there a separate placenta and inner sac

Answer 30

when an early embryo splits BEFORE implanting in the womb

Question 31

when is there a shared placenta and seperate inner sacs

Answer 31

when an early embryo implants in womb AND THEN splits

Question 32

when is there a shared sac and placenta

Answer 32

when an early embryo implants in the womb AND THEN splits later

Question 33

how do you know if its twins when they don’t know

Answer 33

smaller than anticipated birth weight (fetus competing for space)
Fundal height remains high (2nd or more fetus in utero)
Fetal parts may be able to be palpated through abdomen
Always reassess baby

Question 34

Premature birth, what does it look like?

Answer 34

anytime < 37 wks
usually requires resuscitation
poor lung compliance (hard to squeeze BVM)
- you are trying to open the alveoli because they can’t on their own yet
- 35 wks there’s usually sufficient amount to prevent alveoli collapse “atelectasis”

Question 35

What is a Nuchal Cord

Answer 35

the umbilical cord is wrapped around the babies neck

Question 36

How do you manage a nuchal cord

Answer 36

try to get two fingers under the cord to pull it over the babies head. it is stretchy
if the cord is tight, clamp, cut and deliver the baby ASAP

Question 37

Precipitous labour

Answer 37

delivery of baby is usually within 3 hours or regular contractions.
most moms don’t make it to the hospital before it’s time to deliver.
common with 2nd birth

Question 38

How to manage a precipitous Labour

Answer 38

encourage panting vs pushing to slow it down
place mom in a position where gravity isn’t working against you

Question 39

what are all the malpresentation and which is more common?

Answer 39

Occiput Anterior (most common)
Occiput posterior
Breech
Transverse Lie
Face
Compound
Brow