Flashcards in 6.5 Obstetric Problems Deck (34)
If you have a pregnant patient whose primary problem is not obstetric (ag asthma or a seizure) - what is your focus of treatment?
Focus is the primary problem such as asthma or seizure
If a patient has an obstetric problem AND is status one or two, do you transport to maternity or ED?
If a patient has an obstetric problem and their midwife or doctor (Lead Maternity Carer -LMC) is present who is in charge?
LMC is in charge
Miscarriage in the first trimester - what is the treatment plan?
Patient does not require immediate referral or transport to hospital unless:
a) Pain is significant
b) nature of pain is different to a menstrual cycle
c) bleeding is clinically significant (more heavy than a period)
What is your treatment plan if a patient has a miscarriage in first trimester and
- there is no significant pain
- pain is as per a normal period
- bleedig is per a normal period
Reccommend to see LMC or Gp within 24 - 48 hours.
What is the treatment plan for all patients involved with abdominal or pelvic trauma during second or third trimester?
Immediately referred to hospital
Even if trauma is minor.
What is supine hypotension?
When the bloods return to the heart through the inferior vena cava is impeded by the uterus.
In supine position.
What do you do to prevent supine hypotension?
Tilt pregnant patient to their left.
Place a towel or pillow under their right hip.
What is antepartum haemorrhage?
Obstetric bleeding occurring between 20 weeks pregnancy and birth.
What is the usual presentation of antepartum haemorrhage?
Can you have antepartum haemorrhage without vaginal bleeding?
E.g. placental abruption
What is your treatment for a patient with antepartum haemorrhage?
Refer to hospital.
What kind of shock could a patient develop from antepartum haemorrhage?
What is the treatment plan for a patient in premature labour?
Transport to hospital immediately.
Be prepared for neonatal resuscusitation
Do not give any medications to slow labour unless requested to do so by LMC.
What is the treatment process for a patient in labour and wishing to deliver?
Allow patient to adopt position she wants.
Support baby's head and shoulders as they appear.
Do not pull on baby or apply traction
Place baby 'skin to skin' with mum if no resuscitation is required.
Cover both with blanket
Place hat on baby if possible
Clamp and cut cord (5cm from baby) not urgent.
Allow placenta to deliver spontaneously
placenta can take up to 30 minutes
Following delivery of placenta, feel for uterus at approx. umbilical level and rub until it feels firm.
What do you do if baby gets stuck during delivery?
If babys head appears, but body does not after 2 contractions:
get patient to grab her knees
pull knees to chest
push as hard as she can in next 2 contractions.
If this fails:
place the heel of your hand above patients pubic bone
push slowly but firmly straight back towards patients lower back.
this should reposition baby's shoulder
* If the above fails seek immediate help(from midwife, doctor) and transport urgently!!!!!
What is a prolapsed umbilical cord?
When umbilical cord appears ahead of baby.
What is a breech delivery?
Baby coming out feet or buttocks first.
What is the risk to mother or baby of a polapsed umbilical or a breech delivery?
Baby having poor blood supply due to compressed umbilical cord.
True or false - delivery of the baby is urgent in a breech or prolapsed cord situation?
If a baby is presenting breech do you get the patient to push?
How do you as an ambulance officer position a patient who is presenting with a prolapsed cord or a breech baby?
Position patient with her hips higher than shoulders.
What are the two methods of positioning a patient with her hips higher than her shoulders?
On her back, hips on a pillow and stretcher head down
On her knees and elbows, with her head down and stretcher head down.
Why is it so important to position a patient with a prolapsed umbilical cord or a breech delivery in a manner with her hips higher than her shoulders?
So that weight of the baby is taken off the umbilical cord
help delay delivery
Prolapsed umbilical cord/breech baby - If baby presents in the vagina and patient wants to push do you allow delivery?
What is a retained placenta?
When the placenta has not been delivered within 30 minutes of the baby.
What condition could you expect to happen if a placenta is retained?
Post partum haemorrhage.
What is your treatment plan for a retained placenta?
Transport to hospital without delay.
Be prepared to treat post partum haemorrhage
What is post partum haemorrhage?
Bleeding (greater than 500ml) following delivery of baby.
Can a patient suffer hypovolaemic shock from post partum haemorrhage?
What is bi manual compression of the uterus?
Placing one hand in the vagina as far as possible and forming a fist and pushing upwards towards patients umbilicus
placing other hand on the abdomen, feeling for uterus and pushing both hands firmly towards each other.
What are some measures to hand that could possibly stop post partum haemorrhage by causing uterus contraction?
Encourage baby to breast feed
Get partner to stimulate patients nipples for approximately 15 minutes
(encourages oxytocin release to help uterus contract)
Is seeking further treatment urgent for a patient that has post partum haemorrhage?