Ch 36 Obstretric And Gynecologic Emergencies

Question 1

External genitalia

Answer 1

Labia (soft tissues protecting entrance of birth canal)
Perineum (soft tissue between vaginal opening and anus)
Mons pubis (area where pubic hair grows)

Question 2

Internal genitalia

Answer 2

Vagina (connects uterus to outside)
Ovaries
Fallopian tubes
Uterus (located along midline of lower quadrant)

Question 3

Cervix

Answer 3

Muscle separating uterus and vagina

Question 4

Embryo

Answer 4

Ovum becomes this once combined with sperm

Question 5

Embryonic stage

Answer 5

Fertilization to eight weeks

Question 6

Fetal stage

Answer 6

After eight weeks, fetus will develop over next 32 weeks

Question 7

First trimester

Answer 7

Three months, fetus is being formed

Question 8

Placenta

Answer 8

Organ composed of maternal and fetal tissues
Exchange area between maternal and fetal blood

Question 9

Umbilical cord

Answer 9

Blood from fetus sent through here to the placenta where, diffusion, blood picks up nutrient from mother and offloads waste
One vein
Two arteries

Question 10

Amniotic sac

Answer 10

Float
Cushion
Maintain temp

Question 11

Cardiovascular changes in pregnancy

Answer 11

Increase blood volume, cardiac output, and heart rate
But number of red cells remain, anemia
BP slightly decreased
Increase in uterus vascularity

Question 12

All third trimester patients

Answer 12

Transported on left side

Question 13

First stage of labor (dilation period)

Answer 13

Starts with regular contractions and thinning and gradual dilation of cervix
Ends when cervix is fully dilated

Question 14

Second stage of labor

Answer 14

Starts when baby enters birth canal and lasts until baby is born

Question 15

Third stage of labor

Answer 15

Begins after baby is born and lasts until afterbirth (placenta, cord, tissues from amniotic sac, uterus lining) is delivered

Question 16

Lightening

Answer 16

Fetus moving down toward birth canal
Can occur well before labor or indicate beginning of labor

Question 17

Contraction times

Answer 17

Begins 30 min apart
Near delivery is 3 min apart or less

Question 18

Contraction time

Answer 18

Time from beginning of contraction to end

Question 19

Contraction interval or frequency

Answer 19

Start of contraction to beginning of the next

Question 20

Contractions imminent delivery

Answer 20

30sec-1 min duration
2-3 min apart

Question 21

Bloody show

Answer 21

Watery, bloody discharge of mucus from mucous plug (typical) first stage of labor

Question 22

Pt assessment questions for pregnancy

Answer 22

Due date
If this is her first pregnancy
If she has seen a doctor for pregnancy

Transport questions:
When labor pains started
If water broke or bloody show
If she feels urge for bowel movement
Examine for crowning
Take vitals

Question 23

Transporting mother

Answer 23

If no delivery after 10 min, contact MD again
Transport unless delivery is imminent

Question 24

Indications for neonatal rescucitation

Answer 24

No prenatal care
Premature delivery
Labor induced by trauma or medical conditions
Multiple births
History of pregnancy problems
Meconium staining with water breaking

Question 25

Delivery position

Answer 25

Floor, bed, or ambulance stretcher Elevate buttocks with pillow 2 ft workspace below buttocks Assistant at mother’s head

Question 26

Prevent explosive delivery

Answer 26

One hand to maintain slight pressure on baby’s head Hand below head as it delivers

Question 27

Meconium present

Answer 27

Prepare to suction neonate

Question 28

Assist with shoulders

Answer 28

Downward to birth upper shoulder Guide upwards to birth lower shoulder

Question 29

After baby is delivered

Answer 29

Lay on side with head lower than body Same level as mother’s vagina until cord stops pulsating

Question 30

Suctioning baby

Answer 30

If baby is not moving or breathing or if airway is obstructed Suction mouth then nose 1-1 1/2 inches into mouth 1/2 inch into nostril

Question 31

Birth written info

Answer 31

Mothers last name Time of delivery Location

Question 32

Neonate

Answer 32

Less than 1 month old

Question 33

APGAR appearance

Answer 33

0 blue or pale all over 1 extremities blue 2 pink all over

Question 34

APGAR pulse

Answer 34

0 0 1 less than 100 2 greater than 100

Question 35

Grimace

Answer 35

0 no reaction 1 facial grimace 2 sneeze cough or cry

Question 36

Activity

Answer 36

0 no movement 1 only slight activity extremities flex 2 moving around normally

Question 37

Respiratory effort

Answer 37

0 none 1 slow or irregular breathing weak cry 2 good breathing, strong cry

Question 38

Cutting cord

Answer 38

No sooner than 30-60 seconds after birth Don’t cut cord still pulsating unless complicated One clamp 10 inches from baby, another 7 inches Never unclamp a cut cord Placenta end of cord placed on drape

Question 39

If transporting baby and placenta attached

Answer 39

Placenta at same level of baby or higher

Question 40

Central cyanoises but otherwise fine

Answer 40

Blow by oxygen

Question 41

When to resuscitate neonate

Answer 41

If no breathing after 30 seconds of drying and warming If heart rate less than 100 30 sec interventions and then assess again

Question 42

Not active or breathing

Answer 42

Stimulate for 30 sec

Question 43

Neonate pulse check

Answer 43

Auscultate or brachial or end of cord

Question 44

Neonate PPV rate

Answer 44

1 every three seconds 40-60 breaths/min

Question 45

When neonate chest compressions

Answer 45

Less than 60 bpm Two thumbs encircling 1/3 depth of chest 3:1 ratio of compressions to breath

Question 46

Waiting for placenta to deliver

Answer 46

Transportation can be delayed up to 20 min with good conditions

Question 47

Bleeding after birth usually

Answer 47

No more than 2 cups (500 cc)

Question 48

Breech presentation

Answer 48

Initiate Rapid transport in case High concentration oxygen Head down position with legs elevated

Question 49

Limb presentation

Answer 49

Immediate transport Head down position with pelvis elevated Oxygen

Question 50

Prolapsed cord

Answer 50

Cord presents first Position mother head down and pelvis raised with blanket or pillow Check cord for pulse and wrap exposed cord with towel Push up on baby’s head until physician relieves

Question 51

Multiple births

Answer 51

Clamp cord of first baby before second baby is born Second may be delivered before or after placenta is delivered

Question 52

Premature infant

Answer 52

Less than 5 1/2 lb or 2 1/2 kg Before 37 weeks

Question 53

Placenta previa

Answer 53

Placenta formed in abnormal location Covering if implanted in an area blocking birth canal or over cervical opening Occurs in third trimester, heavy bleeding, no abdominal pain

Question 54

Abruptio placentae

Answer 54

Placenta prematurely separates from wall Often caused by trauma but also hypertension and drug use Heavy bleeding with abdominal or back pain Third trimester

Question 55

Ectopic pregnancy

Answer 55

Early on Shock indications Assume any woman with abdominal pain and/or bleeding to have this Acute abdominal pain often beginning on one side Rapid and weak pulse late Low BP late Treatment: do not give anything by mouth

Question 56

Seizures in pregnancy

Answer 56

Caused by eclampsia Tend to occur late in pregnancy Result of preeclampsia (pregnant retains large amounts of fluid and has hypertension) Signs: ALOC Swollen extremities and face High BP Excessive weight gain

Question 57

Spontaneous abortion (miscarriage)

Answer 57

Fetus and placentas deliver before twenty weeks Cramps Moderate to severe bleeding Noticeable discharge of tissue and blood Prepare OB kit if more than 24 weeks

Question 58

Stillborn

Answer 58

Fetus dies in uterus