Chapter 34 - (MASTERY) Obstetrics & Neonatal Care Flashcards
1
Q
After delivery, the ________, or afterbirth, separates from the uterus and is delivered.
A
placenta
2
Q
The umbilical cord contains two _________ and one _________.
A
arteries; vein
3
Q
The amniotic sac contains about _________ to __________ mL of amniotic fluid, which helps to insulate and protect the floating fetus as it develops.
A
500; 1,000
4
Q
A full-term pregnancy is from _______ to _________ weeks, counting from the first day of the last menstrual cycle.
A
36; 40
5
Q
By the end of pregnancy, the pregnant patient’s heart rate increases up to 20%, or about __________ beats more per minute.
A
20
6
Q
There is a high potential of exposure due to ________ ________ released during the childbirth.
A
body fluids
7
Q
The leading cause of maternal death in the first trimester is internal hemorrhage into the abdomen following rupture of a(n) ___________ _________.
A
ectopic pregnancy
8
Q
In serious trauma, the only chance to save the infant is to adequately _________ the mother.
A
resuscitate
9
Q
During the delivery, be careful that you do not poke your fingers into the infant’s eyes or into the two soft spots, called _________, on the head.
A
fontanelles
10
Q
_________ _________ is a developmental defect in which a portion of the spinal cord protrudes outside the vertebrae.
A
spina bifida
11
Q
Passage of the fetus and placenta before 20 weeks is called ___________.
A
abortion
12
Q
Preterm or false labor is commonly referred to as ________ _______ contractions.
A
braxton-hicks
13
Q
The _________ ________ carries oxygenated blood from the woman to the heart of the fetus.
A
umbilical vein
14
Q
The _________ is the area of skin between the vagina and the anus.
A
perineum
15
Q
Due to hormonal changes that cause joints in the musculoskeletal system to “loosen,” a pregnant patient has a greater risk of ________.
A
falls
16
Q
You assess an infant after delivery and note that the child has a loud cry and withdraws to pain. The heart rate is 94 beats/min, the extremities are cyanotic, respirations are rapid, and the infant strongly resists your attempts to straighten the knees. Determine the Apgar score.
Select One
A. 2
B. 10
C. 8
D. 4
A
C. 8
17
Q
The female reproductive system includes which organs?
A
It includes the fallopian tubes, uterus, cervix, vagina, and the breasts.
18
Q
During the menstrual cycle how many follicles are successful at maturing and able to release an egg?
A
There will only be one follicle (out of 10 to 20 that attempt the process each month)
19
Q
When does ovulation occur?
A
It occurs approximately 2 weeks prior to menstruation.
20
Q
What is the endometrium?
A
It is when the lining of the inside of the uterus, begins to thicken and prepare for the potential fertilized egg to implant.
21
Q
What happens if the egg is not fertilized within 36-48 hours after it has been released from the follicle?
A
It will simply die. Eventually, the lining that has thickened inside the uterus will be sheD…It occurs around the 28th day of woman’s cycle.
22
Q
Where does fertilization of the egg usually occur?
A
Fertilization, when a sperm and egg meet, usually occurs when the egg is inside the fallopian tube.
23
Q
What is an embryo?
A
It is the fertilized egg that is the early stages of the fetus.
24
Q
What is the fetus?
A
It is the developing, unborn infant inside the uterus. (Grows for approximately 9 months/40 weeks)
25
What is the birth canal?
## Footnote
**It is the vagina and cervix.**
26
What is the cervix?
## Footnote
**It is the narrowest portion of the uterus that opens into the vagina.**
27
What is a bloody show?
## Footnote
**It is a small amount of blood at the vagina that appears at the beginning of labor and may include a plug of pink-tinged mucus that is discharged when the cervix begins to dilate.**
28
What is the length of the vagina?
## Footnote
**It is about 8-12 cm in length (begins at the cervix & ends as an external opening)**
29
How can you prevent the perineum from tearing?
## Footnote
**By applying pressure to the baby's head to allow the tissues to stretch and to prevent a precipitous birth. An episiotomy may be performed by the physician (incision to the perineum).**
30
What is the placenta?
## Footnote
**It is the tissue attached to the uterine wall that nourishes the fetus through the umbilical cord.**
31
What is the placental barrier?
## Footnote
**It consists of two layers of cells, keeping the circulation of the woman and fetus separated but allowing nutrients, oxygen, waste, carbon dioxide, and many toxins and most medications to pass between the fetus and woman.**
32
What is the umbilical cord?
## Footnote
**It is the conduit connecting mother to infant via the placenta; contains two arteries and one vein.**
33
The umbilical vein carries?
## Footnote
**It carries oxygenated blood from the woman to the heart of the fetus.**
34
The umbilical arteries carry?
## Footnote
**They carry deoxygenated blood from the heart of the fetus to the woman.**
35
What is the amniotic sac?
## Footnote
**It is the fluid-filled, baglike membrane in which the fetus develops.**
36
How much fluid is contained in the amniotic sac?
## Footnote
**It contains about 500-1000 mL, which helps insulate and protect the fetus.**
37
What systems are involved in changes dealing with pregnancy?
## Footnote
**The primary systems are the respiratory, cardiovascular, and musculoskeletal systems.**
38
How much of an increase in blood volume does a pregnancy bring?
## Footnote
**Blood volume may eventually increase as much as 50% by the end of pregnancy.**
39
As the pregnancy continues what happens to the respiratory system?
## Footnote
**The respiratory rate increases, with decreasing minute volumes. The pregnancy also increases the patient's overall demand for oxygen as the metabolic demands increase.**
40
What are the three stages of labor?
## Footnote
**1. Dilation of the cervix**
**2. Delivery of the infant**
**3. Delivery of the placenta**
41
What is a primigravida?
## Footnote
**It is a woman who is experiencing her first pregnancy.**
42
What is a multigravida?
## Footnote
**It is a woman who has experienced previous pregnancies.**
43
What are Braxton-Hicks contractions?
## Footnote
**They are preterm or false labor contractions.**
44
What is Lightening?
## Footnote
**It is a sensation felt by a pregnant patient when the fetus positions itself for delivery.**
45
What is crowning?
## Footnote
**It is the appearance of the infant's head at the vaginal opending during labor.**
46
What is preeclampsia/pregnancy-induced hypertension?
## Footnote
**It is a condition of late pregnancy that involves headache, visual changes, and swelling of the hands and feet.**
47
What are the signs and symptoms of preeclampsia?
## Footnote
**Headache, seeing spots, swelling in the hands and feet (edema), anxiety, and high blood pressure.**
48
What is eclampsia?
## Footnote
**It is seizures (convulsions) resulting from severe hypertension in a pregnant woman.**
49
What is supine hypotensive syndrome?
## Footnote
**It is low blood pressure resulting from compression of the inferior vena cava by the weight of the pregnant uterus when the mother is supine. (Prevent by transporting patient on her left side).**
50
What is an ectopic pregnancy?
## Footnote
**It is a pregnancy that develops outside the uterus, typically in a fallopian tube.**
51
What is the leading cause of maternal death in the first trimester of pregnancy?
## Footnote
**It is the internal hemorrhage into the abdomen following the rupture of an ectopic pregnancy.**
52
What is a miscarriage?
## Footnote
**It is the passage of the fetus and placenta before 20 weeks; spontaneous abortion.**
53
What is an abruption placenta?
## Footnote
**It is a premature separation of the placenta from the wall of the uterus.**
54
What is placenta previa?
## Footnote
**It is a condition in which the placenta develops over and covers the cervix.**
55
Any bleeding from the vagina in a pregnant woman should be treated how?
## Footnote
**As a serious sign and should be treated in the hospital promptly.**
56
What is gestational diabetes?
## Footnote
**It is diabetes that develops during pregnancy in women who did not have diabetes before pregnancy.**
57
Pregnant women have an increased amount of overall what?
## Footnote
**Increased amount of overall blood volume and an approximate 20% increase in their heart rate by the third trimester.**
58
When your patient is pregnant, you have two patients to care for, who is the focus?
## Footnote
**Your focus is on the assessment and the management of the woman.**
59
What are the guidelines for treating a pregnant trauma patient?
## Footnote
**1. Maintain an open airway - increased risk of vomiting**
**2. Administer high-flow O2 - patient also supplying O2 to fetus**
**3. Ensure adequate ventilations - listen to lung sounds**
**4. Assess circulation - maintain Index of S. for internal bleeding**
**5. Transport considerations - call ALS for MOIs or major trauma**
60
What is meconium?
## Footnote
**It is a dark green material in the amniotic fluid that can indicate distress or disease in the newborn; the meconium can be aspirated into the infant's lungs during delivery; aka infant's first bowel movement.**
61
During the physical examination of a pregnant patient what should you focus on?
## Footnote
**You should focus on the contractions and possible delivery.**
62
In terms of litigation, where does obstetrics fall?
## Footnote
**It is among the most litigated specialties in medicine; therefore, scrupulous documentation is essential.**
63
What are some questions to determine if delivery is imminent?
## Footnote
**-How long have you been pregnant?**
**-When are you due?**
**-Is this your first baby?**
**-Are you have contractions, how long?**
**-Do you feel like you will have a bowel movement?**
**-Have you had any spotting or bleeding?**
**-Has your water broken?**
**-Were any of your children delivered by cesarean?**
64
What are some questions to ask to determine any potential complications?
## Footnote
**-Have you had any problems in a previous pregnancy?**
**-Do you use drugs, drink, alcohol, or take any medications?**
**-Do you know if there is a chance for multiple births?**
**-Does your doctor expect any complications?**
65
What is a nucal cord?
## Footnote
**It is an umbilical cord that is wrapped around the infant's neck.**
66
As soon as the infant is born, you should?
## Footnote
**He or she needs to be dried off and wrapped immediately in a blanket or towel and placed on one side.**
67
What is the fundus?
## Footnote
**It is the dome-shaped top of the uterus.**
68
What should you do to help control bleeding in mother who has just given birth?
## Footnote
**After delivery massage the mother's abdomen in a firm, circular motion. The uterus will contract and become firmer.**
69
During delivery of the placenta, the following are considered emergency situations:
## Footnote
**1. More than 30 minutes elapse, and the placenta has not delivered.**
**2. There is more than 500 mL of bleeding before the placenta.**
**3. There is significant bleeding after delivery of the placenta.**
70
When should you begin resuscitation efforts on an infant?
## Footnote
**After 10-15 seconds, many infants require some form of stimulation that will encourage them to breath air.**
71
If chest compressions are required for an infant, which technique should be used?
## Footnote
**Use either the hand-encircling technique or the two-finger technique.**
72
Because cardiac arrest in neonates is nearly always the result of ventilation compromise, a compression to ventilation ratio of what should be used?
## Footnote
**A compression to ventilation ratio of 3:1 should be used, which yields 120 actions per minute (90 compressions & 30 vents)**
73
If the newborn's cardiac arrest is believed to be of cardiac origin, what do you use?
## Footnote
**Consider a higher ratio, 15:2 compressions vs. ventilations.**
74
What is the Apgar score?
## Footnote
**It is a scoring system for assessing the status of a newborn that assigns a number value to each of the five areas of assessment.**
75
What are the five areas of assessment for the Apgar?
## Footnote
**A - Appearance - color of the infant's skin**
**P - Pulse - determine the beats/min**
**G - Grimmace/irritability - newborn's response to stimuli**
**A - Activity/muscle tone - newborns resistance to stretching**
**R - Respiration - how air is ventilated and used for the newborn**
76
What is presentation?
## Footnote
**It is the position in which an infant is born; the part of the infant that appears first.**
77
What is vertex presentation?
## Footnote
**It is a delivery in which the head comes out first.**
78
What is breech presentation?
## Footnote
**It is a delivery in which the buttocks come out first.**
79
What is limb presentation?
## Footnote
**It is a delivery in which the presenting part is a single-arm, leg, or foot.**
80
What is a prolapse of the umbilical cord?
## Footnote
**It is a situation in which the umbilical cord comes out of the vagina before the infant.**
81
What is spina bifida?
## Footnote
**It is a developmental defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly even outside of the body, usually at the lower third off the spine in the lumbar areA.**
82
What is fetal alcohol syndrome?
## Footnote
**It is a condition of infants who are born to women who consume alcohol during pregnancy; characterized by growth and physical problems, mental retardation, and a variety of congenital abnormalities.**
83
What anatomic + physiologic changes occur during pregnancy? How will they affect your assessment of the patient?
## Footnote
**Changes occur in respiratory, cardiovascular, musculoskeletal, gastrointestinal systems.**
84
How will you determine if delivery is imminent or if there is enough time to transport a pregnant patient?
## Footnote
**Primigravida - 1st-time delivery labor longer**
**Multigravida - 2nd-time delivery labor shorter**
**Woman's urge to move her bowels means infant is coming.**
**Crowning - means stay**
85
What are gestational diabetes + preeclampsia?
How can they affect this delivery?
## Footnote
**Obese Women
Resolves on its own
Increased production of the hormones progesterone + estrogen
Pre-eclampsia - hypertension of hands/feet/face + protein in urine, seeing spots, headache
Damages mother's liver
Eclampsia - seizures**
86
Is there time to transport this patient or should you prepare for delivery?
## Footnote
**Prepare for imminent delivery**
**Standard Precautions, OB Kit.**
**Provide reassurance, give oxygen, view of the vagina to see crowning, contractions**
**Uterus/Abdomen will be firm during contraction + relaxed when not contracting.**
**Take short breaths in between contractions.**
87
How should you manage the umbilical cord situation?
## Footnote
**As soon as the head is delivered, stop pushing.**
**Nuchal Cord when the cord is wrapped around baby's neck.**
**Place 2 clamps 2" apart. Cut between two clamps.**
88
Why is it important to suction the newborn's mouth before the nose?
## Footnote
**Suction mouth 1st then nose.**
**Infants are Obligate Nose Breathers, suctioning nostrils will stimulate a gasping response making infant aspirate amniotic fluid.**
**More fluid can be retrieved from mouth.**
89
What is involved in the routine post-delivery care of a newborn?
## Footnote
**Keep baby warm, adequate breathing.
respiratory/heart rate/skin color
dry
warming
positioning
suctioning
stimulation**
90
What immediate treatment is indicated for this newborn?
## Footnote
**Heart rate 80 beats/min cyanosis, hypoxemic
needs supplemental oxygen
Infant remains cyanosis up to 24 hours after birth
Palpate brachial pulse.
12 pulsations, 6 seconds = 120 beats/min
Ventilate newborn 40 to 60 breaths/min for 30 seconds
keep warm, transport**
91
What further treatment is indicated for this mother?
Slow bleeding massage mother's abdomen with firm, circular motion. This stimulates uterus to contract.
Treat mom for shock/sanitary pad by vagina, elevate legs 6' to 12". high flow oxygen, keep warm. vital signs.
92
What Apgar Score should you assign to this newborn?
1 minute & 5 minutes after birth.
Numeric Value (0, 1, 2) in five areas
Appearance - Pink Body, Blue Extremities
Pulse - Heart Rate 130 beats/min
Grimace/Irritation - Moves Foot Away
Activity or Muscle Tone - Resists Leg Straightening
Respirations 40 to 60 breaths/min
**NEWBORN SCORE = 9**
Appearance - Pink Body, Blue Extremities 1
Pulse - Heart Rate 130 beats/min 2
Grimace/Irritation - Moves Foot Away 2
Activity or Muscle Tone - Resists Leg Straightening 2
Respirations 40 to 60 breaths/min 2
93
Ovulation
**lining of the inside of the uterus begins to thicken + prepare for fertilized egg to implant**
**If egg is not fertilized in 36 to 48 hours, lining sheds.**
**It occurs the 28th day of each month in females.**
94
Fallopian Tubes
## Footnote
**Extend from uterus
Egg travels through fallopian tubes to uterus
Fertilization with sperm meets egg inside fallopian tube.**
95
Fetus
## Footnote
**developing, unborn infant**
96
Birth Canal
**vagina + uterus (via cervix)**
**uterus contains mucous plug that seals uterine opening to prevent contamination**
97
Placental Barrier
## Footnote
**allows nutrients, oxygen, waste, carbon dioxide, toxins, medications between fetus + pregnant woman.**
98
Respiratory Changes During Pregnancy
Increased respiratory rate
Decreased minute volume (amount of gas inhaled)
Increased demand for oxygen
99
Cardiovascular Changes During Pregnancy
## Footnote
**Increased blood volume
Preparing for blood loss during child birth
Blood Volume passes through uterus every 8 to 11 minutes/increase of 50% during pregnancy
Red Blood Cells increases = pregnant women need to take iron
Blood Clotting factors change to prepare for childbirth. Heart Rate increases 20% or 20 beats per min.**
100
Gastrointestinal Changes During Pregnancy
## Footnote
**Stomach moves upward for pregnancy
Pregnant Trauma results in vomiting/aspiration secretion into stomach
Manage airway**
101
Musculoskeletal Changes During Pregnancy
## Footnote
**Joints more loose
Change in body's gravity/more prone to fall**
102
Stages of Labor
## Footnote
**Dilation of Cervix
Delivery of Infant
Delivery of Placenta**
103
Dilation of Cervix
## Footnote
**Fetus enters birth canal
Cervix is dilated
Longest stage of labor usually lasting 16 hours**
104
Labor
## Footnote
**Contractions of uterus
Bloody Show/Rupture of Amniotic Sac/Water Breaking
Uterine contractions last about 30 to 60 seconds.**
105
Braxton Hicks Contractions
## Footnote
**false labor**
106
Premature Rupture of Amniotic Sac
## Footnote
**Months before due date
Patient put on bed rest/doctor care**
107
Second Stage of Labor
Spontaneous Birth - Infant is Born
## Footnote
**Deliver baby at scene or transport to hospital
Fetus moves to birth canal
Contractions are closer + last longer
Pressure on rectum/mom thinks she needs a bowel movement.**
108
Third Stage of Labor
Delivery of Placenta
## Footnote
**Placenta must completely separate from uterine wall.
Contractions continue. Takes 30 minutes.
Standard Precautions for fluids.**
109
Leading cause of maternal death in 1st trimester
* *Internal hemorrhage into abdomen following rupture of ectopic pregnancy
symptom: **
* **missed cycle**
* **stabbing unilateral pain in lower abdomen**
110
Trauma in Pregnancy
* **Direct effect on fetus**
* **Risk of falls: loosened up joints, the weight of uterus displacement of abdominal organs**
* **3rd trimester: significant blood volume**
* **Shock will develop quickly with blood loss**
* **Blood to fetus is reduced/goes to mom**
111
Blunt Trauma during Pregnancy
* **Uterus enlarges/rises out of the pelvis**
* **Uterus has rich blood supply**
* **Hypoxic (insufficient oxygen) or shock or hypovolemia (decreased blood)**
* **Signs:vaginal bleeding/pain**
* **Treatment: rapid transport, high flow oxygen, airway,**
* **Sanitary pad by the vagina, put patient on (L) side, ALS backup.**
112
Seat Belt Position for Pregnancy
* **Lap under abdomen + over hip bone**
* **Shoulder between the breasts**
113
Pregnant Patient in Cardiac Arrest
* **To save the infant, you have to save mom.**
* **CPR, transport, call hospital**
* **Hospital may do emergency cesarean section**
114
Guidelines for Treating Pregnant Trauma Patient
* **Open Airway**
* **High Flow Oxygen**
* **Adequate Ventilation**
* **Assess Circulation**
* **Transport**
115
20 Weeks of Gestation
* **Top of uterus grown to belly button**
* **Aid in assessment of pregnant woman's abdomen**
116
Cultural Value Consideration
* **Some cultures may not allow a male to examine a female patient.**
* **Some cultures view pregnancy as achieving status in the family unit others consider it a drop in self-esteem.**
* **Respect + honor requests.**
* **Your responsibility is to provide care + transport.**
* **Patient can refuse treatment.**
117
Teenage Pregnancy
## Footnote
**Respect privacy/do assessment away from parents.**
118
Scene Size Up
* **Safety**
* **Standard Precautions: gloves, eye protection**
* **Gown, Mask**
* **Remain calm + professional.**
* **Get additional resources.**
119
Primary Assessment
* **Rapid Scan for ABC's.**
* **Chief Complaint: Baby is Coming.**
* **Vaginal Bleeding/Seizures/Evaluate 1st/Then assess impact on fetus**
* **AVPU: Alert, Verbal, Pain, Unresponsive**
120
Preventing Supine Hypotensive Syndrome
in Pregnancy Patient
## Footnote
**Place blanket under (R) side of backboard**
121
Airway + Breathing
* **Life threats to mom**
* **Assess adequate breathing**
* **Provide high flow oxygen**
122
Circulation
* **Pregnancy has increased blood volume, increased heart rate, changes in blood clotting**
* **Assess skin color, temperature, moisture**
* **Check pulse too fast or too slow**
* **Control bleeding, give oxygen, keep patient warm**
123
Deliver at Scene
* **Patient's home roomy, warm, comfortable, private** **or transport to hospital**
* **Give oxygen**
* **Last 2 trimesters transport on (L) side**
* **Spinal Immobilization, put blankets under (R) side to elevate to prevent Supine Hypotensive Syndrome**
* **Rapid transport**
124
Chief Complaint
* **Obstetric History expected due date, complications, prenatal care.**
* **Feel anything different in fetus?**
* **How long contractions occurring + lasting?**
* **Is water broken?**
* **Does patient feel like they need a bowel movement?**
125
SAMPLE History
* **History of Medical Problems/Medications**
* **Focus on prenatal care + complications**
* **Due date, frequency of contractions, previous deliveries**
* **Water broken?**
126
Physical Exam
* **Assess major body systems**
* **Fetal Movement**
* **Contractions?**
* **Delivery Imminent: Check Vagina for Crowing but protect patient's privacy**
127
Vital Signs
* **Pulse Oximetry, Skin, Blood Pressure**
* **Pulse, Respirations**
* **Tachycardia (fast hb) + Hypotension (low bp) = Hemorrhage or compression of Vena Cava**
* **Hypertension (high bp) indicates serious problems**
128
Reassessment
* **Repeat Primary Assessment**
* **ABC's + vaginal bleeding**
* **Vital Signs**
* **Hypoperfusion or decreased blood flow**
* **Interventions/Treatments**
129
Interventions
* **Patient has low pulse oximeter so does fetus**
* **Apply oxygen**
130
Communication + Documentation
* **Imminent Delivery/notify hospital**
* **Rapid Transport**
* **Information: Number of Weeks Gestation, Due Date, Complications, thorough documentation**
* **Complete two patient care reports Obstetrics + Regular**
131
Normal Delivery Management
* **Has Patient delivered before?**
* **Does she feel like she has to move her bowels? Infants head is pressing on rectum, delivery is about to occur.**
* **Check for crowning where infant's head can be seen in vagina.**
* **Do not touch vagina without partner present.**
* **Your job is to help, guide, support.**
* **Use standard precautions.**
132
Obstetric Kit
* **surgical scissors or scalpel**
* **umbilical cord clamps**
* **umbilical tape**
* **small rubber bulb syringe**
* **towels**
* **4x4 gauze 2x10 gauze**
* **sterile gloves**
* **infant blanket**
* **sanitary napkins**
* **goggles**
* **plastic bag**
133
Patient Position
* **Clothing pushed up to waist, remove underwear**
* **Pillow under hips to elevate 2' to 4'**
* **Support head, neck, back with pillows**
* **Each team members has a job caring for mom/other member care for baby**
134
Delivery at Home
* **At home, place towels on floor**
* **Put patient on floor, elevate hips**
* **Support head, neck, shoulders with blankets**
135
Delivery
* **Partner at patient's head to comfort her**
* **Apply oxygen**
* **Patient grip someone's hand/nausea/vomit**
* **Clear airway**
* **Assess for crowning**
* **Time contractions to determine frequency**
* **Duration of contraction: feel abdomen**
* **Contraction = uterus tightens**
* **Contraction ends = uterus relaxes**
* **Take quick short breaths/rest breath deeply through mouth**
136
Preciptious
## Footnote
**fast labor + birth**
137
Perineal Tearing
## Footnote
**Apply gentle pressure to the infant's head while gently stretching the perineum.**
138
Cephalic Presentation
## Footnote
**Fetus positioned head first in birth canal**
139
Delivery of Infant
* **Support bony parts of head with hands. Suction mouth first then nose.**
* **Upper shoulder appears, guide head down slight.**
* **Support head + upper body + lower shoulder delivers**
* **Handle infant firmly but gently. keep neck in neutral position, maintain airway. Keep at level of vagina until umbilical cord is cut.**
* **Place umbilical cord clamps 2' to 4' apart + cut.**
* **Allow placenta to deliver itself. Do not pull on cord to speed up.**
140
Delivery of Placenta
* **Placenta is attached to umbilical cord coming out of vagina.**
* **Can be 30 minutes after birth**
* **Size: 7' diameter 1" thick**
* **Surface rough/divided into two lobes**
* **Wrap placenta in towel + place in plastic bag to be examined**
* **Placenta inside mother will cause infection + bleeding**
* **Put napkin by vagina, rub abdomen in kneading motion**
141
Neonatal Assessment + Resuscitation
* **Standard precautions**
* **Newborn breaths spontaneously 15 to 30 seconds**
* **After birth. Heart Rate 120 beats/min. Flick soles of baby's feet to stimulate breathing**
* **Not breathing after 15 sec/begin CPR.**
142
Newborn OB Kit
* **dry towels**
* **infant blanket**
* **bag mask device 450 mL**
* **clear mask**
* **oxygen tubing**
143
Infant Bag Mask
* **Cover infant's nose + mouth.**
* **Ventilate high flow oxygen at rate of 40 to 60 breaths.**
144
Breech Delivery
* **Body part delivered first.**
* **Greater risk for trauma. Mother needs to deliver 10 minutes after buttocks shows.**
* **Need ALS.**
* **Make a "V" with gloved fingers + put inside vagina to keep walls of vagina from compressing airway.**
145
Abortion
passage of fetus + placenta before 20 weeks.
self-induced
146
Multiple Gestation
* **Twins.****45 min after Baby A (Average).**
* **Baby B born within**
147
Substance Abuse
* **no prenatal care**
* **affects: premature, low birth weight, severe respiratory depression**
148
Premature Infant
* **36 weeks of gestation, weigh less than 5 lbs**
* **Smaller, thinner than full-term**
* **Head larger than rest of body**
* **Missing vernix, less body hair**
149
Vernix
## Footnote
**cheesy white coat found on full term baby**
150
Post Term Pregnancy
* **42 weeks**
* **Larger baby, weighing more than 10 lbs**
* **Difficulty delivery**
* **Meconium aspiration, infection, stillborn**
151
Fetal Demise
* **Infant who died in mother's womb before labor**
* **Labor will proceed as normal**
* **Infection will present foul odor**
* **Stage of Decomposition: Skin blisters, skin slogging, dark discoloration, head soft**
152
Delivery Without Sterile Supplies
* **Eye protection, gloves, mask**
* **Clean towels**
* **Wipe inside of newborn's mouth with gloved finger**
* **Keep placenta + infant at same level. Keep infant warm.**
153
Post Partum Complications
* **Excessive bleeding 500 mL**
* **Massage Uterus**
* **Muscles of Uterus Contracting**
* **Treatment:shock position, oxygen, vital signs, transport**
154
Pulmonary Embolism
* **Clot that travels through the bloodstream + becomes lodged in the pulmonary circulation.**
* **Report difficulty breathing/AMS**
155
Abruptio Placenta
* **Placenta separates prematurely from wall of uterus** **from hypertension**
* **Complaints: Severe pain/vaginal bleeding**
* **Calm patient**
* **Signs: Shock**
* **Treatment: High flow oxygen, put patient on (L) side**
* **Sterile sanitary napkin, keep napkins + any tissues from vagina**
* **Trauma is leading cause of abruption placenta.**
156
Amniotic Sac
* **Where fetus develops**
* **Bag of waters 500 mL to 1,000 mL**
* **Insulates floating fetus**
157
Eclampsia
* **Seizures that occur from hypertension**
* **Treatment:**
* **Put patient on (L) side**
* **Maintain airway**
* **Supplemental oxygen**
* **Suction airway**
* **Rapid transport**
* **Call ALS**
158
Ectopic Pregnancy
* **fertilized egg implants someone other than uterus**
* **pregnancy develops outside uterus**
* **in fallopian tubes**
159
Fundus
* **Firm grapefruit-size mass in lower abdomen**
* **Controls bleeding, helps uterus to contract**
* **Stimulates mother's nipples to breastfeed**
160
Fetal Alcohol Syndrome
* **Infants born to mothers who have abused alcohol**
* **Newborn of addicted mother with need CPR right away**
* **Apply oxygen during transport**
161
Gestational Diabetes
* **blood glucose level**
* **treatment:diet/exercise/medication**
* **signs: hyperglycemia or high blood sugar** **or hypoglycemia low blood sugar**
162
What do you do for excessive bleeding?
* **Cover vagina with sterile pad.**
* **Change pads often + keep for hospital.**
163
When you should place your gloved finger in a patient's vagina?
## Footnote
**Keep vagina walls from compressing the infant's airway during breech or to push infant's head away from the cord when the cord is prolapse.**
164
What happens with enlarged uterus?
* **Increased respiratory rate**
* **Decreasing minute volume**
165
What is the most important measure in determining the infant's need for resuscitation?
## Footnote
**Infant does not breathe after 15 seconds**
166
Vertex Presentation
## Footnote
**delivery which head comes out first**
