General Obstetrics

Question 1

What is a full term Pregnancy?

Answer 1

37-42wks

Question 2

What are the general child-bearing years?

Answer 2

14-50 years of age

Question 3

When is a pregnancy considered viable, and what is done after this point?

Answer 3

20 weeks, every effort to resuscitate must be made

Question 4

What are the 3 stages of Pregnancy?

Answer 4

Germinal, embryonic, fetal

Question 5

When is the germinal stage?

Answer 5

0-2 weeks

Question 6

When is the embryonic stage?

Answer 6

3-8 weeks

Question 7

When is the fetal stage?

Answer 7

9 weeks to birth

Question 8

What are the normal Circulatory changes for a pregnant woman?

Answer 8

^ blood volume (5-6 total volume)
Cardiac Output ^by 40-50%
HR increases by 10-20 bpm
SV ^ 30%
Intravascular volume ^45%
Systolic BP - minimal change
Diastolic - 20% decrease mid pregnancy

Question 9

How does resp. system change suring pregnancy?

Answer 9

30-40% increase o2 consumption
Resp rate ^ slightly
30-35% ^ tidal volume
25% decrease residual capacity

Question 10

What is the fundus?

Answer 10

Top part of the uterus

Question 11

Where is the fundus at 20wks?

Answer 11

at the umbilicus

Question 12

How can fundal height be used to predict gestational age?

Answer 12

Umbilicus is 20wks, 1 cm above is another week

Question 13

What are the normal gastrointestinal changes in pregnant women?

Answer 13

Elevated progesterone - causes nausea and vomit (first6-14wks)
constipation, heartburn

Question 14

What is the metabolism like in early pregnancy?

Answer 14

Anabolic state, increase maternal fat stores, small ^ insulin sensitivity. Nutrients stored to meet demands of mother and fetus

Question 15

What is metabolism like in late pregnancy?

Answer 15

Catabolic state, decreased insulin sensitivity, ^ maternal glucose/free fatty acid, fetal growth

Question 16

What does gravida mean?

Answer 16

How many times pregnant? Includes miscarriages/abortions

Question 17

What does Para mean?

Answer 17

Number of pregnancies a woman carried past 28 weeks (dead or living, current not counted, multiples counted as 1)

Question 18

What is an Amniotic Sac?

Answer 18

Fluid filled, bag like membrane where the fetus grows

Question 19

What is an abortion

Answer 19

Expulsion of the fetus, for any cause before 20 wks

Question 20

What does primipara (primip) mean?

Answer 20

First time pregnancy/labour

Question 21

What is a multipara (multip)?

Answer 21

Pt has had 2 or more deliveries

Question 22

What is a pt who is pregnant for the 3 time, with no children at home described?

Answer 22

G3P0

Question 23

What are the two notable factors of contractions?

Answer 23

Frequency (interval between), duration (of contraction)

Question 24

What are Braxton hicks contractions?

Answer 24

False labour pains, 2/3 trimester, body’s way of preparing.
Not in regular pattern, and go away
uncomfortable, but don’t get worse

Question 25

What does the first stage of labor involve?

Answer 25

Uterine contractions that increase in strength, length and frequency. fetus descends, cervix softens, shortens, thins and dilates

Question 26

How is the first stage of labour broken down?

Answer 26

Early and Active labour

Question 27

What are the characteristics of early labour?

Answer 27

Mild and irregular contractions (20-30secs long), bloody show, SROM may occur

Question 28

How may the patient present in early labour?

Answer 28

Walking and talking through mild, irregular, short contractions

Question 29

What characterizes active labour?

Answer 29

Regular, continuous, strong contractions (3-4 mins, lasting 45-60 seconds), progressive dilation, bright red bloody show

Question 30

How might the patient present during active labour?

Answer 30

Difficulty walking and talking through contractions, may be distressed. Vomit/shaking overwhelming emotions possible

Question 31

When does stage 2 of labour start and end?

Answer 31

Starts when pt is fully dilated (10cm), and feels the urge to push, ends once baby is born.

Question 32

What do contractions look like in Stage 2?

Answer 32

less than 2 mins apart, lasting 60-90 seconds, strong.

Question 33

What characterizes Stage 2 of labour?

Answer 33

The uterus will rise up and change shape Urge to push occurs when the presenting part reaches the pelvic floor Pt is actively bearing down Bloody show, stool, amniotic fluid drainage Pain and perineal pressure with distention Bulging perineum until presenting part is visible

Question 34

How is imminent birth explained as per ALS for Primips?

Answer 34

presenting part is visible during and between contractions, maternal urge to push or bear down, contractions are less than two (2) minutes apart

Question 35

How is imminent birth explained as per ALS for Multips?

Answer 35

contractions five minutes apart or less and any other signs of second stage labor present.

Question 36

When does stage 3 start and finish?

Answer 36

Starts from the birth of baby till delivery of placenta?

Question 37

What are paramedic observations of Stage 3?

Answer 37

Lengthening of the cord. Sudden gush or trickle of blood Uterine Contraction

Question 38

What does CCT stand for in delivery?

Answer 38

Controlled Cord Traction

Question 39

What is an Indication that the placenta is being delivered?

Answer 39

Gush of blood, lengthening of cord, contractions

Question 39

What is done with a placenta after it is delivered?

Answer 39

Inspect for wholeness, place in plastic bag (mark mother name and time), transport with patients

Question 40

Why is placental delivery considered high risk?

Answer 40

Increased risk of bleeding and post-partum hemorrhage

Question 41

In an ideal situation, how would you set up the delivery station?

Answer 41

Call for additional crew. Open OBS Kit, Pt on firm surface, prepare neonate resus station, prepare towels and blankets

Question 42

What happens if midwife is on scene?

Answer 42

Let them take over - assist them where they ask

Question 43

What are the 7 phases of a normal birth?

Answer 43

Engagement, Flexion, Internal Rotation, Extension, Restitution, External Rotation, Expulsion

Question 44

What is Restitution?

Answer 44

When baby's (delivered) head turns to side

Question 45

How is external rotation of baby different from internal and why is it important?

Answer 45

External happens once the head is delivered, it allows for the shoulder to deliver

Question 46

Where should the umbilical cord be cut?

Answer 46

at approx. 15 cm and 7 cm

Question 47

What must be done prior to cutting the umbilical cord?

Answer 47

It must be clamped

Question 48

What is delayed cord clamping?

Answer 48

Delaying clamping the cord until pulsations stop (about 2 minutes)

Question 49

What is the benefit of delayed cord clamping?

Answer 49

Increase blood flow, and decrease probability of anemia

Question 50

What does APGAR stand for?

Answer 50

Appearance, pulse, grimace, activity, respirations

Question 51

What is the APGAR criteria at 0

Answer 51

Pale and blue, no pulse, no response, limp, no respirations

Question 52

What is APGAR criteria at 1

Answer 52

Body pink with blue limbs, HR<100, grimace, weak activity, slow/irregular respirations

Question 53

What is APGAR criteria at 2

Answer 53

pink, pulse>100, coughing and crying, strong activity, good resp

Question 54

What are the basics of oxytocin?

Answer 54

promotes uterine contraction, fast onset, duration 2-3hrs, minimal side effects

Question 55

What is Vertex Presentation?

Answer 55

head first, face toward back of mom. majority of births

Question 56

What are some indications that the maternal pt may be having twins?

Answer 56

Smaller than anticipated, fundal height stays high, additional fetal parts palpated through abdomen