Flashcards in Mod 6 Obstetric and Gynecologic Emergencies Deck (61):
-Soft tissues that protect entrance to vagina
-The surface area between the vagina and anus
Mons pubis `
-Soft tissue that covers the pubic symphysis area where hair grows when a woman reaches puberty
-The birth canal
-Female reproductive organ that produces ova
-The narrow tube that connects the ovary to the uterus. Also called the oviduct.
-Where fertilization occurs
-The muscular abdominal organ where the fetus develops also known as the womb
-Can occur if the ovum implants in the fallopian tubes
-The neck of the uterus at the entrance to the birth canal
-Separates uterus and vagina
-The phase of the female reproductive cycle in which an ovum is released from the ovary
-At the same time the walls of the uterus thicken in preparation for implantation of the egg if fertilization occurs
-The baby from fertilization to 8 weeks of development.
-Created by combining of sperm and an ovum
-The baby from 8 weeks of development to birth
-Develops over the next 32 weeks
How long does pregnancy last?
-The organ of pregnancy where exchange of oxygen, nutrients, and wastes occurs between a mother and a fetus
-The fetal structure containing the blood vessels that carry blood to and from the placenta
-Circulates blood between fetus and placenta
Diffusion in pregnancy
-Exchange of oxygen and nutrients between and fetus
-The "bag of waters" that surrounds developing fetus
-Membrane filled with fluid
-Allows fetus to float, cushions fetus, and maintains fetal temperature.
How does the cardiovascular system respond to pregnancy
-Increased blood volume, increases cardiac output, and increases heart rate.
How does respiratory system respond to pregnancy
-Increased oxygen demand and consumption
How does gastrointestinal system respond to pregnancy
-Nausea and vomiting, slowed digestion
Hormones in pregnancy
-Hormones released with pregnancy make the ligaments of pregnant woman's musculoskeletal system more elastic an more vulnerable to injury
Supine hypotensive syndrome
-Dizziness and a drop in blood pressure caused when the mother is in a supine position and the weight of the uterus, infant, placenta, and amniotic fluid compress the inferior vena cava, reducing return of blood to heart and cardiac coutput
-Dizziness and drop in blood pressure
-Transport these patients on their left side
First stage of labor
-Starts with regular contractions and the thinning and gradual dilation of the cervix and ends when the cervix is fully dialated
Second stage of labor
-This stage is the time from when the baby enters the birth canal until he is born
Third stage of labor
-Begins after the baby is born and lasts until afterbirth (placenta, umbilical cord, and some tissues from the amniotic sac, and lining of uterus) is delivered.
Braxton-Hicks contractions (First stage)
-Irregular prelabor contractions of the uterus
-Usually does not indicate impending delivery
Lightening (First stage)
-The sensation of the fetus moving from the high abdomen to low in birth canal
Contraction time, or duration (First stage)
-This is the time from the beginning of a contraction to when the uterus relaxes (from start to end)
Contraction interval, or frequency (First stage)
-This is the time from the start of one contraction to the beginning of the next (from start to start)
Contraction indications that baby may be imminent (First stage)
-Contractions last between 30 seconds and a minute and are 2 to 3 mins apart.
First stage of labor
-Amniotic sac usually breaks
-Amniotic fluid is usually clear
-Fluid that is greenish or brownish yellow in color may be an indication of material or fetal distress. Fetal deification. This is called meconium staining
Second stage of labor
-Cervix fully dialates
-Contractions become increasingly frequent
-Labor pain severe
-Mother feels urge to make bowel movement. Do not let her. Delivery may be imminent.
-Decision made to transport or stay and deliver
Third stage of labor
-After baby birth contractions continue until placenta is delivered
-Usually lasts 10-20 mins
Evaluation of woman in labor
-Ask her name, age, and expected due date
-Ask if this is her first pregnancy. Average time of labor for a woman having first baby is 16-17 hours. Typically shorter for subsequent births
-Ask her when the labor pains started and how often she is having pains. Ask her if water broke and if she has had any bleeding
-Examine mother for crowning (when part of baby is visible through vaginal opening) or cephalic presentation (when the baby appears headfirst during birth. Normal presentation)
-Feel for uterine contractions by placing gloved hand on abdomen above naval
-Take naval signs
Findings that may indicate the need for neonatal resusitation
-No prior prenatal care
-Labor induced by trauma or medical condition affecting the mother
-Multiple births (twins, triplets ect.)
-History of problems with pregnancy, especially placenta previa and breech presentations
-Labor induced by drug use especially narcotics
-Meconium straining with the rupture of membrane (water breaking)
Preparing mother for delivery
-Control scene so that mother will have privacy
-Put on surgical gloves, gowns, caps, face masks, and eye protection.
-Prepare mother on a bed, floor, or the ambulance stretcher
-Remove clothing that obstructs view of vaginal opening
-Position partner at mothers head for emotional support or if patient vomits
-Position the obstetrics kit near the mother
-If possible make environment as warm as possible
-If delivery takes place in automobile position mother flat on seat arrange legs so one foot is resting on seat and other foot resting on floor.
Assisting with delivery
-Keep person at head of mother
-Placed gloved hand on mothers vaginal opening when the baby's head starts to appear
-Place one hand below the baby's head as it delivers and do not pull on baby
-If amniotic sac has not broken by the time the baby's head is delivered use your finger to puncture the membrane. Examine for meconium staining
-Once head delivers check if umbilical cord is wrapped around baby's neck. Tell mother not to push while you check. She can pant or take quick short breaths. If cord is wrapped around neck place 2 fingers under the cord at the back of baby's neck. Bring the cord forward over the baby's upper shoulder and head
-Help deliver the shoulders. Upper shoulder will deliver next.
-Assess the airway. Suction if necessary. Use bulb syringe. Insert 1 to 1 1/2 inches into baby's mouth and 1/2 inch into baby's nostrils.
-Note exact time of birth
-A newly born infant or an infant less than one month old
-Appearance: Blue (or pale) all over (0 points) Extremities, trunk pink (1 points) Pink all over (2 point)
-Pulse: 0 (0 points) 100 (2 points)
-Grimace (reaction to suctioning or flicking of the feet): No reaction (0 points) Facial grimace (1 point) sneeze, cough or cry (2 points)
-Activity: No movement (0 points) only slight activity (flexing extremities) (1 point) moving around normally (2 points)
-Respiratory effort: none (0 points) slow or irregular breathing, weak cry (1 point) good breathing, strong cry (2 points)
How to warm baby
-Swaddle in dry blankets.
-Encourage breast feeding as it can prevent heat loss and allows for bonding.
When does cutting the umbilical cord become a necessity
-If cord is wrapped around baby's neck and cannot be slipped over head
-If attachment to the cord impedes a resuscitation effort.
-If attachment interferes with urgent transport of mother
-If system requires cord to be cut.
General procedure for cutting umbilical cord
-Do not cut or clamp if baby is not breathing on own or if cord is still pulsating
-Keep infant warm
-Use sterile clamps or umbilical tape when cutting cord
-Apply one clamp to cord 10 inches from baby
-Place second clamp 7 inches from baby
-Use surgical scissors to cut between clamps
-Be careful when moving baby so no trauma is brought to clamped cord.
Initial care for a neonate
-Provide warmth and assess baby's airway
-Establish that the baby is breathing, respiration, heart rate, and muscle tone do not be alarmed if feet are slightly blue
-Assess infants heart rate. Less than 100 bpm provide artificial ventilation's at a rate of 40-60 per min. If heart rate is less than 60 bpm start compression's at a rate of 120 per min working at a 3:1 compression to breath ratio
-If infant has adequate respiration's and a pulse rate greater than 100 per min reassess airway
-Drying, warming, positioning, suction, tactile stimulation
-For advanced do intubation, then medications
Stimulate newborn to breathe
Controlling vaginal bleeding after delivery of baby and placenta
-Place napkin over vaginal opening and do not place anything in the vagina
-Have mother lower legs and keep them together. Tell her she does not have to squeeze them together
-Massage the uterus will help it contract to control bleeding.
-Encourage mother to begin nursing the baby. Nursing will stimulate the uterus to contract and may help decrease bleeding.
-When the baby's buttocks or both legs appear first during birth. Risk of trauma is high. Meconium staining often occurs.
-When an infants limb protrudes from the vagina before the appearance of any other body part. Cannot be done in prehospital care. Must be rapid transport
Prolapsed umbilical cord
-When an umbilical cord presents first and is squeezed between the vagina wall and the baby's head.
Care for prolapsed umbilical cord
-Position mother head down and pelvis raised with a blanket or pillow using gravity to lessen pressure on birth cannal
-Provide mother O2
-Check for cord pulses and wrap exposed cord in a sterile towel
-Insert several fingers into mother's vagina to push baby's head or buttocks to keep pressure off the cord
-Keeping mother, child, and emt as a unit transport immediately to medical facility. Be prepared to stay in this position until you reach hospital.
-All prolapsed cords require rapid transport. Have partner obtain vital signs while en route
-When more than one baby is born during a single delivery
-Any newborn weighing less than 51/2 pounds or born before the 37th week of pregnancy.
-Placenta is formed in an abdominal location that will not allow for normal delivery of baby causing excessive prebirth bleeding.
-Placenta seperates from uterine wall. A cause of prebirth bleeding.
-A severe complication of pregnancy that produces seizures and coma
-A complication where mother retains large amounts of fluid and has hypertension. May also experience seizures and/or coma during birth which is very dangerous to infant
-Spontaneous (miscarriage) or induced termination of pregnancy
-When the fetus and placenta deliver before the 28th week of pregnancy commonly called a miscarriage
-Expulsion of a fetus as a result of deliberate actions taken to stop pregnancy