Approximately how many cells does the embryo contain when it implants into the uterine wall?
Function of placenta
Synthesis of glycogen and cholesterol.
Metabolizes fatty acid.
Transfer of certain antibodies.
Performs respiratory gas exchange, transport of nutrients, excretion of wastes, and heat transfer.
Produces necessary hormones and serves as a barrier against harmful substance in woman’s circulation.
Premature rupture of membranes
Rupture of amniotic sac prior to the onset of labor.
Increasing risk of fetal infection or injury.
What is considered preterm?
Less than 37 weeks
Cardiovascular changes during pregnancy
HR elevates by 10-20 beats
CO increases by 30-50%
BP decreases by 10-15
Blood changes during pregnancy
Blood volume increases by 50%
RBC increase by 30#
Elevated RBC increases the need for iron
Respiratory changes during pregnancy
Respiratory minute volume increases by 40%
Increased CO2 during exhalation
GI changes during pregnancy
Peristalsis decreases resulting in constipation
Musculoskeletal changes during pregnancy
Edema in LE
Approximately 27 lb weight gain
Most common cause of vaginal bleeding during the first nd second trimester?
Causes of abortions.
Chronic illness in mother
Maternal exposure to toxic substances or illicit drugs
Abnormal attachment of placenta
Abortion that is impending or potentially occurring
Treatment for threatened abortion
Best rest to avoid activity or fluctuations in vital signs
Impending or threatened spontaneous abortion that cannot be prevented
Treatment for imminent abortion
Administering 250 mL bolus - repeat PRN NRB at 15L Emotional support Rapid transport Be alert for signs of shock
Part of the products of conception is expelled, but some remain in the uterus.
s/s ectopic pregnancy
Sudden onset of lower abdominal pain and cramping
May or may not have vaginal bleeding
Premature separation of normally planted placenta from the wall.
s/s abruptio placenta
Sudden onset of severe abdominal pain
Decreased fetal movement
Decreased fetal hart tones
Minimal vaginal bleeding or none
Placenta is implanted low in the uterus and partially or fully obscures cervical canal
s/s placenta previa
Painless vaginal bleeding
Chronic HTN in pregnancy can cause
Retard growth and development of the fetus
Impaired liver and renal function
Progress to life-threatening tonic-clonic seizures
Severe headache N/V Agitation Rapid weight gain Visual disturbances
pulmonary embolus SOB AMS Upper abd pain Myoclonus
24 hours - 4 weeks after birth
Supine hypotensive syndrome
vena cava compression
s/s supine hypotensive syndrome
Nausea Dizziness Tachycardia Claustrophobia SOB Syncopal episodes
Gestational diabetes mellitus
Inability to process carbohydrates during pregnancy
Treatment for hyperemesis gravidarum
NRB 100% Blood glucose levels IV access Saline bolus Transport
Deceleration forces may cause :
eXsanguinating hemorrhage Airway Breathing Circulation Disability Exposure
Assessment for trauma in pregnancy
Questions to ask during hx taking
If the patient is pregnant G/P/A Length of gestation Estimated due date or date of confinement Fetal movements present Complications w/ past pregnancies C-section Under physician's care Taking prenatal vitamins Last OB visit Contractions? How far apart?
When would you consider delivering a newborn on scene?
Delivery is expected in minutes
Natural disaster, bad weather or other catastrophe making it impossible to reach the hospital
No transportation is available
What BP would you consider preeclampsia?
First stage of labor
Onset of contractions and ends when the cervix is fully dilated
Second stage of labor
Full cervical effacement and dilation until fetus is delivered
Third stage of labor
Delivery of newborn and ends with delivery of placenta
Emergency situations after delivery
Placenta has not delivered after 30 minutes
More than 500 mL of bleeding occurs before delivery of placenta
Substantial bleeding occurs after the delivery of the placenta
When is labor considered preterm?
20th week, but before 37th week
When is a newborn considered a premi?
Born before 36 weeks or weighs less than 5 lbs
Physical findings of uterine rupture.
May or may not have substantial vaginal bleeding
Possible sign: palpate fetal body parts through abdominal wall
Symptoms of uterine rupture
Weakness Dizziness Thirst Strong, painful contractions that are now slackened off Severe abdominal pain
Factors increasing the chance of amniotic fluid embolism.
Maternal age greater than 35 Eclampsia Abruptio placenta Placenta previa Uterine rupture Fetal distress
s/s amniotic fluid embolism
Sudden onset of respiratory distress Hypotension Cyanosis Seizures Cardiogenic shock Unresponsiveness Cardiac arrest
Buttocks or both feet
Frank breech presentation
Incomplete breech presentation
One or both hips and knees extended
One or both feet presenting
Complete breech presentation
Hips and knees are flexed with buttocks presenting
Two goals in the situation of a limb presentation
Prevent further trauma to newborn
Transport patient rapidly and safely
What position should the mother be placed in during transport of a limp presentation?
On her back w/ head down and hips elevated
Used in cases of shoulder dystocia.
Have mother hyperflex her knees tightly to her abdomen. Apply suprapubic pressure and gently pull on fetus’s head
What is the major concern after a newborn is born with a shoulder dystocia complication?
Damage to brachial nerve plexus
Examples of potential embolic processes during pregnancy.
Pregnancy-related venous thromboembolism
Treatment for spina bifida?
Place a sterile, moist dressing over opening. Maintain body temperature.
In which instances should you insert your fingers into your pregnant patient’s vagina?
Umbilical cord prolapses
Causes of delayed transition in newborns
Hypoxia Meconium staining Blood aspiration Acidosis Hypothermia Pneumonia Hypotension Sepsis Birth asphyxia Pulmonary hypoplasia Respiratory distress syndrome
What does “Do What Probably Seems Simple” stand for?
Drying Warming Positioning Suctioning Stimulation
When should you provided positive pressure ventilations on a newborn?
HR below 100
Tactile stimulations acceptable and safe for newbown.
Slapping or flicking the soles of the feet
Gently rubbing the back, trunk, or extremities
Appearance APGAR Score
Completely pink : 2
Body pink, extremities cyanotic : 1
Centrally cyanotic, pale : 0
Pulse rate APGAR score
> 100 : 2
<100, >0 : 1
Absent : 0
Grimace APGAR Score
Cries : 2
Grimaces : 1
No response: 0
Activity APGAR Score
Active motion : 2
Some flexion of extremities : 1
Limp : 0
Respiratory APGAR Score
Strong cry : 2
Slow and irregular : 1
Absent : 0
Indications for artificial ventilation of newborn
Persistent despite breathing 100% oxygen
When should you d/c chest compressions and continue ventilations during a neonatal resuscitation? When do you stop ventilations?
HR is above 60 but below 100.
Stop ventilations once HR is more than 100.
When do you administer free-flow oxygen?
Central cyanosis present
When do you perform positive pressure ventilations w/ 100% oxygen when newborn has central cyanosis?
If the newborn remains cyanotic after 30 minutes of free-flow oxygen
Signs of respiratory distress that suggest a need for BVM?
Grunting on expiration
How much of the BVM bag are you going to compress?
Ventilation rate for newborn
40 to 60 breaths
Count for ventilation of newborn
Delivery of compressions and ventilations ratio of neonate
Apnea of prematurity is a result of _____.
Primary apnea vs secondary apnea
Primary: caused by oxygen deprivation
Secondary: period of gasping respirations, falling HR, and falling BP
Tx for primary apnea
Attempt drying and stimulation
Tx for secondary apnea
Positive pressure ventilation by BVM
Where should you asses HR in newborn?
Palpating base of umbilical cord
Blood glucose levels 12 hours after birth
Tx of hypovolemia in newborn
Administer 10 mL/kg isotonic solution over 5-10 minutes