OB Emergencies (2B)

Question 1

Suctioning mouth and nose of infant during delivery is recommended?

Answer 1

False: It is now recommended that you wipe excess secretions around mouth and nose during delivery.

Question 2

APGAR: First A

Answer 2

Activity

0: Absent
1: Flexed arms and legs
2: Active

Question 3

APGAR: P

Answer 3

Pulse

0: Absent
1: Below 100
2: Above 100

Question 4

APGAR: G

Answer 4

Grimace

0: Flaccid
1: Minimal response to stimulation
2: Proper response to stimulation

Question 5

APGAR: Second A

Answer 5

Appearance

0: Blue; Pink
1: Pink with blue extremities
2: Pink

Question 6

APGAR: R

Answer 6

Respirations

0: Absent
1: Slow and Irregular
2: Vigorous cry

Question 7

Excessive hemorrhage post delivery?

Answer 7

Unless multiple births are anticipated, begin fundal massage.

Question 8

Nuchal cord

Answer 8

Attempt to slip over the infants head, if unable then immediately clamp in two places and cut between clamps.

Question 9

In what two birthing presentations do we not attempt delivery?

Answer 9

Prolapsed cord and limb presentation.

Question 10

With prolapsed cord and limb presentation what is your primary objective?

Answer 10

Maintain a pulsatile cord.

1. Insert two fingers into vagina to raise presenting portions off of the cord.
2. Keep cord moistened with sterile saline.
3. If possible place mother in trendelenburg position. If unable place mother in knee-chest position.

Question 11

Breech presentation: If the head does not deliver but the baby is attempting to breathe then…?

Answer 11

Place hand into vagina with palm towards the newborns face. Form a V with fingers on either side of the nose and push the vaginal wall away from face. Maintain this position throughout transport.
Also, Breech presentation 2B states to immediately suction mouth then nose after delivery.

Question 12

Intervention when an infants head has deilvered but shoulder will not pass? AKA, Shoulder Dystocia presentation

Answer 12

Apply firm, open hand pressure above the symphysis pubis.

If delivery does not occur, focus on maintaining airway patency as best as possible and rapidly transport.

Question 13

In the event of uterine inversion after delivery?

Answer 13

Cover uterus with moistened sterile gauze.

Question 14

High-risk preterm labor when delivery is imminent interventions include?

Answer 14

1. Rapidly infuse 1 liter of NS
2. Albuterol 2.5mg via SVN.
3. Magnesium Sulfate 1 gram IV

This requires OLMC approval

Question 15

Pitocin dose?

Answer 15

10 units IM

If bleeding continues contact OLMC for approval of 40 units into 1000cc NS. Titrate to decrease bleeding and pt comfort.

Question 16

Vaginal bleeding during pregnancy prior to 20th week gestation commonly results from?

Answer 16

Ectopic pregnancy or spontaneous abortion.

Question 17

Late-pregnancy bleeding (>20 weeks) often arises from?

Answer 17

Abnormal or premature separation of the placenta from the inner wall.

Question 18

The umbilical cord has how many veins/arteries?

Answer 18

One vein. Two arteries.

Question 19

Abruptio Placentae

Answer 19

premature separation of the placents from the uterine wall after 20 weeks gestation.
Occurs in about 1% of pregnancies and accounts for 30% of bleeding episodes late in pregnancy and 15% fetal perinatal deaths.

Question 20

Blunt trauma during pregnancy may cause abruptio placentae because?

Answer 20

The placenta is a relatively inelastic organ whereas the uterus is relatively elastic. This may cause the placenta to be sheared from the uterine wall when significant blunt force is applied causing the uterus to stretch at the time of impact.

Question 21

What is a risk factor for abruptio placentae?

Answer 21

Maternal hypertension (>140/90)
Increased maternal age (>35)
Multiparity (>5 pregnancies)
Uterine abnormalities

Question 22

Will there always be vaginal bleeding with abruptio placentae?

Answer 22

No. If it is a partial separation and the placental margins are intact there may be significant hemorrhage with no blood escaping.
Typically associated with abdominal pain and uterine tenderness.

Question 23

Signs and symptoms associated with abruptio placentae?

Answer 23

Abdominal pain, lower lumbar pain, uterine tenderness - 70%
Vaginal bleeding - 80%
Abnormal uterine contractions- 35%
Fetal distress - 60%
Signs and symptoms of hypovolemic shock

Question 24

Placenta previa?

Answer 24

Common cause of vaginal bleeding >20 weeks.
Abnormal implantation of the placenta over or near the cervical opening.
Prior C-sections increase risk by 1.5x to 5x.

Question 25

Common signs and symptoms of placenta previa?

Answer 25

Painless vaginal bleeding that usually occurs in third trimester. Uterus remains soft and non-tender. Possible S/S of hypovolemic shock.

Question 26

Prehospital management of abrutio placentae and placenta previa?

Answer 26

Focused on supporting vital functions. | NS bolus to maintain maternal and fetal perfusion.

Question 27

Pregnant patient can lose _____ amount of her circulating blood volume prior to exhibiting obvious signs of hypovolemic shock.

Answer 27

30% | This is due to the 40-50% increase in circulating blood volume experienced in pregnancy.

Question 28

How can you assess fetal distress in the field?

Answer 28

Assess fetal HR. Fetal bradycardia is a sign of fetal distress.

Question 29

What is the purpose of the left lateral decubitus position?

Answer 29

Prevent compression of the vena cava by the uterus. The compression of the uterus can result in a 30% decrease in cardiac output.

Question 30

All pregnant trauma patients with a viable pregnancy (>23 weeks) should...

Answer 30

undergo fetal monitoring for at least 4 hours.

Question 31

All pregnant trauma patients >23 weeks with adverse factors...._________ ... should be admitted for observation for 24 hours.

Answer 31

``` adverse factors include: abdominal pain vaginal bleeding sustained contractions (>1 / 10 minutes) atypical or abnormal fetal heart rate pattern. ```

Question 32

Seatbelts during pregnancy...

Answer 32

cause a reduction in maternal death from 33% to 5% associated with MVC. MVC is the leading cause of death for maternal death in the pregnant population.

Question 33

Blunt trauma during pregnancy can cause shearing of placenta from uterus because...

Answer 33

uterus is elastic and the placenta is not. The uterus may deform during trauma due to the elasticity and the placenta will no which can cause shearing of placenta from the uterus.

Question 34

Maternal oxygen saturations should be maintained above...

Answer 34

95% | to ensure adequate fetal oxygenation.

Question 35

Vasopressors in pregnant women...

Answer 35

should only be used for intractable hypotension (hypotension caused by septic shock... possibly due to DIC with amniotic fluids mixing with blood circulation) that is unresponsive to fluid resuscitation. This is because vasopressors have an adverse effect on uteroplacental perfusion.