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Special Issues in Emergency Care and Resuscitation > Obstetrics > Flashcards

Flashcards in Obstetrics Deck (39)
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1
Q

anatomy and physiology of the female reproductive

A
  • cervix
  • sacrum
  • rectum
  • vagina
  • placenta
  • uterus
  • amniotic fluid
  • bladder
  • pubic symphysis
2
Q

placenta

A
  • attaches to the inner lining of the wall of the uterus and connects to the fetus by the umbilical cord
  • the placental barrier consists of two layers of cells
  • after delivery, the placenta, or afterbirth separate from the uterus and delivers
  • very vascular
  • connects fetus and mother
  • umbilical vein carries oxygenated blood*
  • umbilical artery carries deoxygenated blood from baby to mom*
3
Q

umbilical cord

A
  • lifeline of the fetus
  • the umbilical vein carries oxygenated blood from the women to the fetus**
  • there is one umbilical vein**
  • the umbilical arteries carry deoxygenated blood from the fetus to the woman**
  • there are two umbilical arteries **
4
Q

amniotic sac

A
  • the fetus develops inside a fluid filled baglike membrane called the amniotic sac, or bag of waters
  • contains about 500-1,000mL (ccs) of amniotic fluid
  • fluid helps insulate and protect the fetus in development
  • fluid increases as you get further along
  • routinely check amniotic fluid levels
  • fluid is released in a gush (sometimes) when the sac ruptures, usually at the beginning of labor
  • you can break the water manually
  • you can remove the baby with the sac present if premature
5
Q

stages of labor

A
  • dilation of the cervix
  • delivery of the infant
  • delivery of the placenta
6
Q

first stage

A
  • begins with the onset of contractions as the fetus enters the birth canal
  • Braxton hicks- contractions prior to delivery (not always present)
  • longer, more frequent, more painful, more regular, and short time in-between contractions before ***
  • 0-1 cm dilation initially
  • full cervical dilation is 10 cm dilated
  • usually the longest stage, lasting an average of 16 hours
  • quicker in lower weight children or previous pregnancy
  • uterine contractions become more regular and last about 30-60 seconds each (60 seconds is usually peak)
  • some women experience a premature rupture of the amniotic sac -> fetus not ready to be born -> provide supportive care and transport
  • PROM- premature rupture of membrane
  • toco monitor- assess baby heart beat
  • ultrasound to check positioning
  • head of the fetus descends into the women’s pelvic as it positions for delivery -> this is called lightening
7
Q

lightening

A
  • head of the fetus descends into the womans pelvis as it positions for delivery
  • this never occurs in some women -> then c-section
  • usually give 2 hours of attempting to push to then decide for c-section (longer for women with epidural)
8
Q

second stage

A
  • begins when the fetus begins to encounter the birth canal past the cervix
  • ends when the infant is born (spontaneous birth) by vaginal delivery (or c-section)
  • uterine contractions are usually closer together and last longer
  • never let the mother sit on the toilet -> catheterized
  • the perineum will bulge significantly (gets larger), and the top of the infants head will appear at the vaginal opening (or limb/butt -> breached) -> this is crowning
9
Q

crowning

A
  • perineum will bulge significantly, and the top of the infants head will appear at the vaginal opening
  • head only
  • not limbs or butt
10
Q

third stage

A
  • begins with the birth of the infant and ends with the delivery of the placenta
  • the placenta must completely separate from the uterine wall -> not done forcefully, its done naturally (can cause hemorrhage)
  • always follow standard precautions to protect yourself, the infant, and the mother from exposure to body fluids
11
Q

hypertensive disorders: preeclampsia (HDP)

A
  • preeclampsia is a common complication
  • pregnancy induced hypertension
  • protein in the urine
  • visual disturbances -> photophobia
  • swelling in hands, feet, umbilical cavity
  • 140/80/90 -> at risk for preeclampsia
  • can continue for at least two weeks post-partum
  • can develop after the 30th week of gestation (some as early as 20)
  • signs and symptoms include headache, seeing of spots, swelling in the hands and feet, anxiety, and high blood pressure
  • not sure what causes it but some women are more predisposed
12
Q

hypertensive disorders: eclampsia

A
  • characterized by seizures that occur as a result of hypertension
  • when does preeclampsia become eclampsia -> seizure*
  • assume its a eclamptic seizure before anything else
  • life threatening
  • to treat:
  • lie the patient on her side, preferably the left
  • maintain an airway
  • provide supplemental oxygen
  • if vomiting occurs, suction the airway
  • provide rapid transport and call for ALS
  • IV magnesium in very high doses (4-6G) **- to stop seizures
13
Q

bleeding: ectopic pregnancy

A

internal bleeding may be the sign of an ectopic pregnancy

  • a pregnancy that develops outside the uterus, most often in the fallopian tubes
  • occurs about once in every 300 pregnancies
14
Q

bleeding

A
  • the leading cause of maternal death in the first trimester is internal hemorrhage following rupture of an ectopic pregnancy
  • hemorrhage from the vagina that occurs before labor begins may be very serious
  • painless bleeding is most commonly caused by placenta previa - part of or all of placenta attaches on uterine wall and around cervix and vaginal opening -> as long as its not a lot and they arnt anemic its ok
15
Q

uterus

A

where baby develops

16
Q

amniotic fluid

A

surrounds amniotic sac

  • amniotic fluid is fetal urine
  • premature rupture of membranes - early breaking of water PROM
  • you do not need amniotic fluid
17
Q

PDA (Patent Ductus Arteriosus?) and PFO (patent foramen ovale)

A
  • fetal circulation
  • dont need lungs to breath
  • bypasses pulmonary circulation
  • lungs are one of the last things to develop
  • PDA and PFO exist in fetal circulation and then close
18
Q

30-34 weeks

A

lungs develop

-premature babies need support with breathing

19
Q

50%

A
  • is are c sections
  • we want to get it down to 30%
  • higher potential for side effects
  • longer hospital stay
  • more expensive
  • blood transfusion or support
  • respiratory conditions are associated with c section (asthma, seasonal allergies)
20
Q

ectopic pregnancy

A
  • development of zygote anywhere other than uterus
  • most frequently the fallopian tube
  • abdominal pain
  • ruptured ectopic pregnancy is a surgical emergency
  • you can bleed to death
  • any abdominal pain from a female in child bearing age that is sexually active is an ectopic pregnancy until proven otherwise
21
Q

spontaneous abortion/miscarriage

A
  • in abruptio placenta, the placenta separates (rips away) prematurely from the wall of the uterus -> leading cause is abdominal trauma (MVA or falls) -> surgical emergency
  • in placenta previa, the placenta develops over and covers the cervix -> infrequently an emergency
22
Q

diabetes

A
  • develops during pregnancy in many women who have not had it previously
  • gestational diabetes will clear up after delivery (some can continue)
  • treatment is the same as for any other patient with diabetes
  • diet, exercise, or insulin injections
23
Q

special considerations for trauma and pregnancy

A
  • with a trauma call involving a pregnant patients, you have 2 patients:
  • the women
  • the unborn fetus
  • any trauma to the women has a direct effect on the fetus
24
Q

blood volume and heart rate

A
  • pregnant women have an increased amount of overall total blood volume and a 20% increase in heart rate
  • may have a significant amount of blood loss before you will see signs of shock
  • uterus in vulnerable to penetrating trauma and blunt injuries
  • larger than normal abdominal cavity -> hides blood
25
Q

assessment and management

A
  • your focus is on the women
  • suspect shock based on the MOI
  • be prepared for vomiting and aspiration (medicine for pregnancy nausea is different for nonpregnant)
  • attempt to determine the gestational period to assist you with determining the size of the fetus and the position of the uterus
  • fetal depression the vena cava -> limited venous return -> obstructive shock -> never lay pregnant patient supine
  • lay left lateral recumbent
    1. have you felt the baby move or kick or 2. use a fetal doppler ? -> no risk or demise**
26
Q

cavities you can bleed to death in

A
  • retroperitoneal cavity
  • both femurs
  • head
  • street
  • chest
  • abdomen
27
Q

history taking

A
  • investigate the chief complaint
  • ask questions that will help you identify the cause of her complain and the associated signs and symptoms
  • obtain a thorough obstetric history:
  • her expected due date
  • any complications that she is aware of (high risk factors)
  • if she has been receiving prenatal care
  • her thorough medical history (past OB history -> have many pregnancy, how many delivered, how many delivered to term, how many vaginally, how many c-section, how many elective/spontaneous abortions)
  • GNP- grava (times pregnant) and para (delivered)
28
Q

obtain SAMPLE history

A
  • do not focus only on the pregnant history
  • determine the due date, frequency of contractions, a history of previous pregnancies and deliveries, the possibility of twins, and if she has taken any drugs or medications
  • if her water has broken, ask whether the fluid was green (what color and does it have an odor)
  • green fluid is due to meconium (fetal stool)
  • the presence of meconium can indicate newborn distress, and its possible for the fetus to aspirate meconium during delivery
29
Q

physical examinations

A
  • fetal movement- sign of distress and viability
  • assess the major body systems
  • for a pregnant in labor, focus, on contractions and possible delivery
  • if you suspect that delivery is imminent check for crowning (by eye)
30
Q

vital signs

A

-Include pulse; respirations; skin color,
temperature, and condition; and BP
-Pay attention to tachycardia and hypotension or hypertension.
-Hypertension, even mildly elevated BP, may indicate more serious problems

31
Q

breech delivery*

A
  • the presentation is the position in which an infant is born or the body part that is delivered first
  • frank breech- butt presentation
  • most infants are born head first
  • occasionally, the buttocks are delivered first
  • can delivered breech if the practitioner knows how to
32
Q

presentation complications

A
  • limb presentation- breech

- on rare occasions the presenting part of the infant is neither the head nor but but a single arm, leg, or foot

33
Q

prolapse of the umbilical cord

A
  • must be treated in the hospital
  • umbilical cord comes out of the vagina before the infant
  • rupture can happen
  • abruptio placentae- can cause
  • fetus compress umbilical cord -> cuts off oxygen -> no nutrients, bradycardia, fetal demise,
34
Q

infants head will compress the cord and cut off circulation

A
  • do not push the cord back into the vagina
  • put in knee chest position
  • Trendelenburg’s position
  • insert your gloved hand into the vagina, and push the infants head away from the umbilical cord
35
Q

postterm pregnancy

A
  • 37-42- term
  • 36 and earlier- preterm
  • 42 and greater- post term
  • infants can be larger, sometimes weighing 10 ib or more
  • 22-24 weeks - viability
  • can lead to problems with the mother and infant: a more difficult labor and delivery
36
Q

postterm pregnancy problems

A
  • increased chance of injury to the fetus
  • most common injury is shoulder dystocia- as shoulders come up against pubic bones while being born -> uterine contraction pushes down on the child and brachial plexus -> developmental issues
  • increased chance of cesarean section
  • women is at risk for perineal tears and infection
  • infants have increased risks of meconium aspirations, infection, and being stillborn
  • infants may not have developed normally
37
Q

fetal demise

A
  • you may deliver an infant who died in the mothers uterus before labor
  • onset of labor may be premature, but labor will progress normally in most cases
  • if an intrauterine infection caused the demise you may note a foul odor
  • do not attempt to resuscitate an obviously dead infant
38
Q

postpartum complications

A
  • bleeding that exceeds 500mL is considered excessive
  • can be measured by the amount of pads bled through
  • continue to massage the uterus after delivery
  • check your technique and hand placement if bleeding continues
  • excessive bleeding is usually caused by the uterine muscles not fully contracting
  • oxytocin is administered externally to help
  • uterine contraction can be most helpful way to control internal hemorrhage postpartum
  • continue massaging the uterus and cover the vagina with a sterile pad
  • change the pad as often as possible
  • do not discard and blood soaked pads
  • place the women in the shock position, administer oxygen, monitor vital signs, and transport her immediately
  • hysterectomy might be necessary if bleeding out
39
Q

embolism- postpartum complication

A
  • hypercoagulapathic
  • most commonly and pulmonary embolism
  • results from a clot that travels through the bloodstream and becomes lodged in the pulmonary circulation
  • the obstruction will block blood flow to the lungs and is potentially life threatening
  • DVT- deep vein thrombosis
  • encourage to walk around