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Gateway 4 - AT Grad Paramedic > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Four types of breech birth

A
  • Complete Breech where hips and knees are flexed so foetus is sitting cross legged
  • Frank Breech: legs flexed at the hip and buttocks presents first
  • Kneeling breech
  • Footling breech
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2
Q

Signs of imminent delivery of birth

A
  • Increasing frequency of contractions with urge to push
  • Membrane rupture
  • Primal instinct
  • Bulging perineum
  • Appearance of presenting part
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3
Q

Complications of breech delivery

A
  • Fetal distress and hypoxia
  • prolapsed cord
  • Head entrapement
  • Meconium aspiration
  • Inversion of uterus
  • PPH
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4
Q

Birthing manoeuvres: Breech Birth

A
  1. Delivery of the buttocks and legs:
    - Ask mother to push with contractions once but has entered vagina and let them delivery until shoulder blades are seen.
    - If legs do not delivery spontaneously, delivery on leg at a time but grabbing ankle.
    - Hold baby by the hips with thumbs on the buttocks
  2. Delivery of the arms (if stretched out):
    - Lovset’s Manoeuvre: Apply dry cloth wrapped around bab ‘s pelvis; hold baby by hips and turn 180 degrees, applying downwards pressures that the arm can dislodge anteriorly.
    - Assist by placing 1-2 fingers on the upper part of arm; draw arm down and over the chest
    - Rotate baby back 180 degrees to deliver second arm.
  3. Delivery of the head:
    - Mauriceau Smellie Veit manoeuvre: place baby face down with length of body over hand and arm. Place 1st and 2nd fingers on baby’s cheek bones and flex head.
    - Use other hand to support occiput and back.
    - pull gentley to delivery head
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5
Q

Care of the newly delivery baby

A
  • Clean newborns mouth and nose of mucous, blood or meconium.
  • If obstruction, gently suction the mouth and nasal flares.
  • Use a dry towel to immediently and thoroughly dry baby, stimulating also.
  • Within 30seconds: assess HR (stethoscope) and breathing status.
  • IF HR <100, apply SpO2 monitoring to R) finger and commence resuscitation.
  • Skin to skin and promote breastfeeding
  • Apply SpO2 monitoring R) hand. SpO2 85-90% after 10mins.
  • 1 min: APGRA
  • 5 mins: APGAR
  • Keep tab ywarm
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6
Q

When to commence resuscitation for newborns

A
  • HR <100
  • Reduced muscle tone
  • Slow or irregular respirations
    _ Centrally pale or cyanosed or CPO2 <60%
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7
Q

Newborn cord clamping

A
  • Delay cord clamping and cutting 3-5 mins following birth
  • Always gain permission
  • Clamp at 10, 15 and 20cm and cut between the 15 and 20cm
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8
Q

New born resuscitation: assessment for resuscitation

A
  • Observe colour and tone: limp muscle tone and minimal activity
  • Breathing adequacy: recession, retraction, or irregular respirations
  • HR: auscultate for 6 seconds.
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9
Q

Newborn resuscitation procedure

A
  • Preterm: wrap in glad wrap (don’t dry)
  • Blanket and beanie.
    1. Airway: Supine with 1cm pad under shoulder blades
    2. Breathing: If inadequate breathing, IPPV at a rate of 40-60 breaths/min
  • SpO2 R) hand
  • Assess every 30 seconds
    3. Circulation: <60bpm commence compressions

If HR >100bpm, stop resuscitation

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10
Q

Primary PPH

A

> 500mL blood loss in the first 24 hours following delivery.

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11
Q

Secondary PPH

A

Abnormal or excessive blood loss from birth canal 24hours to 12 weeks postpartum.
Excessive bleeding considered more than one heavily soaked pad per hour.

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12
Q

Risk factors of PPH

A
  • Previous Hx of PPH
  • Anaemia
  • > 35 YO
  • Multiparty
  • Prior uterine surgery
  • Preeclampsia and HELLP syndrome
  • Obesity
  • Uterine anomolies
  • Abnormal placenta
  • Prolonged second or third stage
  • Large baby
  • Infection or rupture of membranes
  • Cesarean
  • Manual removal of placenta
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13
Q

Causes of PPH (4 T’2)

A

Tone - inability for uterus to contract
Tauma - cervical and genital tract damage during delivery
Thrombin - Coagulation disorder
Tissue - retained products

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14
Q

PPH Management

A
  • PPH identified
  • Placenta birthed? if no, manage third stage of labour; if yes, commence fundal massage until firm and central.
  • Empty bladder and breast feed
  • If bleeding hasn’t stopped, manage cause of haemorrhage:
  • continue fundus massage and administer oxytocin
  • Assess for tears and apply compression
  • Aortic compression
  • Bimanual compression
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15
Q

Pre-eclampsia definition

A

high blood pressure, protein in the urine and severe swelling.Occurs during pregnancy after 20 weeks gestation and up to one month post partum.

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16
Q

Pre-eclampsia diagnosis

A

SBP >140mmHg AND/OR
DBP >90mmHg plus one or more of:
- Neurological problems
- Proteinuria
- renal insufficiency
- Liver disease
- Haematological disturbances
- Foetal growth restriction

17
Q

Health consequences of pre-eclampsia and eclampsia

A

Placental abruption
DIC
Cerebral haemorrhage
Hepatic failure
Acute renal failure

18
Q

HELLP Syndrome definition

A

Hemolysis, elevated liver enzyme’s and low platelets
- Severe variant of pre-eclampsia

19
Q

Risk factors of pre-eclampsia

A

First pregnancy
Hx pre eclampsia
Gestational HTN
Increased maternal age
Renal disease
Diabetes
Obesity
Family Hx
Multiple babies

20
Q

Pre-eclampsia clinical features

A
  • Neurological: Headache, visual disturbances, seizure, hyperreflexia, clonus, dizziness
  • Resp: acute pulmonary oedema
  • CVS: HTN, oedema
  • GIT: Epigastric pain, RUQ tenderness, N/v
  • Jaundice
21
Q

Pre-eclampsia management

A
  • Identified pre-eclampsia: SBP >140; DBP >90; peripheral/generalised oedema; GIT disturbance.
  • Lateral position to avoid hypotension.
  • High flow O2
  • Dark and cal envonrment
22
Q

Eclampsia management

A
  • Lateral position and maintain airway
  • ICP back up
  • High flow O2
  • If delay in MgSO4, administration of midaz
  • MgSO4 infusion (ICP only)
23
Q

Trimester periods

A

Trimester 1: 1-12 weeks: Growing uterus is protected by bony pelvis

Trimester 2: 13-28 - Fondus is the height of the umbilicus

Trimester 3: 29-40 - fondus is the height of the ziphoid process

24
Q

Cardiovascular changes in pregnancy

A
  • Increase HR due to increase blood volume & O2 demand
  • Increased SV
  • Plasma volume increases by the 10th week
  • Increased CO
  • Decrease in BP 2nd trimester
  • Hypercoaguluable state
25
Q

Respiratory changes in pregnancy

A
  • Dyspnoea due to diaphragm being pushed upwards
  • Increased O2 requirements
  • Increased tidal volume and RR
26
Q

Renal & GIT changes in pregnancy

A
  • Increased GFR by week 28
  • Increased urinary frequency due to compression of bladder
  • more UTI susceptibility
  • Displacement of organs and peristalsis is slower
27
Q

Three stages of labour

A

First stage: Dilation of cervix begins with regular painful contractions.
Second stage: Expulsion of foetus from full cervical dilation to complete birth of baby (recognised by transition to primal instinct)
Third stage: Separation and expulsion of placenta and membranes.

28
Q

Obstetrics history

A

Number of pregnancies
Hx of labours/durations/gestationla outcomes
previous full-time or pre?
When did contractions being
Frequency and duration of contractions
Membrane rupture?
What position in last scan
Multiple babies?
Antenatal issues?

29
Q

Preterm baby

A

<37 weeks

30
Q

What stimulates the neonate to breathe?

A
  • Fall in blood pH; when cord is clamped, lower O2 and increases CO2, detected by chemoreceptors and stimulating the respiratory centre
  • Sensory and tactile stimuli
  • Temperature changes from internal to external environment
  • Chest wall compression during birth expels fluid and creates a negative pressure
31
Q

APGAR

A
  • Appearance: 0 - cyanosis/pallor; 1 - blue extremities, pink body; 2 - normal colour
  • Pulse: 0 - absent; 1 - <100 BPM; 2 - >100bpm
  • Grimace: 0 - no response; 1 - minimal reflex response; 2 - cry or responds to reflex.
  • Activity: 0 - flaccid; 1- minimal flection of extremities; 2-good, active motion
  • RR: 0 - Absent; 1 - slow, irregular or weak cry; 2 - good, vigorous cry
32
Q

What causes a low APGAR score?

A
  • Foetal distress due to hypoxia before delivery
  • Maternal anaesthetic or analgesia
  • Preterm infant
  • Difficult or traumatic delivery
  • Excessive suctioning
  • Severe respiratory distress
33
Q

HOW SHOULD YOU STIMULATE RESPIRATION IMMEDIATELY AFTER BIRTH?

A

Dried with a warm towel and rubbing newborn to stimulate breathing. Stimulation alone will normally start breathing in most cases.

Gateway 4 - AT Grad Paramedic (12 decks)

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