Flashcards in Obstetrics & Neonatal Care Deck (64):
The placenta and other tissues that are expelled after the delivery of the fetus.
A thin, transparent membrane that forms a structure sac that holds the fetus suspended in amniotic fluid (500–1,000 mL); also called bag of waters.
The period of pregnancy before the onset of labor.
The mucus and blood that are expelled from the vagina as labor begins
A common abnormality of delivery in which the fetal buttocks or both lower extremities are low in the uterus and are the first to be delivered.
Transport should be immediate when a breech presentation is recognized. If it cannot be prevented, provide high concentration oxygen to mother and insert fingers forming "V" in vagina around fetus's nose.
The neck of the uterus.
The stage in delivery when the fetal head presents at the vagina.
Thin, flexible structures that extend from the uterus to the ovaries; also called uterine tubes.
The child in the uterus from the third month of pregnancy to birth; before that time it is called an embryo.
The period of time from the onset of labor to delivery of the infant.
The physiological process by which the fetus is expelled from
the uterus into the vagina and then to the outside of the body;
Also called childbirth.
An abnormal obstetric presentation when an arm or single leg is the first fetal part to protrude from the vaginal opening.
Care: Rapid transport is needed, as a cesarean section must be performed.
A greenish or brownish yellow staining of the amniotic fluid caused by a fetal bowel movement resulting from distress.
- Occurs when fetus ingests dead skin cells or vernix; passes into the fetal digestive tract and forms the first stool—a thick, sticky, tarlike substance called “meconium.”
- Meconium might enter the lower airway and cause meconium aspiration syndrome, resulting in severe respiratory distress.
- If complete obstruction occurs, atelectasis of fetus can result.
Multiple birth (Special considerations)
The delivery of more than one baby during a single birth; for example, twins or triplets.
-Uterine contractions start again approximately 10 minutes after the first baby has been delivered
- First baby is small compared with the mother’s abdomen before delivery.
- Babies might require resuscitation. Remember to call for additional resources, if needed to treat mother and babies.
- If delivery of the second fetus has not occurred within 10 minutes, transport immediately.
A child from birth to 1 month of age.
Nuchal cord (Definition & Care)
An umbilical cord that is wrapped around the infant's neck during the delivery.
Corrected by slipping the cord over the baby's head or clamping and cutting the cord.
Having to do with pregnancy or childbirth.
The female gonads or sex glands.
The area of skin between a female’s vagina and anus.
The fetal organ through which the fetus exchanges nourishment and waste products
Condition that occurs when the fetus remains in the uterus more than 42 weeks; the placenta can no longer meet the nutritional and metabolic needs of the fetus.
The period after delivery of the infant
Postpartum hemorrhage (management)
The loss of more than 500 mL of blood after delivery of the infant.
- placing a sanitary napkin, trauma dressings, or trauma pad over the vagina
- performing a fundal massage
- allowing the neonate to breast-feed (which releases oxytocin and promotes uterine contraction)
- NEVER pack the inside of the vagina with dressings to control hemorrhaging.
Post-term pregnancy (Special considerations)
Gestation of the fetus that extends beyond 42 weeks; see also
- Delivery might be more difficult because the cranium has begun to harden
- Fetus might be too large for a normal delivery and a cesarean section might be needed
- Meconium staining is also likely as fetal intestines have started to mature and function.
- Hypoxia is a main concern because of decreased blood flow from the placenta.
Birth of the fetus after less than 3 hours of labor.
- Might be an increase in trauma to the fetus and mother
- Umbilical cord might tear.
In a pregnant woman, a blood pressure greater than 140/90 mmHg on two or more occasions at least 6 hours apart,
or an increase from prepregnancy of greater than 30 mmHg in systolic pressure and greater than 15 mmHg in diastolic pressure.
An infant weighing less than 5 pounds, or an infant born before its 38th week of gestation.
Premature rupture of membranes (PROM)
Spontaneous rupture of the amniotic sac before the onset of true labor and before the end of the 37th week of gestation.
- May not be immediate emergency, but increases chances of infection of uterus & contents
- If PROM occurs, delivery might be difficult because the vaginal walls could be dry.
Prolapsed cord (S&S)
When the umbilical cord, rather than the head of the fetus, is the first part to protrude from the vagina.
- The cord can become compressed against the vaginal wall by the fetus’s head or buttocks, results in fetal hypoxia.
- Premature infant
- Multiple births
- Premature rupture of membranes (PROM)
Shoulder dystocia (Predisposing factors & care)
Abnormal delivery when the fetal shoulders are larger than the fetal head and the head delivers but the shoulders are caught between the symphysis pubis and the sacrum.
- gestational diabetes
- postterm pregnancy
- short maternal stature
- abnormal pelvic structure
- Transport immediately
- Ask the mother to pant to reduce the force and pressure of contractions
- Place the mother on her back and have her draw her knees up as close to her belly as possible.
This is known as the McRobert position and it moves the symphysis pubis anteriorly and superiorly.
Spontaneous abortion (S&S)
Without apparent cause, the termination of a pregnancy before the fetus reaches the stage of viability, generally before the 20th week of pregnancy; also called miscarriage.
Caused by genetics, uterine abnormalities, infections, drugs, or disease
- Cramplike lower abdominal pain similar to labor pains
- Bright- or dark-red vaginal bleeding
- Passage of blood clots or tissue.
Supine hypotensive syndrome (S&S)
Inadequate return of venous blood to the heart, reduced cardiac output, and decreased blood pressure resulting from pressure on the inferior vena cava; caused by the weight of the uterus and
fetus when the patient in late pregnancy is in a supine position.
Similar signs and symptoms as cardiogenic shock, such as pale skin, hypotension, tachycardia, and syncope.
An extension of the placenta through which the fetus receives nourishment while in the uterus.
An organ of the female reproductive system for containing and nourishing the embryo and fetus from the time the fertilized egg is implanted to the time of birth.
Groups of cells that surround an oocyte (immature egg)
Lining of the uterus, becomes part of the placenta during pregnancy
The sloughing of the endometrial tissue that was ready for implantation of an ovum if it was fertilized by sperm.
- If fertilization does not occur, menstruation occurs, which is marked by approximately 60 to 80 mL of vaginal bleeding over a 3- to 5- day period, every 24 to 35 days.
- Ovulation occurs on the 14th day of the menstrual cycle
The growth that the embryo undergoes during the first 14 days after conception
Full term pregnancy (# Days & Trimesters)
- Lasts approximately 280 days from the last menstrual cycle (approximately 9 months)
- First trimester, weeks 1–12
- Second trimester, weeks 13–27
- Third trimester, weeks 28–40
Body System Changes in Pregnancy
- Enlargement of uterus (houses 10 mL to 5,000 mL of fluid)
- A plug of thick mucus seals the cervix to protect the fetus from infection
- White discharge from uterus prevents bacterial growth
- The diaphragm is pushed upward.
- The thoracic cage increases in size to compensate
- Hormones are released that cause smooth muscles to dilate, decreasing resistance within the respiratory tract.
- The mother’s tidal volume increases by approximately 40%, minute volume increases, and oxygen consumption increases as much as 20%.
- Cardiac output increases 30% to 50% during pregnancy.
- Maternal Heart rate increases 10 to 15 BPM
- By the end of the pregnancy, the placenta and uterus receive approximately 600 to 800 mL of blood per minute.
- Maternal blood volume increases 45% so there is enough blood for mom and fetus
- Mother has "relative anemia", usually takes iron supplements (more plasma per RBC, although both increase)
- Blood pressure decreases
- Heart can be pushed up towards the left
- Gastric and waste products emptying from the intestines slows
- Women are prone to constipation during pregnancy not only because of the slowing peristalsis, but also because of iron supplements
- Pressure from the uterus and relaxation of sphincters cause frequent heartburn
- Hormones and blood sugar changes make nausea and vomiting very common, especially during the first trimester.
- Kidneys also increase in size during pregnancy.
- Renal blood flow increases.
- The uterus can also press on the ureters, causing urine to back up (causing frequent urination), contributes to the increased size of the kidneys.
- It also causes the ureters to dilate, which increases the chance of urinary tract infections (UTIs).
- The bladder is pushed superiorly and anteriorly, making it susceptible to trauma.
- Change in woman's center of gravity, which usually causes lordosis (inward curvature of the spine; abnormal anterior convexity of the spine) and increases the chance for falls.
- Hormones loosen the pelvic joint (this aids in delivery of the fetus), and other joints are also affected.
Total placenta previa
The placenta occludes the cervical orifice, which usually prevents the baby from being delivered and leads to emergent cesarean section.
Partial placenta previa
A partial portion of the cervical orifice is covered, which also usually prevents a vaginal delivery.
Marginal placenta previa
The placenta is located near the neck of the uterus and might tear when the cervix effaces and dilates
Placenta Previa (S&S)
Occurs when the placenta is near the opening of the cervix (sometimes referred to as the “cervical os”)
- Multiparity (more than one fetus)
- Rapid succession of pregnancies
- Age more than 35 years
- Previous history of placenta previa
- History of earlier vaginal bleeding
- Bleeding immediately after intercourse.
- The hallmark sign of placenta previa is painless vaginal bleeding during the third trimester
- The bleeding might be dark or bright red (typically bright red)
- Patient can present with signs of hypovolemic shock.
Abruptio Placentae (S&S)
Occurs when the placenta prematurely separates in whole or in part from the uterine wall before the birth of the baby
- Small vessels located in the lining of the uterus rupture in between the uterine wall and placenta, creating space for blood which causes the placenta to tear of the uterine wall
- If it separates completely, mortality rate of fetus without intervention is 100%
- Use of cocaine
- Previous history of abruptio placentae
- Shortened umbilical cord
- Premature rupture of the amniotic sac
- Severe blunt force trauma can also cause an abruption, especially motor vehicle collisions (MVCs).
- Severe vaginal hemorrhage with constant abdominal pain (hallmark sign)
- Can be mild, sharp or acute muscle spasms
- Pain to the lower back
- Uterine contractions
- Tender abdomen on palpation
- Hypovolemic shock
- Dark-red or bright-red blood, depending on the location of the fetus.
- If the head of the fetus is in the vaginal canal near the cervical os, no obvious signs of vaginal bleeding are present.
Ruptured Uterus (S&S)
Uterine wall can rupture spontaneously, releasing the fetus into the abdominal cavity.
- history of previous uterine rupture
- abdominal trauma
- large fetus
- history of a prolonged or difficult labor (which can tear the wall and force the fetus into the abdominal cavity)
- history of prior cesarean section or uterine surgery
- tearing sensation in the abdomen
- constant and severe abdominal pain
- vaginal bleeding
- cessation of noticeable uterine contraction
- signs of hypovolemic shock
- ability to palpate the fetus in the abdominal cavity
Ectopic pregnancy (S&S)
Ectopic pregnancy occurs when the ovum implants itself in other areas, typically the fallopian tube, or outgrows the area
- previous ectopic pregnancies
- adhesions (scar tissue) from previous surgeries
- tubal surgery
- STDs or PID
- pain to the shoulders as a result of blood in the abdominal cavity causing irritation
- dull and aching pain that is poorly localized that becomes sharp or “knifelike,” pain to the lower abdomen
- tender and rigid abdomen
- vaginal bleeding that could be minimal to profuse
- signs of hypovolemic shock
- nausea, and vomiting.
A condition that is associated with hypertension, proteinuria (protein in the urine), and generalized edema.
- Typically occurs during the second half or third trimester of pregnancy
- Characterized by high blood pressure and swelling of the extremities, headache, sensitivity to light.
- She may experience seizures or coma during birth (Eclampsia)
- Poor nutrition
- History of hypertension, diabetes
- Renal disease
- Liver disease or heart disease
- Sudden weight gain (typically 2 pounds per week)
- Abdominal pain
- Blurred vision
- Seeing spots
- decreased urine output
- persistent headache
- persistent vomiting
- abdominal pain
- edema to face, fingers, legs, and feet
- an elevated blood pressure usually greater than 140/90 mmHg
- OR a systolic pressure of more than 30 mmHg
- OR a diastolic pressure more than 15 mmHg of prepregnancy pressure.
A complication of pregnancy which produces seizures and coma during pregnancy or birth
Stage 1 of Labor
Begins with contractions and ends with full dilation of the cervix.
Stage 2 of Labor
Begins with full dilation of the cervix and ends with delivery of the infant.
Stage 3 of Labor
Begins with delivery of the neonate and ends with delivery of the placenta.
Braxton Hicks contractions
Contractions that occur early during pregnancy; false labor
BLS care for prolapsed cord
- On scene, instruct the mother not to push, as this might cause increased compression on the umbilical cord.
- Position the mother on the stretcher in a knee-to-chest position to help decrease pressure on the cord.
- Another position is elevating the mother’s pelvis with pillows.
- Insert a gloved hand into the vagina and find the presenting part of the fetus and apply gentle pressure to relieve pressure on umbilical cord and restore perfusion to the fetus.
- Cover the prolapsed cord with a sterile moist dressing.
- Provide high-concentration oxygen to mother
- Transport the mother rapidly and monitor the pulse in the cord to ensure that the fetus is receiving circulation.
Head-first delivery of fetus
Care for suspected Preterm labor & predisposing factors
- Because diagnosis requires an obstetric provider to conduct a thorough vaginal or sonographic examination, take all complaints of preterm cramping and contractions seriously, and treat the patient as if delivery is imminent.
- A mother who has a history of preterm labor is usually placed on bed rest.
- Preterm labor is susceptible to an abnormal presentation
- If suspected, try to calm the mother, place her on oxygen, and consider contacting advanced life support (ALS) for transport.
- Use of illicit drugs such as cocaine
- Maternal infection
- Tobacco use
- Alcohol use
- Poor nutrition (lack of prenatal care)
- Stress & long work hours
True labor contractions v. False labor
- Occur at 2-3 min intervals
- Last 30-90 seconds
- Are intense
- Interval varies
- Duration varies
- Intensity varies
- May be relieved by walking
Air embolism postpartum
- During pregnancy or postpartum, the mother is at risk for an embolism (obstruction or occlusion of blood vessels from things such as air or blood) because of the increased blood volume and coagulation properties of the blood.
- This can result in the formation of clots in the venous system, which can lead to a pulmonary embolism.
- An amniotic fluid embolism can occur if fetal cells, hair, and amniotic fluid enter the mother’s blood circulation, which results in cardiopulmonary compromise or an anaphylactic reaction.
Normal progression for newborn resuscitation (Always to rarely needed)
1. Drying, positioning, suctioning,tactile stimulation
2. Oxygenation & BVM ventilation
4. Chest compressions
How to stimulate infant that is not breathing
Flicking the soles of the feet or by rubbing the back.
S&S of newborn in distress
- RR of more than 60 breaths per minute
- Respiratory arrest or signs of severe distress
- Diminished breath sounds,
- Heart rate of more than 180 BPM or less than 100 BPM
- Signs of trauma from the delivery
- Poor or absent skeletal muscle tone
- Meconium staining
- Weak pulses
- Poor response to stimulation
- Apgar score less than four points.
Components of Apgar score
A = Appearance: This is skin color. When perfect, the skin color of the extremities and body should be pink.
P = Pulse: This is the pulse rate. For the neonate, this should be more than 100 BPM.
G = Grimace: This is directly related to muscle tone and/or facial grimace when stimulated. Optimally, the neonate should have good muscle tone and pull away or cough, sneeze, or cry when stimulated.
A = Activity: This is related to how much the neonate is moving. Optimally, the baby moves using both its hands and feet.
R = Respirations: This is the rate and regularity at which the neonate is breathing. Optimally, the baby has a strong cry and regular respiratory pattern.
- Should be performed 1 min after birth, then 4 min later
Guidelines for infant resuscitation
- If breathing is inadequate, apply PPV for 1 min, reassess, then continue as necessary
- If HR is >100, but infant is cyanotic but breathing adequately, administer blow-by oxygen at >5 lpm until color improves
- If HR is b/w 60-100 BPM, begin PPV at 40-60 times per minute for 1 min, reassess, then continue as necessary
- If HR s chest, at 120 per min, 3 compressions per ventilation