PARA3008 Flashcards
(45 cards)
What is HCG and what are its roles during pregnancy
Is a hormone produced by the placenta during pregnancy that stimulates the corpus luteum to increase the production of progesterone therefore maintaining the pregnancy
What are the negative consequences of lying a pregnant patient on their back in supine
The weight of the foetus and uterus puts pressure on the vena cava and therefore decreases preload to the heart and decreases cardiac output.
Instead we should position pregnant patients in the left lateral position hence proping up the patient right side.
What are the important questions to ask a pregnant woman ?
- ORANGE BOOK
- Gestation : How many weeks along?
- Foetuses : how many babies are inside
- Complications : are there any know problems with the pregnancy
- G and P : gravidity and parity
- Foetal movements been regular
- antenatal care : have they had testing and scans
What is Gestational Diabetes and how does it occur in a pregnant woman
The pregnant females body has decreased levels of insulin hence more free glucose so the baby can grow
Typically Self RESOLVING
Can be controlled with diet management
28 week screening to test for gestational diabetes
Increases the risk of type 2 diabetes
Complications :
macrosomia, the baby grows very big then is harder to give birth
polyhydramnios, fluid overload in the placenta because water follows sugar
What is preeclampsia and what are some of the treatments associated
Multisystemic disorder
NORMAL Cytotrophoblasts go from the foetal side and migrate to the mothers side and this effects the spiral artery which allows blood flow to the foetus.
Preeclampsia : the Cytotrophoblasts don’t transfer to the mother hence spiral artery is vasoconstricted and reduced blood flow (oxygen and nutrience) to the foetus hence baby is hypoxic
Presentation :
- Hypertension due to the constriction of the spiral artery
- Increased ICP – headache
- Epigastric region pain
- Pitting oedema
- GFR impacted ( proteins are weed out, proteinuria)
Poor foetal growth
Treatment
- Beta blockers
- Magnesium
- Calcium channel blockers
What is eclampsia and its management pathways prehospitally
The conversion of preeclamsia to eclampsia
This is present when the patient has an onset of tonic clonic seizures
Management :
IV magnesium – helps to decrease BP and ICP
If seizure needs to be stopped immediately follow normal seizure management guidelines (midaz)
What are the 5 maternal H’s (collapse)
Head : eclampsia, epilepsy, CVA, intracranial haemorrhage, vasovagal response
Heart : MI, arrhythmias, peripartum cardiomyopathy, congenital heart diseases, thoracic aorta dissection
Hypoxia : asthma, PE, pulmonary oedema, anaphylaxis
Haemorrhage : abruption, uterine stony, GI tract trauma, uterine rupture, uterine inversion, reutpured aneurysm
Hazards and wHole body : hypoglycaemia, amniotic fluid embolism, septicaemia, trauma, complications to anaesthetic, anaphylaxis
Define Placental Abruption
When the placenta is forcefully separated from the uterus.
- Intense constant pain
- Uterus becomes ridged and hard
- Foetus becomes distress
- Birth baby sooner rather than later
- Sometimes can heal on its own
Define Placenta Previa
overlapping of the placenta of the internal oz
The placenta is covering the exit for the baby
Low lying placenta – where the placenta is lower down towards the cervix (internal oz)
Type 4 cannot have a vaginal birth
Anyone with placenta previa is strongly encouraged to not have a natural birth
Define Vasa Previa
where unprotected fetal blood vessels run across the cervix, potentially rupturing when the membranes break, leading to fetal blood loss and even death. Early diagnosis through ultrasound and planned cesarean delivery before labor is crucial for improving outcomes.
Define Uterine Rupture
When the uterus ruptures exposing the foetus to the internal abdominal
- Susceptible with scar tissue and previous surgery
- Extreme pain when ruptured then feel nothing once ruptured
- Can feel tearing
- Signs of hypovolemic shock due to blood loss
- Baby sits in the abdomen
- Can see when it happens
- Treat symptomatically
Define an Ectopic Pregnancy
- Where the fertilised egg implants outside of the uterus typically in the fallopian tubes
- 8 – 9 weeks detected
- Intense Flank pain
- Sometimes can remove fallopian tubes other times they can be saved
- Huge blood loss in abdominal cavity
- Psychological support due to death of baby
Define Miscarriage and the types associated
A miscarriage, also known as a spontaneous abortion, is the unintentional loss of a pregnancy before 20 weeks of gestation. It commonly occurs in the first trimester (before 13 weeks) and is often due to chromosomal abnormalities in the developing embryo or fetus.
Types of Miscarriage
Threatened Miscarriage
Definition: Vaginal bleeding occurs, but the cervix remains closed and the pregnancy may still continue normally.
Signs: Vaginal bleeding, possibly mild cramping.
Prognosis: Pregnancy may still proceed to term.
Inevitable Miscarriage
Definition: Bleeding and cramping are present, and the cervix is open, indicating that miscarriage cannot be prevented.
Signs: Moderate to heavy bleeding, open cervix, strong cramping.
Incomplete Miscarriage
Definition: Some pregnancy tissue has been passed, but some remains in the uterus.
Signs: Heavy bleeding, cramping, passage of tissue, open cervix.
Complete Miscarriage
Definition: All pregnancy tissue has been expelled from the uterus.
Signs: History of bleeding and cramping that have now resolved, closed cervix, empty uterus on ultrasound.
Missed Miscarriage
Definition: The embryo or fetus has died but has not been expelled from the uterus.
Signs: No bleeding or pain; often discovered during a routine ultrasound with no fetal heartbeat.
Septic Miscarriage
Definition: A miscarriage complicated by infection of the uterus and surrounding tissues.
Signs: Fever, foul-smelling vaginal discharge, abdominal pain, bleeding, signs of sepsis.
Urgency: A medical emergency requiring prompt treatment with antibiotics and possibly surgery.
What is premature labour
- Before 37 weeks gestation
- The foetus is not yet fully developed
- Present the same as a full labour
- Irregular contractions leading to regular contractions
- Delay the baby being born to administer medications (steroids for the development of lung surfactant) maybe antibiotics but too many antibiotics can be linked to cerebral palsy
- Give tocolytic to stop the labour progressing
- Magnesium for neural protection
What are the 5 P’s to birthing
- Passage – want the baby to manoeuvre the pelvis
- Passenger – head first birth hence best and safest birthing opportunity
- Powers – primary and secondary
Primary : uterus itself
Secondary : the mother pushing and hormones - Positioning – what feels most comfortable for the mother - Standing helps with the head on the cervix and the positive feedback mechanisms of labour - Laying flat on back decreases pelvic outlet hence harder to give birth
- Psychology – relationship with paramedic and mum, positive and safe environment. Belief in mum
Explain stage 1 in the birthing process
Stage 1 : onset of painful contractions
The pregnant mother’s cervix will begin to effacete and dilate, it becomes wider and shorter.
The mucous plug is lost (water breaking) which will look like bloodstained snot
This is when the uterine contractions begin lasting for around 1 - 1.20 minutes in 5 minute intervals
- Long contractions with no break in between that a problem / overstimulation can cause placental abruption and hence puts baby and mum at risk
In this stage the administration of oxytocin infusion can be necessary if the contractions are irregular and you think something is going wrong
Explain the 2 stage in the birthing process :
The second stage of birthing : baby being born
This stage the baby is welcomed to the outside world.
Cardinal movements of labour (mechanisms of labour)
Engagement : the baby begins the process of moving out
Descent : the baby decreases into the cervix
Flexion : the baby puts chin to chest
Internal rotation : the baby turns inside mother to its tum to bum
Extension : the head it birthed
External rotation : the baby rotates 180 so the shoulders are transverse with the pelvis
Expulsion : the shoulders and rest of the baby comes out
What are the three important thing for baby after birthing ?
- Dry and stimulate : get baby skin to skin with mother ANS dry off with towels and rub to stimulate respirations
- APGAR at 1 and 5 minutes (appearance, Pulse, Grimace, Activity, Respirations)
- Clamp and cut cord (3 clamps, 10cm, 15cm, 20cm - cut between 15 and 20)
Other things to consider
- temperature management
- skin to skin contact
- avoid ECG dots on premi babies because of tender skin
- BGL on heal
- pink, warm, sweet
What are the three important thing for mum after birthing ?
- Monitor closely (internal haemorrhage, decline in mental status)
- Assess Fundus (feeling for firm mass on the top of belly, if its squashy massage to make it stiff, if pushed to one side mum needs to urinate. Might feel other body parts another baby to deliver)
- inspection perineum (assess for any tears and bleeding, if yes stop bleeding with direct pressure)
Explain stage 3 in the birthing process
Stage three : birthing of the placenta
This is where the placenta if birthed out, this typically occurs within an hour on the baby being birthed
10units of IM oxytocin may be administered to help with placenta birthing and decrease the risk of post partum haemorrhaging.
TAKE PLACENTA TO HOSPITAL
Once placenta is out exam the placenta for;
- clots which may indicate placental abruption
- Intact membranes
- Insertion of the cord (should be central)
APGAR score
Describe the cardinal movements of labour. Show them
What is this image displaying
Placental Abruption
What is this and describe what is occurring
Placental Previa : this is where the placenta is covering the cervix so the baby cannot be birthed naturally
