Upgrade to remove ads
Only $35.99/year

Obstetrics and care of the newborn.

Terms in this set (69)

Female organs
Vagina, uterus, ovaries, and Fallopian tubes.
The uterus is a pear shaped muscular organ that provides an appropriate site for egg implantation and fetal development during pregnancy.
...
Uterus
Organ where fetus grows.
Vagina
Lower part of birth canal.
Fetus
Developing unborn baby.
Placenta
Fetal organ that provides perfusion from uterus.
Umbilical cord
Connects fetus to placenta.
Amniotic sac
Sac that surrounds fetus in utero.
Perineum
Skin area between vagina and anus.
Ovaries
Responsible for secreting the hormones estrogen and progesterone and for development and release of the mature egg necessary for reproduction.
Fallopian tubes
Thin flexible structures that extend from the uterus to the ovaries.
Cervix
Connects with the vagina. Contains a plug of mucus that seals the uterine opening during pregnancy, preventing contamination from entering the uterus.
The bloody show
First stage of labor. Pink discharge.
The blood of the mother and the blood of the fetus do not mix, except during birth or miscarriage.
...
Afterbirth
After the infant is born, the placenta separates from the uterine wall and is delivered.
Umbilical cord
Is the unborn infants lifeline, attaching the fetus to the placenta.
Pre-Byronic stage
The first 14 days after conception.
Embryonic stage
From day 15 to 8 weeks.
Fetal stage
Beings at 8 weeks and ends at delivery of the baby.
Gestational age
Refers to the age of the fetus in weeks.
Full term pregnancy
Approximately 280 days.
Trimesters refers to each 3 month period.
First trimester month 1-3
second trimester month 4-6.
Third trimester month 7-9.
Most emergencies that we will deal with are in trimester 1 and 3
...
Physiological changes in pregnancy
Reproductive system.
Respiratory system.
Cardiovascular.
Gastrointestinal.
Urinary.
Musculoskeletal.
The maternal heart rate increases by 10-15 bpm.
...
Preterm emergencies.
Those medical conditions that present before the fetus has reached term.
Term defined as 36-40 weeks.
Pregnancy is divided into three trimesters.
...
Preterm emergencies: miscarriage
Loss of fetus up to 20 weeks:
Most occur in first 12 weeks of pregnancy.
Due to fetal abnormalities.
Miscarriage/spontaneous abortion.
Spotting and intense cramping.
Naturally occurring expulsion of the fetus.
Any tissue that is retained within the uterus following a spontaneous abortion may lead to severe bleeding and infection.
...
Placenta previa
Abnormal implantation of the placenta over or near the opening of the cervix.

*bleeding:bright red, painless.
Placenta previa
When the fetus changes position in the uterus, or the cervix begins to thin and dilate, the placenta is torn. Results in bleeding
Factors of placenta previa
More than two deliveries.
Bleeding immediately after intercourse.
History of vaginal bleeding.
Hallmark sign is third trimester bleeding that is painless.
Ectopic pregnancy
Implantation of placenta outside of uterus.
Usually occurs in Fallopian tubes.
Signs of shock.
Abdominal pain.
Patients may bleed out quickly.
Ectopic pregnancy
Any female of childbearing age with signs and symptoms of shock should be assumed to have an ectopic pregnancy until proven otherwise.
12-50 years of ages
Treatment for preterm bleeding
General patient care.
Place pad between legs. Do not allow patient to insert a tampon.
Preeclampsia/eclampsia
Eclampsia is a more severe form of preeclampsia and includes coma or seizures. Preeclampsia is characterized by high blood pressure and swelling in extremities.
Pregnancy induced hypertension
BP in a pregnant woman that is greater that 140/90 on two or more occasions at 6 hours apart.
When edema and protein in the urine are found with the elevated BP it is defined as preeclampsia.
This is characterized by high blood pressure, swelling, headaches, and visual disturbances.
Eclampsia
Signs and symptoms of preeclampsia including life threatening seizures or coma.
During seizure the placenta can seperate from the uterine wall, causing death of the fetus and severe hemorrhage.
...
ALS upgrade
Lower abdominal pain in women age 12-50: with
Dizziness.
Syncope.
Heavy vaginal bleeding.
ALS continued
BP greater than 160 systolic or greater than 90 diastolic.
Seizure.
Pre-eclampsia.
Signs of shock.
Signs and symptoms of pre delivery emergencies
Ab pain, nausea, vomiting.
Vaginal bleeding.
Altered mental status.
Weakness, dizziness.
Signs of imminent delivery
Gestation of 36 or more weeks.
Contractions less then 2 minutes apart, lasting at least 1 minute.
Crowning is present. Mother feels urge to push.
Mother feels need to push bowels.
Preparing for delivery
Consider completing delivery at scene, then transport.
Warm towels for baby.
Avoid microwaving towels.
BSI and childbirth
Minimum is gloves and splash protection.
Prepping for field delivery
Consider ways to maintain baby's body heat.
Inspect amniotic fluid.
Remind mothers of child birth class techniques.
Contractions that follow a pattern of greater intensity, longer duration, and shortening interval between them indicate true labor.
...
Stages of labor
First stage: uterine contractions to dilation of cervix.
Second stage: birth of baby.
Third stage: delivery of placenta.
Crowning
Infants head appears at the opening of the birth canal. At this point the mother should be coached to push with each contraction.
Cephalic delivery
Top of the head is presenting.
Delivering the baby.
Support baby's head.
Check for nuchal cord.
Suction mouth, then nose.
Deliver anterior shoulder guiding baby's head down.
Deliver posterior shoulder guiding baby's head down.
Delivery baby continued
Complete delivery.
Clamp, cut the cord.
Calculate apgar score
Nuchal cord
Umbilical cord is wrapped around the baby's neck. Check for this prior to suctioning. Attempt to slip the cord over head. If the cord can't be removed, clamp and cut in place.
Determine baby's apgar score after delivery.
...
Delivery of the placenta
Usually takes 10-20 minutes after delivery of baby.
Do not pull on umbilical cord to speed up process.
Transport placenta with mom and baby.
Post-partum care of mother.
Observe for delivery of placenta.
Observe for hemorrhage.
Place 1-2 sanitary napkins at Vagina.
Treat for shock, position, oxygen, warmth.
Transport mom, baby, placenta.
Neonatal resuscitation
Compressions.
One finger width from nipple line, two thumbs encircling the chest. One third depth of the chest.
Rate of compressions: 120 a minute.
Compression : ventilation ratio- 3 to 1.
Rescue breathing rate. 40-60 minute.
Newborn resuscitation: do what probably seems simple.
Dry the baby.
Warm the baby.
Position the baby.
Suction the baby again.
Stimulate the baby.
Abnormal deliveries: breech.
Body part other than the head presents.
Delivery should not be attempted. Ensure cord is not compressed. Place mother in knee chest position.
Transport immediately.
Abnormal deliveries: prolapsed cord.
The umbilical cord may present before baby's head. The baby's oxygenated blood supply can be cut off.
Prolapsed cord
Instruct the patient not to push. And to pant like a dog to prevent her from constricting ab muscles. Position patient in knee-chest position. Insert a sterile, gloved hand into vagina and move cord away from baby. Cover cord with sterile dressing. Transport immediately
Multiple births
One OB kit will be needed for each baby.
Clamp, cut cord of first baby, prior to delivering the next one.
Track time of birth, birth orders and apgar scores. Twins tend to be smaller in birth weights.
Meconium staining
Baby's first bowel movement "worrisome if it occurs in the uterus."
Occurs when baby is stressed.
Danger of aspiration pneumonia.
Suction airway before delivery is complete.
Arrange ALS rendezvous.
Suction mouth, then nose.
Premature deliveries
More resuscitation needed.
Ensure ABC's are provided.
Care as normal.
As soon as baby is delivered
Place to clamps two inches apart at least 6-8 inches from the baby and cut the cord between the clamps.
Stimulate the baby by drying the baby with towels
Assess the need for neonate resuscitation.
Assess apgar score at 1 minute. Assess apgar score at 5 minutes.
Sets found in the same folder