OB/GYN Complications & Delivery

Placenta Previa

Placenta Covers cervix

• painless

• bright red vaginal bleeding

Placental Abruption

Placenta separates from wall

• painful

• dark red bleeding

• abdominal ridgidity

Preeclampsia/ Eclampsia

• what is it

• what’s the difference

• symptoms

Pregnancy-induced hypertension & edema

becomes eclampsia upon onset of seizures

• hypertension

• headache

• visual disturbances

• swelling

Normal Delivery

• when does it happen?

• what to do?

Field delivery is imminent if crowning is present or contractions are less than two minutes apart.

• support the head

• check for nuchal chord

• deliver anterior shoulder first, then posterior

Prolapsed Chord

Cord presents first

• insert gloved hand and push the baby’s head off the cord until arrival at the hospital

• Knee chest position + cover chord

Breech

Buttocks/ feet present first

if the head is trapped, form a V with fingers to create an airway

FAST TRANSPORT, HIGH FLOW OXYGEN

Neonatal Evaluation (APGAR)

• what does it stand for

Calculated at 1 and 5 minutes post delivery:

Appearance:

0 = Blue/ Pale

1 = Pink body + Blue Limbs

2 = Completely Pink

Pulse:

0 = Absent

1 = <100 BPM

2 + >100 BPM

Grimace:

0 = No response

1 = Grimace

2 = Cough / Sneeze / Cry

Activity:

0 = Limp

1 = Some flexion

2 = Active Motion

Respiration:

0 = Absent

1 = Slow/ Irregular

2 = Strong Cry

SCORE _/10

What is the Golden Minutes

1st critical seconds outside the womb

• warm, dry, stimulate the infant

• position the airway & clear secretions ONLY if visible obstruction is present

Cord Management

For vigorous term infants, delay cord clamping for at lease 60 seconds

until cord stops pulsating/ turns white

place clamp 6-8 inches away from abdomen

place 2nd clamp 3-4 inches further (toward placenta)

If infant is apneic or HR < 100 BPM

initiate positive pressure ventilation at 30-60 breaths per minute

Infant HR below 60BPM after 30s of ventilations

CHEST COMPRESSIONS

3:1 synchronized (90 compressions and 30 ventilations per minute)

Oxygen Saturation Targets

1 min (60-70)

5 min (80-85)

NORMAL @ 10 min (85-95)

How long before newborns should spontaneously breath?

• if not?

15-30s

flick soles or rub back

Pediatric Assessment Triangle

Visually assess severity of symptoms:

Appearance:

Tone

Interactiveness

Consolability

Look/ Gaze

Speech/ Cry

Breathing:

Abnormal airway sounds

Abnormal positioning

Retractions

Nasal Flaring/ grunting

Circulation:

Pallor

Mottling

Cyanosis

Capillary Refill

Shock

Respiratory Distress/ Failure

Cardio-Pulmonary Failure

Central Nervous System (Brain Oxygenation/ Mental Status)

Supine Hypotensive Syndrome

When pregnant patient lies directly on their back.

uterus compresses the inferior vena cava, reducing blood return to the heart.

SYMPTOMS: dizziness, nausea, and hypotension

TREATMENT: place patient on their left side.

Preterm Labor

• uterine contractions and cervical changes occurring before 37 weeks

• regular contractions or pelvic pressure

• following TRAUMA

Pulse Checks

Adult (puberty & older) - Radial

Child (1yo - puberty) - Carotid or Femoral

Infant (under 1yo) - Brachial