OB/Special Populations Exam

Abnormal Vaginal Bleeding

• Definition: Vaginal bleeding outside of what is normal for the patient or significant bleeding associated with illness/pregnancy.

• Important details: Determine amount, duration, pain, pregnancy possibility, and LMP; monitor for shock.

• Recognizable features: Heavy bleeding + weakness/dizziness + pale/cool/clammy skin + tachycardia/hypotension.

Ectopic Pregnancy

• Definition: Fertilized egg implants somewhere outside the uterus.

• Important details: Usually occurs early in pregnancy; patient may not know she is pregnant; treat for shock and transport.

• Recognizable features: One-sided abdominal pain → vaginal bleeding usually after pain.

Spontaneous Abortion / Miscarriage

• Definition: Delivery/pregnancy loss before 20 weeks.

• Important details: Transport; monitor for shock; bring delivered contents to hospital; therapeutic communication.

• Recognizable features: Pregnancy <20 weeks + vaginal bleeding + passage of fetal/tissue contents.

Gestational Diabetes

• Definition: Diabetes developing during pregnancy.

• Important details: Develops around week 24; commonly tested between 24–28 weeks; check BGL.

• Recognizable features: Pregnant patient in 2nd/3rd trimester with abnormal blood glucose.

Preeclampsia

• Definition: Pregnancy-induced hypertension occurring after 20 weeks.

• Important details: Can progress to eclampsia.

• Recognizable features: HTN + persistent headache + visual changes + swelling of hands/feet.

Eclampsia

• Definition: Preeclampsia that progresses to seizures.

• Important details: Manage airway/breathing; transport in left lateral recumbent position.

• Recognizable features: Pregnant patient + hypertension/preeclampsia + seizure.

Supine Hypotensive Syndrome

• Definition: Hypotension caused when the pregnant uterus compresses major blood vessels while patient lies supine.

• Important details: Move patient into left lateral recumbent position.

• Recognizable features: Late pregnancy + lying flat + hypotension/dizziness → improves when turned left.

Placenta Previa

• Definition: Placenta covers the cervical opening.

• Important details: Usually after 20 weeks; treat for shock; external sterile dressing/pad only.

• Recognizable features: Significant PAINLESS vaginal bleeding.

Placental Abruption

• Definition: Placenta partially or completely detaches from the uterus before delivery.

• Important details: Usually third trimester; may occur after trauma; internal bleeding may be significant despite little external blood.

• Recognizable features: Sudden/severe abdominal PAIN + minimal/no visible bleeding.

Stage 1 of Labor

• Definition: Beginning of labor until complete cervical dilation.

• Important details: Contractions become more regular, stronger, longer, and closer together.

• Recognizable features: Contractions + bloody show + possible rupture of amniotic sac.

Stage 2 of Labor

• Definition: Complete cervical dilation through delivery of the baby.

• Important details: Active pushing/delivery occurs during this stage.

• Recognizable features: Crowning, urge to push, baby moves through birth canal.

Stage 3 of Labor

• Definition: Begins after birth and ends with delivery of the placenta.

• Important details: Placenta may take time to deliver; do not delay transport waiting for it.

• Recognizable features: Baby already delivered → contractions resume → placenta delivers.

Stage 4 of Labor

• Definition: Immediate post-delivery recovery/bonding period.

• Important details: Encourage bonding and skin-to-skin when appropriate.

• Recognizable features: Baby delivered + placenta delivered + mother/newborn bonding.

Imminent Delivery

• Definition: Birth is about to occur and transport before delivery is unlikely.

• Important details: Prepare for delivery on scene.

• Recognizable features: Crowning + urge to push/bowel movement + contractions ≤2 min apart.

Breech Presentation

• Definition: Buttocks or feet present before the head.

• Important details: If body delivers but head is trapped, insert sterile-gloved hand and create a V-shaped airway; rapid transport.

• Recognizable features: Buttocks/feet visible first instead of the head.

Prolapsed Umbilical Cord

• Definition: Umbilical cord enters the birth canal before the fetus and becomes compressed.

• Important details: Position mother; sterile-gloved hand lifts baby's head/presenting part off cord; maintain until hospital; high-flow O₂.

• Recognizable features: Umbilical cord visible before baby.

Nuchal Cord

• Definition: Umbilical cord wrapped around the baby's neck.

• Important details: Attempt to release/slip cord; speed delivery.

• Recognizable features: Cord seen around neck after head delivers.

Limb Presentation

• Definition: An arm or leg presents first through the birth canal.

• Important details: Do not pull limb or push it back in; oxygen; pelvis elevated/head-down positioning; rapid transport.

• Recognizable features: Single arm or leg appears first.

APGAR Score

• Definition: Assessment of newborn condition after birth.

• Important details: Appearance, Pulse, Grimace, Activity, Respirations; each scored 0–2; maximum = 10.

• Recognizable features: Question gives newborn color, HR, response to stimulation, movement, and breathing/crying.

Neonatal Resuscitation — HR <100

• Definition: Newborn with inadequate heart rate requiring ventilatory assistance.

• Important details: Ventilate with BVM on room air at 40–60/min; reassess after 60 seconds.

• Recognizable features: Newborn HR 60–99 and/or inadequate breathing → BVM.

Neonatal Resuscitation — HR <60

• Definition: Severe neonatal bradycardia requiring CPR.

• Important details: Begin compressions + ventilations; 3:1 compression-to-ventilation ratio.

• Recognizable features: Newborn HR below 60 = CPR.

Pediatric Assessment Triangle — PAT

• Definition: Rapid visual pediatric assessment used to determine sick vs not sick.

• Important details: Can be performed from doorway in about 30 seconds.

• Recognizable features: Appearance + Work of Breathing + Circulation to Skin.

Appearance

• Definition: PAT component evaluating neurologic/general condition.

• Important details: Assess tone, interactiveness, consolability, look/gaze, speech/cry.

• Recognizable features: Limp, poorly interactive, inconsolable, abnormal gaze, weak/absent cry = concerning.

Work of Breathing

• Definition: Evaluating how hard a child is working to breathe in assessment

• Important details: Increased work indicates respiratory compromise.

• Recognizable features: Grunting, retractions, accessory muscles, head bobbing, nasal flaring.

Circulation to Skin

• Definition: Evaluating perfusion in child assessment

• Important details: Look at skin color and moisture.

• Recognizable features: Pallor, cyanosis, mottling, abnormal skin appearance.

Compensated Pediatric Shock

• Definition: Child is maintaining blood pressure despite inadequate perfusion.

• Important details: Children compensate well and may appear relatively stable before suddenly worsening.

• Recognizable features: Awake + tachycardia + tachypnea + pale/cool skin.

Decompensated Pediatric Shock

• Definition: Child can no longer compensate for inadequate perfusion.

• Important details: Hypotension is a late and dangerous finding.

• Recognizable features: Worsening mental status + falling BP + falling HR + cyanosis.

Pediatric Hypotension Formula

• Definition: Formula used to estimate minimum expected systolic BP in children.

• Important details: 70 + (2 × age).

• Recognizable features: Systolic BP below calculated value suggests shock.

Pediatric Respiratory Distress

• Definition: Child is struggling to breathe but is still compensating.

• Important details: Treat before they progress to respiratory failure.

• Recognizable features: Nasal flaring, grunting, retractions, accessory muscles, tripod position.

Pediatric Respiratory Failure

• Definition: Child can no longer maintain adequate ventilation/oxygenation.

• Important details: Requires aggressive airway/ventilatory support.

• Recognizable features: Lethargy, behavior change, bradycardia, cyanosis, worsening/ineffective respirations.

GEMS Diamond

• Definition: Framework for evaluating geriatric patients.

• Important details: Geriatric patient, Environmental assessment, Medical assessment, Social assessment.

• Recognizable features: Older patient where baseline, home environment, medical problems, and support system all matter.

Orthostatic Hypotension

• Definition: Drop in BP when changing to an upright/standing position.

• Important details: Common in older adults and increases fall risk.

• Recognizable features: Older patient becomes dizzy/lightheaded after standing; BP may fall about 20 points.

Dementia

• Definition: Chronic, progressive decline in cognitive function.

• Important details: Often related to Alzheimer's; affects short- and long-term memory.

• Recognizable features: GRADUAL onset, memory problems, decreased attention span.

Delirium

• Definition: Acute change in mental status caused by an underlying problem.

• Important details: Can be caused by sepsis, dehydration, etc.; often reversible.

• Recognizable features: SUDDEN mental-status change.

Polypharmacy

• Definition: Use of multiple prescription medications by one patient.

• Important details: Raises risk of overdose, medication interactions, and medication errors.

• Recognizable features: Geriatric patient taking many medications with new/unexplained symptoms.

Child Abuse

• Definition: Improper or excessive action that injures or harms a child.

• Important details: May be physical, sexual, emotional, or involve neglect.

• Recognizable features: Injuries inconsistent with story, unexplained/repeated injuries, concerning caregiver interactions.

Neglect

• Definition: Failure/refusal of caregiver to provide life's necessities.

• Important details: Includes food, shelter, hygiene, medicine, comfort, and safety.

• Recognizable features: Poor hygiene, malnutrition, unsafe environment, untreated medical needs.

Autism Spectrum Disorder

• Definition: Developmental condition associated with differences in communication, behavior, and sensory processing.

• Important details: Limit stimulation; involve patient/family; describe procedures before performing them.

• Recognizable features: Increased sensitivity to noise/touch; unusual response to pain, heat, or cold; tape/bandages may trigger anxiety.

Down Syndrome

• Definition: Genetic condition also known as Trisomy 21.

• Important details: Assume competence; engage patient directly; ask one question at a time; allow processing time.

• Recognizable features: Known history of Down syndrome/Trisomy 21.

Visual Impairment

• Definition: Partial or complete loss of vision.

• Important details: Introduce yourself; explain actions; bring cane/walker/service animal when possible; ask before leading.

• Recognizable features: Cane, visual aids, glasses, service animal.

Hearing Impairment

• Definition: Partial or complete difficulty hearing.

• Important details: Find hearing aids; written communication if needed; do not shout; speak slowly and lower pitch; ASL may be preferred.

• Recognizable features: Hearing aids, difficulty responding to spoken questions, reliance on lip reading/sign language.

Bariatric Patient

• Definition: Patient with obesity who may require special transport considerations.

• Important details: Bring enough personnel/resources and correct equipment.

• Recognizable features: Patient size makes assessment, lifting, moving, or transport difficult.

Tracheostomy Patient

• Definition: Patient breathing through a surgically created opening in the neck/trachea.

• Important details: Airway is priority; assess tube patency, secretions, and breathing; remember D-O-P-E from your grid.

• Recognizable features: Tracheostomy tube/opening in neck + difficulty breathing, secretions, or device problem.

LVAD

• Definition: Device that mechanically assists circulation.

• Important details: Continuous flow; patients may not have a palpable pulse.

• Recognizable features: Battery/vest/device + apparently no pulse despite patient being conscious/perfused.