Obstetrics + normal delivery + prolapsed cord + breech + shoulder dystocia + postpartum hemorrhage + pre-eclampsia/eclampsia + newborn care.

Normal labour and delivery

The expected physiological process of childbirth.

Pregnancy assessment

Evaluation of the pregnant patient's condition including history and physical exam.

Obstetrical complications

Issues that may arise during pregnancy or delivery, such as pre-eclampsia or placenta previa.

Postpartum care

Care provided to the mother following childbirth.

Newborn care

Management and assessment of the newborn following delivery.

BLS and ALS PCS management

Basic and advanced life support protocols for prenatal and perinatal emergencies.

Three stages of labour

The dilation stage, the expulsion stage, and the placental stage.

Contraction types

Braxton Hicks contractions, false labour, and true labour.

Labour information assessment

Timing, intensity and duration of contractions, pregnancy history, and more.

Gravida

Refers to the number of pregnancies a woman has had.

Para

Refers to the number of times a woman has delivered after 20 weeks of gestation.

Indications of imminent birth

Signs such as strong frequent contractions and crowning.

Crowning

The point in which the baby's head becomes visible at the vaginal opening.

Estimating due date formula

Last normal menstrual period minus 3 months plus 7 days.

Uterine height at 20 weeks

The uterus is roughly at the level of the umbilicus.

Uterine height at 36 weeks

The uterus is at the costal margins.

Transport position for pregnant patient

Left lateral position.

Spinal board positioning for pregnant patient

Tilt approximately 30 degrees to the left.

Maternal assessment priority in emergencies

Focus on the mother's condition while considering fetal health.

Serious pregnancy complications

Identify issues like pre-eclampsia, ectopic pregnancy, and placental abruption.

Additional obstetrical complications

Include antepartum bleeding, shoulder dystocia, and postpartum hemorrhage.

Pre-eclampsia suspicion criteria

BP 140/90 mmHg or greater in patients beyond 20 weeks gestation.

Severe pre-eclampsia blood pressure

Diastolic blood pressure 110 mmHg or greater.

Accompanying findings of pre-eclampsia

Symptoms may include headache, generalized edema, and visual disturbances.

Eclampsia

Severe complication of pre-eclampsia characterized by seizures.

Key patient history for pregnant patients

Due date, complications, vaginal discharge, and previous pregnancy history.

General ALS approach to delivery

Position appropriately and follow Emergency Childbirth Medical Directive.

Failure to progress in labour

Encourage patient to refrain from pushing if delivery is not progressing.

Transport considerations after assessment

Consider transport if no progress after 10 minutes and based on findings.

Management for limb presentation

Cover limb, discourage pushing, and initiate transport.

Nuchal cord

Umbilical cord wrapped around the baby’s neck.

Loose nuchal cord management

Slip the cord over the baby's head.

Tight nuchal cord management

Clamp and cut the cord if it cannot be moved.

Immediate umbilical cord cutting condition

If maternal or neonatal resuscitation is required.

Normal timing for umbilical cord clamping

Clamp and cut once cord pulsations have ceased, usually after 2-3 minutes.

Prolapsed umbilical cord

Emergency where the cord descends and is compressed by the fetal part.

Major danger of prolapsed cord

Compromised fetal circulation due to cord compression.

Goal in treating prolapsed cord

Relieve pressure on the umbilical cord.

Positions for prolapsed cord

Knee-chest position or exaggerated Sims position.

Manual intervention for prolapsed cord

Apply digital pressure to lift the presenting part off the cord.

Duration for manual pressure maintenance

Until transfer of care at the hospital.

Preferred transport position for prolapsed cord

Exaggerated Sims position.

Effective position during strong contractions for prolapsed cord

Knee-chest position.

Exaggerated Sims position description

Left lateral position with right knee towards chest, pelvis elevated.

Basic rule for breech delivery

HANDS OFF the breech as much as possible.

Breech neonate delivery process

Allow descent to umbilicus, release legs or arms if necessary.

Mauriceau-Smellie-Veit manoeuvre timing

When hairline is visible or after 3 minutes of umbilicus visibility.

Time to deliver breech head after umbilicus visibility

4 minutes.

Action if breech head does not deliver in time

Initiate MSV manoeuvre and transport if unsuccessful.

Finger placement during MSV manoeuvre

On the malar bones or cheekbones.

Purpose of MSV manoeuvre

Assist in controlled delivery of the breech head.

Shoulder dystocia definition

Delivery complication where shoulders do not deliver normally.

Clue indicating shoulder dystocia

Head delivers, but body or shoulders fail to follow.

ALARM frequency on scene

Performed twice under the PCP Directive.

Transport consideration after unsuccessful ALARM

Transport to the closest appropriate facility.

A in ALARM

Ask for assistance.

L in ALARM

Legs abduction using McRoberts manoeuvre.

Second A in ALARM

Adduct the shoulder using suprapubic pressure.

R in ALARM

Roll over using the Gaskin manoeuvre.

M in ALARM

Manually release the posterior arm.

McRoberts manoeuvre description

Hyperflex the patient's hips by bringing knees towards chest.

Pressure application in suprapubic step of ALARM

Over the suprapubic area.

Position for Gaskin manoeuvre

Hands-and-knees position.

Final ALARM intervention

Manual release of posterior arm.

Time from delivery of head to completion of shoulder dystocia delivery

8 minutes.

Post-shoulder dystocia delivery actions

Assess and monitor mother and newborn for complications.

Postpartum hemorrhage definition

Excessive bleeding occurring after delivery.

Action for excessive postpartum bleeding post-placenta delivery

Perform external uterine massage.

Can external uterine massage be done pre-placenta delivery?

No, it is contraindicated.

Duration for external uterine massage

Continue until bleeding stops.

Vagina packing for postpartum hemorrhage

No, it should not be done.

Alternative for uncontrolled postpartum hemorrhage

Consider external bimanual compression.

Use of external bimanual compression if placenta not delivered

Yes, it can be used.

External bimanual compression method

Compress uterus between hands, one on fundus, one supporting lower uterus.

Medications allowed post-delivery for postpartum management

Oxytocin.

PCP dose for oxytocin

10 units IM.

Number of oxytocin doses to administer

One.

Systolic blood pressure condition for oxytocin

SBP must be less than 160 mmHg.

Consideration for oxytocin use

After delivery, if directive conditions are met.

Contraindications for oxytocin

Allergy to oxytocin, undelivered fetus, or known pre-eclampsia.

Post-delivery handling of placenta

Inspect for wholeness and transport it with the patient.

Placenta delivery impact on transport

No, it should not delay transport.

Newborn care goal post-birth

Facilitate transition from uterus to external environment.

Priority for newborn survival

Establish adequate lung inflation and ventilation.

Initial interventions for all newborns

Drying, positioning, stimulation, and hypothermia prevention.

Newborn Resuscitation Medical Directive age group

Newborns less than 24 hours old.

Indication for positive pressure ventilation in newborn

Heart rate below 100 bpm for newborns less than 24 hours old.

Indication for CPR in newborn resuscitation

Heart rate below 60 bpm after 30 seconds of ventilation.

Assessment during newborn stimulation

Respirations and heart rate.

Importance of hypothermia prevention in newborn resuscitation

Specifically identified as critical.

Priority for resuscitative support in newborns

Inflate and ventilate lungs as needed.

Preferred method for checking newborn heart rate

Cardiac monitoring.

Alternative heart rate assessment methods if delayed

Auscultation, brachial pulse palpation, or SpO2 probe.

Location for newborn SpO2 probe placement

On the right hand for pre-ductal readings.

Routine suctioning requirement for newborns

No, it is not required for every newborn.

Meconium presence suctioning requirement

Only consider if newborn has poor muscle tone or is not breathing.

Order of suctioning if needed in newborn

Suction mouth and pharynx before nose.

Troubleshooting mnemonic for ineffective newborn ventilations

MR SOPA.

MR SOPA meaning

Mask seal, Reposition airway, Suction mouth and nose, Open mouth, Positive pressure, Alternate airway.

Apgar assessment times in BLS PCS

One minute and five minutes after delivery.