Chapter 34 Obstetrics and Neonatal Care (EMT B)

Where does the fertilized egg implant?

In the lining of the inside of the uterus (endometrium)

• If the egg is not fertilized within 36 to 48 hours it has been released, it will die, and the lining is shed as menstrual flow

What does the placenta do?

Provides nourishment to the fetus

• Umbilical cord connects the woman and fetus through the placenta

Nuchal Cord

The umbilical cord gets wrapped around the baby’s neck

→ Use two fingers and go under cord to get it off the neck

→ Cut the cord, but make sure It is clamped or else blood will flow

Prolapsed Cord

Cord sticking out of vagina before the child is out, during contraction

→Get moist dressing and apply to the cord to keep It wet

Breech Delivery

When mom is pushing, you see butt cheeks or a foot

→You may have to slide your hand in and lift baby’s head off vaginal wall

→You do NOT want the women to push during this time

→positions: Supine with legs and hips lifted, or on all fours

Placenta Previa

Painless bright red bleeding

• Placenta develops over and covers the cervix

Abruptio Placentae

Placenta separates prematurely from uterine wall

• Often fatal for both female fetus

• Caused by hypertension and trauma

Signs/Symptoms

• Severe pain

• Dark red bleeding

• Rapid pule

• Signs of shock

Tubal/etopic pregnancy

Sperm and egg implant in fallopian tube

• Fallopian tube can rupture after fertilized egg starts growing

• Can result in inter-abdominal hemorrhage

• A load and go

Spontaneous Abortion

Loss of pregnancy prior to 20 weeks gestation

What do we check for when delivering a baby?

pink, warm, and sweet

Eclampsia

Pregnant mother now is having a seizure

→Blood pressure is 140 over 90

Gestational Diabetes

Develops during pregnancy then goes away after the baby was born

• Happens because hormones from the placenta can make It harder for insulin to work properly

• Happens in pregnant women who have not have diabetes before

• Treatment is the same as for any other patient with diabetes

Internal bleeding can be a sign of what?

Etopic pregnancy

• Sudden onset of severe abdominal pain and vaginal bleeding in the first trimester of pregnancy should be considered atopic

  →Also consider possibility if they have missed a menstrual cycle and complains of sudden, severe, usually unilateral pain in the lower abdomen

Hemorrhage from the vagina before labor may be signs of what?

• In early pregnancy, it may be a sign of a spontaneous abortion

• In later stages of pregnancy, vaginal hemorrhage may include

→Abruptio placenta: Placenta separates prematurely from the wall of the uterus, commonly caused by hypertension or trauma

→ Placenta Previa: Placenta develops over and covers the cervix

Abuse during pregnancy increases what?

• Spontaneous abortion

• Premature delivery: (when a baby is born too early; anything earlier than 37 weeks is considered premature)

• Low birth weight

Effects addiction has on the fetus include?

• Prematurity

• Low birth weight

• Severe respirator distress

• Death

Management of a trauma pregnant patient

• Maintain an open airway

• Administer high-flow oxygen

• Ensure adequate ventilation

• Assess circulation

• Transport

→Transport patient on her left side

Three stages of labor

The first stage: onset of contractions and ends when the cervix is fully dilated

→ Starts with contractions of the uterus or rupture of the amniotic sac

The second stage: Fetus begins to encounter the birth canal and ends with delivery of the new born

The third stage: Birth of the newborn and ends with the delivery of the placenta

When helping deliver a baby what should you do

• Patient’s clothing should be removed or pushed up to her waist

• Preserve the patient’s privacy as much as possible

• Place on a firm surface that is padded with blankets, folded sheets, or towels

• Elevate hips 2 to 4 inches with a pillow or blankets

• Support head, neck, and upper back with pillows and blankets

• Have her keep her legs and hips flexed, with her feet flat on the surface beneath her and her knees spread apart

Apgar Score

Standard scoring system used to asses the stats of a newborn

1. Highest Apgar score is 10, calculate the score at 1 minute and 5 minutes after birth

2. Assigns a number value of (0,1, or 2) to five areas of activity

• Appearance

• Pulse

• Grimace or irritability

• Activity or muscle tone

• Respirations

Vertex presentation

Infants that are born head first

Breech presentation

Buttocks are delivered first

• Fetus is at great risk for trauma from the delivery

• Prolapsed cords are more common in a breech delivery (must be treated at the hospital)

Can an infant with a limb presentation be delivered in the field? (single arm, leg, or foot)

No, must be transported to the hospital ASAP

• If a limb is protruding cover it with a sterile towel

• Never try to push it back in, and never pull on it

• Place the patient on her back, with her head down and pelvis elevated

Spina Bifida

Development defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly outside of tour body

Premature birth

Any newborn who delivered before 8 months (36 weeks) or weighs less than 6lb at birth

Posttem pregnancy

Postterm pregnancy refers to pregnancies lasting longer than 41 weeks of completed gestation

• Can be larger than a typical 40-week fetus, sometimes weighing 10 lb or more

Birth Canal

The vagina and cervix

Crowning

The appearance of the fetus’s head at the vaginal opening during labor

Spina bifida

When the developing in the womb, and the spinal cord and backbone don’t form properly leaving a gap in the spine

→ Can lead to nerve damage

Supine Hypotension Syndrome

Low blood pressure resulting from compression of the inferior vena cava by the weight of the pregnant uterus when the woman is supine

Term Gestation

Pregnancy that has reached full term

→Between 39 weeks and 40 weeks, 6 days

Preeclampsia

Body is reacting badly to pregnancy, especially the placenta and affects the mothers blood pressure

• Differentiated from eclampsia by the lack of seizure activity

→Blood pressure is 140 over 90 Hypertension

Signs/Symptoms

• Severe or persistence headache

• Blurred vision or sensitivity to light

• Edema

• Upper abdominal or epigastric pain

• Dypnea and/ or restrosternl pain

• Anxiety

• Altered mental Status

Amniotic Sac

Fluid filled, bag like membrane

• The sac contains 500 to 1,000 mL amniotic fluid

  → The sac ruptures usually at the beginning of labor( “my water broke”)

• This fluid helps insulate and protect the fetus