ch 34: obstetrics and neonatal care

uterus

muscular organ that protects the fetus

consists of the vagina and the cervix (the lower third of the uterus).

Physiological changes during pregnancy

• blood volume and heart rate (up to 20%) increase.

• increasing the risk of aspiration

• increasing risk of injury during trauma

• Joints become less stable

• increasing fall risk

Preeclampsia

Pregnancy-induced hypertension

Placenta

Attaches to the uterine wall and acts as the lifeline, exchanging oxygen,nutrients, and waste between mother and fetus

Umbilical Cord

Contains one vein (oxygenated blood to fetus) and two arteries
(deoxygenated blood to placenta)

Amniotic Sac

A fluid-filled membrane (containing 500–1,000 mL of fluid) that insulates and protects the fetus

at what point does preeclampsia present

after 20 weeks

symptoms of preeclampsia

• severe headache

• visual abnormalities

• swelling of hands/feet

• anxiety

eclampsia

seizures resulting from hypertension(preeclampsia)

Management for eclampsia

• Lay the patient on her left side

• maintain the airway

• suction if needed

• provide oxygen

• transport rapidly.

Supine hypotensive syndrome

Compression of the vena cava by the uterus when the patient lies supine.

Ectopic Pregnancy

Embryo implants outside the uterus (usually in a fallopian tube)

Signs of ectopic pregnancy

sudden, severe lower abdominal pain and vaginal bleeding during the first trimester

Abruptio Placenta

The placenta separates prematurely from the uterine wall

Placenta Previa

The placenta develops over and covers the cervix

Gestational hypertension

• systolic bp over 140mm Hg

• diastolic pressure higher than 90 mm Hg

severe gestational hypertension

• systolic >160 mm Hg

• diastolic > 110 mm Hg

Cause of abruptio placenta and placenta previa

hemorrhage from the vagina before labor

scene ppe

• gloves eye and face protection(minimum)

• gowns

Sample history questions

• Due date

• frequency of contractions

• history of previous pregnancies and deliveries

• possibility of multiples

• if taken any drugs or medication

• if received prenatal care

• aware of any complications

Stages of labor

1. dilation of cervix

2. delivery of fetus

3. delivery of placenta

first stage

Begins with onset of contractions and ends when the cervix is fully dilated (marked by crowning in the field).

Contraction characteristics

• become more regular and last about 30-60 sec each

• frequency and intensity increases

• pain starts in lower back and wraps around to lower abdomen

• physical activity increases intensity of contractions

• amniotic sac breaks

Lightening

descent of head of fetus into woman’s pelvis as it positions for delivery

Characteristics of Braxton hicks contractions

• no regular contractions

• pain start and stays in lower abdomen

• alleviate pain via physical activity

• brownish blood

Second Stage:

Begins when the fetus enters the birth canal and ends with the birth of the newborn.

Third Stage:

Begins after the birth of the newborn and ends with the delivery of the placenta (usually within 30 minutes).

When prepare to deliver at scene

If delivery is imminent (contractions are close together, patient feels the urge to push, or crowning is visible),

Scene preparation

• Place the patient on a firm surface, elevating the hips 2–4 inches.

  • keep legs and hips flexed with knees spread apart

• Create a sterile field using the OB kit.

Head Delivery

• Support the head as it rotates

• apply gentle pressure to the perineum to prevent tearing

Nuchal Cord

• Check for the umbilical cord around the neck immediately upon head delivery

• Make one attempt to slip it over the head

• If unsuccessful, clamp and cut it

Body Delivery

Support the head and body as they deliver the newborn will be slippery

unruptured amniotic sac

• puncture sac with clamp or tear it by twisting it between your fingers

  • will suffocate fetus if not removed

• clear newborn’s mouth and nose immediately

Post-Delivery

• If stable, place the newborn on the mother's abdomen for skin-to-skin contact

• clamp and cut umbilical cord after approximately 60 seconds

Bleeding control after birth

• Massage the mother's uterus (firm, circular motion) to help control bleeding

Emergency situations

• more than 30 minutes elapse and placenta not delivered

• more than 500mL of bleeding before delivery of the placenta

• significant bleeding after delivery of placenta

Golden Minute

first minute after birth where initial stabilization occurs

Initial steps

● Dry, warm, airway positioning, tactical simulation and suction (if needed) the newborn.

Normal breathing and circulation

• begin breathing 30 sec after birth

• heart rate is 100 beats/min or higher

If the newborn is not breathing or has a heart rate <100 beats/min

provide positive pressure ventilation

If the heart rate is <60 beats/min despite ventilation

begin chest compressions using the hand-encircling technique (3:1 ratio of compressions to ventilations).

APGAR stands for

appearance, pulse, grimace, activity, respiration

What do for apgar

Calculated at 1 and 5 minutes post-birth. A perfect score is 10.

Appearance

2 Points: Pink

1 Point: Body pink , extremities blue

0 Points: blue/pale

Pulse

2 Points: >100 bpm

1 Point: <100 bpm

0 Points: Absent

Grimace

2 Points: Sneeze/cough/cry

1 Point: Weak cry

0 Points: No reaction

activity

2 Points: Active movement

1 Point: Flexed arms/legs

0 Points: Limp

respiration

2 Points: Strong cry

1 Point: Slow/irregular

0 Points: Absent

Breech Presentation

Buttocks first

Steps with breech

Generally slower support the body and allow the head to deliver spontaneously. Create an airway for the infant by inserting two fingers into the vagina to prevent wall compression

Who to contact during breech

call als and consult medical control

Limb Presentation

Arm/Leg first

Steps with limb presentation

Life-threatening. Never deliver in the field. Cover
the limb with a sterile towel, place the mother in a knee-chest position, and transport immediately for surgery

Prolapsed Cord

If the cord presents first

Steps with prolapsed cord

the fetus’s head compresses it. Do not push
the cord back. Insert a gloved hand to push the fetus’s head away from the cord and transport immediately in a knee-chest position

Spina bifida

Developmental defect in which portion of spinal cord or meninges may protrude outside of the vertebrae

Steps when spina bifida

• cover open area of spinal cord with sterile, moist dressing

• maintenance of body temperature is important when apply moist dressing

What is classified as premature

baby delivers before 8 months(36 weeks) or weighs< 5lb

Characteristics of premature baby

• smaller and thinner

• head is proportionately larger

• less body hair

• vernix caseosa absent(white coating on baby)

Characteristics of post term pregnancy

• longer than 41 weeks

• fetus larger, > 10lb

Issues with post terms pregnancies

• increased chance of injury to fetus

• increased liklihood of c section

• risk of perineal tears and infection

• risk of meconium aspirations, infection and still born

Postpartum patients are increased risk of a

pulmonary embolism

What happens right after ovulation

the inner lining of the uterus thickens in preparation for implantation

Precipitous labor is the

expulsion of a fetus within three hours of the start of regular contractions.

Precipitous labor and delivery is common in women who

have delivered a baby before

Why does bleeding stop after massage uterine funds and mother breastfeeds

the production of oxytocin caused uterine contraction