WestCoast EMT Chapter 34 Flashcards

Placenta

A disk-shaped structure attached to the uterine wall that provides nourishment to the fetus.

Umbilical Cord

Connects the woman and fetus through the placenta. The umbilical vein carries oxygenated blood while the arteries carry deoxygenated blood.

Normal Changes in Pregnancy

Rapid uterine growth occurs during the second trimester. Pushes up on diaphragm, causes the moms respiratory rate to increase and become more shallow.

Hormone levels increase to support fetal development. Increased risk of vomiting and potential aspiration. Heart workload increases.

Preeclampsia (Pregnancy-Induced Hypertension)

Can occur at 20 weeks of gestation. S/S: Hypertension, edema, headache.

Eclampsia

Seizures that occur as a result of hypertension. Lie patient on left side, maintain airway, oxygen if needed.

Ectopic Pregnancy

Internal bleeding may be a sign of an ectopic pregnancy, when an embryo develops outside the uterus, most often in a fallopian tube.

Leading cause of death first trimester:

Internal hemorrhage into the abdomen following rupture of an ectopic pregnancy. Consider missed menstrual cycle and unilateral pain.

In the later stages of pregnancy, vaginal hemorrhage may indicate:

Abruptio placenta or Placenta previa

Abruptio Placenta

Premature separation of an implanted placenta from the wall of the uterus. Most common in the 3rd trimester. Usually vaginal bleeding (but not all the time) and high pain. Treat for signs of shock, the abdomen usually is tender. Fetal heart sounds are often absent.

Placenta Previa

Will always see bleeding and is painless. Placenta is implanted low in the uterus and, as it grows, it partially or fully obscures the cervical canal. Usual bleeding in the second and third trimester.

Abortion

Passage of the fetus and placenta before 20 weeks is called abortion. Complications are bleeding and infection.

Substance Abuse

The effects of addiction on the fetus include: prematurity, respiratory distress, death. If a substance abused woman gives birth, the newborn will probably need immediate resuscitation.

Transport Decision

If delivery is imminent, prepare to deliver at the scene. The first thing you should do is check for crowning. If delivery is not imminent, prepare the patient for transport.

If her water has broken and the fluid was green (due to meconium-fetal stool):

Signs that the baby has aspiration issues.

False Labor

Contractions are not regular and do not increase in intensity, pain stays in the lower abdomen (does not “wrap around”).

First Stage of Labor

Begins with the onset of contractions and ends when the cervix is fully dilated (longest stage). Contractions are timed from the beginning of one to the beginning of the next.

Second Stage of Labor

Begins when the fetus begins to encounter the birth canal and ends with delivery of the newborn (spontaneous birth).

Third Stage of Labor

Begins with the birth of the newborn and ends with the delivery of the placenta. Placenta must separate from the uterine wall and may take 30 minutes (contractions should come back).

Prepare for delivery if:

The patient says she has to move her bowels. Look for crowning. Once labor has begun, it cannot be slowed or stopped.

Once the umbilical cord has…

stopped pulsing, clamp and cut the cord.

A newborn will usually begin breathing spontaneously within:

15 to 30 seconds after birth, and the heart rate will be 120 beats/min or higher. Many newborns require some form of stimulation that will encourage them to breathe air.

Resuscitation First Steps

Stimulate to breathe air (warming, suctioning, drying, tactile). If necessary, suction. If no breathing after 10 to 15 seconds of stimulation, begin resuscitation efforts.

Resuscitation Efforts

Pulse > 100bpm: Warm, transport, reassess.

60 to 100 bpm: BVM room air, reassess. If pulse/respiratory rate not normal, BVM with 100% oxygen. Consider ALS, reassess, warm.

Below 60 bpm: Begin BVM 100% oxygen. Reassess every 90 seconds. Begin chest compressions. Call ALS.

Newborn Resuscitation BVM Ventilation Ratio

Ventilation during a pause after every third compression, using a ratio of 3:1.

The APGAR Score

Used to assess the status of a newborn. Appearance, Pulse, Grimace/irritability, activity or muscle tone, respirations. Calculate the Apgar score at 1 minute and 5 minutes after birth.

Limb Presentation

Cannot be delivered in the field.

Premature vs. Postterm Birth

Before 36 weeks vs after 42 weeks. 37-42 is the normal range for pregnancy

Fetal Demise

May note a foul odor, blistering, and discoloration.

Postpartum patients are at an increased risk of…

a pulmonary embolism.

Gravida, Para, Abortus

Gravida- indicates the number of times the mother has been pregnant (live or miscarriage).

Para- number of live births (twins count as one).

Abortus- number of pregnancies lost (aborted or miscarriage).