EMT Chapter 34 Obstetrics and Neonatal Care

abruptio placentae

premature separation of the placenta from the uterine wall; dark red blood and painful

Amniotic sac

the fluid-filled sac that contains and protects a fetus in the womb. It is where the fetus develops

Anemic

Describes a condition in which the patient has too few red blood cells, resulting in a decreased ability to transport oxygen throughout the body via the bloodstream.

Apgar score

a scale of 1-10 to evaluate a newborn infant's physical status at 1 and 5 minutes after birth

Birth canal

vagina and cervix; Area between the cervix and the vagina that the baby passes through during delivery

Bloody show

A small amount of blood at the vagina that appears at the beginning of labor and may include a plug of pink-tinged mucus that is discharged when the cervix begins to dilate.

Breech presentation

A delivery in which the buttocks come out first

Cervix

The lower third, or neck, of the uterus; Opening at the neck of the uterus, must dilate to 10 cm during labor for delivery

Crowning

The appearance of the infant's head at the vaginal opening during labor.

Eclampsia

A pregnancy complication that is characterized by new onset hypertension (systolic blood pressure>140mmhg or diastolic pressure >90mmhg) with seizure activity and preceding systemic effects, such as blurred vision,headache, or protein in the urine; true emergency and baby may die if a seizure occurs

Ectopic pregnancy

A pregnancy outside of the uterus , usually in a Fallopian tube, not viable

Embryo

early stages of development after fertilization of an egg (1st 8 weeks)

Endometrium

inner lining of the uterus

Fetal alcohol syndrome

A condition caused by the consumption of alcohol by a pregnant woman; characterized by growth and physical problems, mental retardation, and a variety of congenital abnormalities.

Fetus

The developing, unborn infant inside the uterus, from 9 weeks after fertilization until birth.

Fundus

The dome-shaped top of the uterus.

gestational diabetes

Diabetes that develops during pregnancy in women who did not have diabetes before pregnancy.

Gestational hypertension

A blood pressure greater than or equal to 140 mmhg systolic or 90 mmhg diastolic in a pregnant female in whom hypertension has emit previously been diagnosed

Induced abortion

the elective termination of a pregnancy prior to the time of viability

lightening

The movement of the fetus down into the pelvis late in pregnancy.

Limb presentation

A delivery in which the presenting part is a single arm or leg.

Meconium

Fetal stool. When appearing as dark green material in the amniotic fluid, it can indicate distress or disease in the newborn; it can be aspirated into the fetus's lungs during delivery

Menarche

The first mentrial cycle or onset of the first menstrual bleeding in females

Menopause

cessation of menstruation,typically in the fourth or fifth decade of life

Miscarriage

The spontaneous passage of the fetus and placenta before 20 weeks; also called spontaneous abortion.

Multigravida

woman who has been pregnant more than once

Nuchal cord

An umbilical cord that is wrapped around the fetus's neck.

Perineum

area of skin between vagina and anus

Placenta

The tissue attached to the uterine wall that nourishes the fetus through the umbilical cord.

placenta previa

A condition in which the placenta develops over and covers the cervix; painless and bright red blood

Preeclampsia

A pregnancy condition that is characterized by new onset hypertension (systolic>140 mmhg, diastolic>90mmhg) along with systemic effects,such as blurred vision,headache, or protein in the urine. Differentiated from eclampsia but the lack of seizure activity; after the 20th week

Presentation

The position in which an infant is born; defined by the part of the body that appears first.

primigravida

a woman who is pregnant for the first time

Prolapse of the umbilical cord

A situation in which the umbilical cord comes out of the vagina before the fetus.

Spina bifida

A development defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly even outside of the body, usually at the lower third of the spine in the lumbar area.

spontaneous abortion

The loss of a pregnancy prior to 20 weeks of gestation without any preceding surgical or medical intervention. Often called a miscarriage

supine hypotensive syndrome

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

Term gestation

A pregnancy that has reached full term, between 39 weeks and 40 weeks, 6 days (9 months)

Umbilical cord

The structure that connects the fetus to the placenta. It contains vessels that carry blood between the mother and the fetus. Contains two artistries and one vein

vernix caseosa

A white, cheesy substance that covers the body of the fetus.

Vertex presentation

A delivery in which the head of the newborn comes out first.

Female reproductive system includes

Ovaries, Fallopian tubes, Uterus, Cervix, Vagina, Breasts

The ovaries are two glands, one on each side of the

uterus

The fallopian tubes extend out laterally from the uterus, with one tube associated with

each ovary

The uterus is a muscular organ that encloses and protects the fetus as it grows for

40 weeks

The _ is made up of the vagina and the lower third of the uterus, called the cervix

birth canal

The _ is the outermost cavity of the female reproductive system and forms the lower part of the birth canal

vagina

Anything ingested by a pregnant woman has the potential to affect the fetus

Nutrients, Oxygen, Waste, Carbon dioxide, Many toxins, medications, Alcohol & Drugs

The __ is the lifeline of the fetus

umbilical cord

The umbilical cord contains __ arteries and __ vein

2;1 (AVA)

The umbilical _ carries oxygenated blood from the placenta to the fetus

vein

The umbilical carry deoxygenated blood from the fetus to the placenta

arteries

The fetus develops inside a fluid-filled, baglike membrane called the

amniotic sac

Trimester

90 days, 3 during pregnancy

Due Date

Estimated from the first day of their LMP

Premature Birth

before 36 weeks

Gravida

of times the female has been pregnant, regardless if baby was lost, includes this pregnancy

Para

of live births, twins only count as one birth

Primapara

woman that has only one live birth

Multipara

more than one live birth

Many normal changes occur in the body that are not all directly related to the

reproductive system

Normal Changes in Pregnancy

Hormone levels increase, Rapid uterine growth occurs during the second trimester, In the third trimester, there is an increased risk of vomiting and potential aspiration following trauma, Blood volume gradually increases

Blood volume gradually increases to

Allow for adequate perfusion of the uterus, Prepare for the blood loss during childbirth

Blood volume gradually increases along with

Number of red blood cells increases, Speed of clotting increases, Patient’s heart rate increases up to 20%

To treat seizures caused by eclampsia

Lie the patient on her left side

Hemorrhage

Vaginal bleeding that occurs before labor begins

Four main causes of Hemorrhage

Spontaneous abortion/Miscarriage, Ectopic pregnancy, Abruptio placenta, Placenta previa

Effects of addiction on the fetus include

Prematurity, Low birth weight, Severe respiratory distress, Death

Pregnant women have an increased amount of overall total blood volume and a _ increase in heart rate

20%

When a pregnant woman is involved in a motor vehicle crash, severe hemorrhage may occur from injuries to the

uterus

Improper positioning of the _ can result in injury to a pregnant woman and the fetus

seat belt

If delivery is _, check for crowning, and prepare to deliver at the scene

imminent

If delivery is __, prepare the patient for transport

not imminent

Stages of Labor

Dilation of the cervix, Delivery of the fetus, Delivery of the placenta

First Stage of labor

Begins with the onset of contractions; Ends when the cervix is fully dilated (check for crowning)

Labor is generally longer in a ___ than in a multigravida

primigravida (first pregnancy)

Some women experience a __ of the amniotic sac

premature rupture (PROM)

The __ descends into the woman’s pelvis as it positions for delivery in the first stage

head of the fetus

Second Stage of labor

Begins with when the fetus begins to encounter the birth canal; Ends when the newborn is born

Third Stage of labor

Begins with the birth of the newborn and ends with the delivery of the placenta (may take up to 30 min)

If the patient says that she is about to deliver, she has to ___, you should prepare for delivery

move her bowels, or feels the need to push

Once labor has begun, it cannot be

slowed or stopped

Preparing for Delivery - Patient position

Elevate the hips about 2 to 4 inches; Have her keep her legs and hips flexed, with her feet flat and her knees spread apart

If the baby is crowning and mother feels the urge to push, encourage her to do so

during contractions

Duration

Time from the beginning of a contraction until it ends

Interval/Time between

From the beginning of one contraction until the beginning of the next

Delivering the head

Apply gentle pressure across the perineum with a sterile gauze pad to reduce the risk of perineal tearing; Support the head with your gloved hand as it rotates

Suction the newborn’s _ immediately

mouth then nose with a bulb suction

Guide the head down so the upper shoulder can deliver and then

Guide the baby up to help bottom shoulder deliver

Once the cord __, as long as the baby is doing well, clamp and cut the cord

stops pulsating

A Appearance

central and peripheral skin color

P Pulse

rate

G Grimace/Irritability

strong cry, reacts to stimulus

A Activity

muscle tone

R Respirations

rate

If there is significant vaginal bleeding (500ml+)

Massage the uterus with a firm, circular, “kneading” motion over the fundus

During the “golden minute”, perform the initial steps of newborn care

Airway positioning and suctioning, if needed; Drying; Warming; Tactile stimulation

Normally the newborn will begin breathing within ____ seconds after birth, and the heart rate will be _____ beats/min or higher

30; 100

Neonatal Resuscitation Triangle

Tactile Stimulation, Blow-By Oxygen, Ventilate, Chest Compressions, Drugs (Top to bottom)

Chest Compressions if HR

<60 despite adequate O2 for 30 seconds