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35 Cards in this Set
- Front
- Back
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What physiological changes come with pregnancy?
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=Reproductive system
-Uterus increases in size. -Vascular system. -Formation of mucous plug in cervix. -Estrogen causes vaginal mucosa to thicken. -Breast enlargement. =Respiratory system -Progesterone causes a decrease in airway resistance. -Increase in oxygen consumption. -Increase in tidal volume. -Slight increase in respiratory rate =Cardiovascular system -Cardiac output increases. -Blood volume increases. -Supine hypotension. =Gastrointestinal system -Hormone levels. -Peristalsis is slowed. =Urinary system -Urinary frequency is common. =Musculoskeletal system -Loosened pelvic joints. |
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What is abortion?
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-Termination of pregnancy before the 20th week of gestation.
-Different classifications. -Signs and symptoms include cramping, abdominal pain, backache, and vaginal bleeding. -Treat for shock. -Provide emotional support. |
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What is an ectopic pregnancy?
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-Assume that any female of
childbearing age with lower abdominal pain is experiencing an ectopic pregnancy. -Ectopic pregnancy is lifethreatening. -Transport the patient immediately. |
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What is Placenta Previa?
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-Abnormal implantation of placenta on the lower half or the uterus
-Painless vaginal bleeding (3 rd trimester) -Never attempt vaginal exam -Treat for shock -Rapid transport -Definitive management is delivery by c-section |
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What is Abruptio Placenta?
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-Premature separation of a normally implanted placenta
-Life threat for mother and fetus -Signs and symptoms vary -Classified as partial, severe, or complete -Treat for shock, fluid resuscitation -Transport left lateral recumbent position |
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What are some medical complications of pregnancy?
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-Hypertensive disorders
-Supine hypotensive syndrome -Gestational diabetes |
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What is Pre-eclampsia?
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-Most common hypertensive disorder
-Occurs in last 10 weeks of pregnancy -Thought to cause abnormal vasospasm -Hypertension -Peripheral edema -Proteins in urine May progress to eclampsia -Seizures |
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What is management of Pre-eclampsia?
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-Closely monitor mother and fetus
-Left lateral recumbent -Oxygen therapy -IV access -May have to manage seizures -Threat of hypoxia to fetus |
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What is Supine Hypotensive Syndrome?
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-Occurs in third trimester
-Gravid uterus compresses inferior vena cava -Left lateral recumbent or elevated right hip -Monitor maternal vital signs -Fluid resuscitation |
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What is Gestational Diabetes?
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-Hormonal influences and
increased tissue response -High risk for later development of diabetes -Consider hypoglycemia in patient with decreased LOC -Administer dextrose as indicated |
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What are Braxton-Hicks Contractions?
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-As early as 13 weeks
-Uterus begins intermittent contractions -May enhance placental blood flow -Painless irregular contractions -Do not cause cervical changes |
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What are Maternal Factors that can cause Preterm labour?
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-Cardiovascular disease
-Renal disease -Diabetes -Uterine and cervical abnormalities -Maternal infection -Trauma -Contributory factors |
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What are Placental factors that can cause Preterm labour?
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-Placenta previa
-Abruptio placenta |
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What are Fetal factors that can cause Preterm labour?
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-Multiple gestation
-Excessive amniotic fluid -Fetal infectio |
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What are the parts of the assessment of a patient in labour or with complications of pregnancy?
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-Determine the approximate gestational age
-If fewer than 38 weeks then suspect preterm labour -Obstetrical history -Evaluate contractions -Signs of imminent delivery |
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What is management for pregnant patients or patients in labour?
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-Transport
-Frequent monitoring of both mother and fetus -Prepare for resuscitation of two patients |
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What are the stages of labour?
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=Stage 1 (Dilation)
-Onset of true contractions to full dilation and effacement of cervix =Stage 2 (Expulsion) -Full dilation to delivery of fetus =Stage 3 (Placental) -Delivery of the fetus to delivery of the placenta |
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What is the management for a women in labour?
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-Transport the patient in labour
unless delivery is imminent. -Maternal urge to push or the presence of crowning indicates imminent delivery. -Delivery at the scene or in the ambulance will be necessary. |
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What are the Physiological Adaptations at Birth?
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At birth, newborns make three
major physiological adaptations necessary for survival -Emptying fluids from their lungs and beginning ventilation -Changing their circulatory pattern -Maintaining body temperature |
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What is Neonatal Care?
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-Support the infant’s head and
torso, using both hands Maintain warmth -Clear infant’s airway by suctioning mouth and nose -Assess the neonate using Apgar score |
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What are the elements of the APGAR score?
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-Appearance
-Pulse rate -Grimace -Activity -Respiratory Effort |
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What are the criteria for Neonatal Resuscitation?
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-Respirations < 30 per minute and tactile stimulation does not increase rate Assist ventilations using BVM
-Heart rate < 60 and does not respond to ventilations Initiate chest compressions -Transport to a facility with neonatal intensive care capabilities |
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What is a Breech Presentation and how is it managed?
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-The buttocks or both feet present first.
-Not suitable for field delivery If the infant starts to breath with its face pressed against the vaginal wall -Form a “V” and push the vaginal wall away from infant’s face -Continue during transport |
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What is a Prolapsed Cord?
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-The umbilical cord precedes the fetal presenting part.
-Elevate the hips, administer oxygen, and keep warm. -If the umbilical cord is seen in the vagina, insert two gloved fingers to raise the fetus off the cord. Do not push cord back. -Wrap cord in sterile moist towel. -Transport immediately; do not attempt delivery. |
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What should you do for Limb Presentation?
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-Place the mother in knee-chest position
-Administer oxygen -Transport immediately -Do not attempt delivery |
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What about Other Abnormal Presentations?
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-Reassure the mother
-Administer oxygen -Transport immediately -Do not attempt field delivery in these circumstances |
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What about Multiple Births?
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-Follow normal guidelines, but have additional personnel and
equipment. -In twin births, labour starts earlier and babies are smaller. -Prevent hypothermia. |
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What is Cephalopelvic Disproportion?
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-Infant’s head is too big to pass through pelvis easily.
-Causes include oversized fetus, hydrocephalus, conjoined twins, or fetal tumors. -If not recognized, can cause uterine rupture. -Usually requires cesarean section. -Give oxygen to mother and start IV. -Rapid transport . |
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What is a Precipitous Delivery?
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-Occurs in less than 3 hours of
labor. -Usually in patients in grand multipara, fetal trauma, tearing of cord, or maternal lacerations. -Be ready for rapid delivery , and attempt to control the head. -Keep the baby warm. |
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What is Shoulder Dystocia?
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-Infant’s shoulders are larger than its head.
-Turtle sign. -Place mother in knee-chest position -Do not pull on the infant’s head. -If baby does not deliver, transport the patient immediately. |
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What is Meconium Staining?
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=Fetus passes feces into the
amniotic fluid. =If meconium is thick -Suction -Continue until all meconium has been cleared from the airway |
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What is Postpartum Hemorrhage?
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-Defined as a loss of more than
500 cc of blood following delivery. -Establish two large-bore IVs of normal saline. -Treat for shock as necessary. |
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What is a Uterine Rupture?
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-Tearing, or rupture, of the uterus
-Severe abdominal pain -Abdomen is often tender and rigid -Fetal heart tones are absent -Treat for shock -Give high-flow oxygen -Fluid resuscitation -Transport patient rapidly |
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What is a Uterine Inversion?
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-Uterus turns inside out after delivery and extends through the cervix
-Blood loss ranges from 800 to 1,800 cc -Begin fluid resuscitation -Make one attempt to replace the uterus. -If this fails, cover the uterus with towels moistened with saline -Transport immediately |
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What is a Pulmonary Embolism?
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-Venous thromboembolism
-Presents with sudden severe dyspnea and sharp chest pain -Administer high-flow oxygen and support ventilations as needed -Establish an IV of normal saline -Monitor patient closely -Transport immediately |
