Aemt Obstetrics (Mwn)

Front 1

Pituitary glands release ____________ and ______________hormones monthly. Stimulate the oocyte to undergo cell division. Mature ovum is released into one of the fallopian tubes during ovulation.

Back 1

Pituitary glands release follicle-stimulating and luteinizing hormones monthly.

Front 2

Uterus

Back 2

Pear-shaped organ
Located in midline of lower abdomen
Allows implantation, growth, and nourishment of fetus during pregnancy

Front 3

At ovulation, ovum ruptures through surface of ovary.
If fertilization occurs, fertilized egg _________________

Back 3

proceeds through fallopian tube to implant in uterus

Front 4

If fertilization does not occur, a series of hormonal changes causes the ________________ and______________ to be sloughed

Back 4

corpus luteum

uterine lining

Front 5

Menstrual cycle begins at ______________ and ends at ______________

Back 5

menarche

menopause

Front 6

Gestation

Back 6

Process of fetal development after fertilization of egg
Fertilization occurs when sperm and ovum meet.

Front 7

Zygote

Back 7

Fertilized egg
Implants in uterine wall
Developing zygote
-Embryo, fertilization through week 8
-Fetus, week 9 until birth

Front 8

Placenta

Back 8

Formed in the uterus about 3 weeks after fertilization
Serves a number of crucial functions

Front 9

Fetal circulation bypasses the ______ until birth

Back 9

Lungs

Front 10

Gestational period

Back 10

Normally 38 weeks

Front 11

Trimester periods (length & activity in each)

Back 11

First trimester
-Last menstrual cycle through week 12
-Embryonic period Weeks 3 through 8
Second trimester
-Weeks 13 to 27
-First fetal movements
Third trimester
-Week 28 to term (week 40)
-Once amniotic sac ruptures, fetus should be delivered within 24 hours - Due to risk of infection

Front 12

Most common cause of vaginal bleeding during first and second trimesters

Back 12

Spontaneous Abortion

Front 13

Most life-threatening emergency during first trimester

Back 13

Ectopic Pregnancy
Implantation and growth of embryo outside of the uterus. Most common place is fallopian tube.
Bleeding usually (not always) occurs. Can be severe or minor, internal or external

Front 14

Blood pressure usually ____________ during pregnancy

Back 14

lower

Front 15

Preeclampsia (PIH)

Back 15

Increase in blood pressure after 20th week of gestation. Most important feature for AEMT to recognize is hypertension. Know normal blood pressure levels during each trimester. Signs and symptoms:
-Headache
-Swelling in the hands, face, and feet
-Anxiety
-Nausea/vomiting
Severe cases:
-Pulmonary edema/shortness of breath
-Confusion or other altered LOC
-Visual disturbance
-Upper abdominal pain
-Myoclonus

Front 16

Eclampsia

Back 16

Seizure in a pregnant woman who has preeclampsia
May occur before, during, or up to several weeks after delivery (postpartum eclampsia)

Front 17

Isoimmunization (Rh Disease)

Back 17

Rh factor is a protein found on the red blood cells of most people. When factor is absent, person is Rh negative. Rh negative woman who becomes pregnant by Rh positive man creates risk to fetus. Can result in death of fetus or cause hemolytic disease.

Front 18

Gestational Diabetes

Back 18

Women predisposed to diabetic state become chemical diabetics during pregnancy
Usually, spontaneously resolves after delivery
Predisposes patient to hyperglycemia or hypoglycemia

Front 19

Placenta Previa

Back 19

Occurs when fetus implants in the uterus and the placenta starts to grow at the bottom of the uterus over the cervix. Usually causes no problems until near term

Front 20

Abruptio Placenta

Back 20

Placenta separates prematurely from the wall of uterus. More commonly life threatening than placenta previa. Usually occurs during third trimester. Trauma is one of the leading causes of abruptio placenta.

Front 21

Field treatment of pregnant trauma patient

Back 21

Maintain an open airway.
Administer high-flow oxygen.
Ensure adequate ventilation.
Assess circulation.
Provide IV fluids.
Transport considerations
In case of significant vaginal bleeding or severe abdominal pain:
-Quickly assess and transport.
-Support the airway.
Administer high-flow oxygen.
-Place sanitary pads against the vaginal opening.
-Position the patient on her left side.
-Call for paramedic backup.

Front 22

If cardiac arrest occurs, if resuscitation efforts are not effective within ______ minutes, emergency cesarean section must be performed.

Back 22

5 minutes,

Even if woman is dead, good CPR and ventilatory support may keep fetus viable.

Front 23

Transport decision for woman in labor:

Back 23

-If delivery is imminent, prepare to deliver at scene.
-If delivery is not imminent, prepare patient for transport. Perform remainder of assessment en route
If spinal immobilization is indicated: Secure the mother to the backboard. Elevate the right side of the board with rolled towels or blankets.
Provide rapid transport for patients who:
-Have significant bleeding and pain
-Are hypertensive
-Are having a seizure
-Have an altered mental status

Front 24

History Taking with pregnant Pt

Back 24

Investigate the chief complaint. Elaborate using OPQRST mnemonic. You want to know:
-If patient is pregnant
-How many times she has been pregnant
-How many times she has had a live birth
Obtain SAMPLE history. Know what to ask the patient related to previous pregnancies (if any) and her current pregnancy.
Consider delivering at scene if:
-Delivery is expected within a few minutes.
-Reaching the hospital is not possible.
Determine if delivery is within a few minutes:
-Look for crowning.
-Ask the patient questions, such as:
-When are you due?
-Is this your first baby?
-Have you had routine prenatal care?
If patient’s water has broken, ask: Color of fluid
Whether it had an odor ,If brown or black or has strong odor, it may indicate meconium staining.
(Thick, tarry substance and is fetus’s first bowel movement. If it occurs in utero, it is a sign of distress.)

Front 25

_____________ can be used to slow vaginal bleeding after delivery

Back 25

Uterine massage

Front 26

Three stages of labor

Back 26

First stage:
-Begins with onset of contractions
-Ends when cervix is fully effaced and dilated
Second stage
-Begins with crowning
-Ends when fetus is delivered
Third stage
-Begins with delivery of newborn
-Ends with delivery of placenta

Front 27

Lightening

Back 27

Movement of baby down into pelvis prior to birth

Front 28

If birth is imminent

Back 28

Place patient on high-flow oxygen.
Start large-bore IV line of an isotonic crystalloid.
During contractions, inspect vagina for crowning.

Front 29

Once labor has begun

Back 29

If you deliver on scene, you are only assisting.
Take standard precautions at all times.
Limit distractions for yourself and patient.
Contact medical control for further guidance.

Front 30

Normal Childbirth:Delivering the Head

Back 30

Watch newborn’s head as it begins to exit vagina.
Place your gloved hand over emerging bony parts of head and exert very gentle pressure.
Continue to support head as it rotates
Employ methods to reduce the risk of perineal tearing during labor.
Be prepared for possibility of bowel movement.
Do not poke your fingers into newborn’s eyes or into the fontanelles.

Front 31

Once head is delivered....

Back 31

Use index finger to feel whether umbilical cord is wrapped around neck while your other hand supports head.
Suction amniotic fluid from newborn’s airway before delivery proceeds.

Front 32

Normal Childbirth: Delivering the Body

Back 32

Head usually rotates to one side or the other.
Once the head is delivered, the rest of the newborn usually delivers easily.
Grasp the newborn’s feet as they are born.
Newborns are covered with vernix caseosa.

Front 33

Normal Childbirth: Postdelivery Care

Back 33

Take steps to prevent drop in temperature.
Make sure that newborn’s neck is in neutral position.
-Wipe the mouth with a sterile gauze pad.
-Suction mouth and nose.
Keep infant at same level as mother’s vagina until umbilical cord is cut.
To cut umbilical cord: Using clamps from OB kit, clamp the cord between the mother and the newborn.
Once the clamps are firmly in place, cut the cord extremely carefully.
After you have cut the cord, tie the end coming from the newborn.
The part of the cord protruding from the mother’s vagina will be delivered with placenta.
The newborn should be pinkish and breathing on his or her own.
Reassess the mother and prepare for delivery of the placenta. Give newborn to her if she is stable.

Front 34

Uterus will usually deliver placenta within ___________ (time) after birth

Back 34

within a few minutes and a half an hour

Front 35

Normal Childbirth: Delivery of the Placenta -
After delivery and before transport:

Back 35

-Place a sterile pad over the vagina.
-Straighten the mother’s legs.
-Help slow bleeding by gently massaging the mother’s abdomen with a firm, circular, “kneading” motion.

Front 36

Normal Childbirth: Delivery of the Placenta -The following are emergency situations:

Back 36

-More than 30 minutes elapse and placenta has not delivered.
-There is more than 500 mL of bleeding before delivery of placenta.
-There is significant bleeding after delivery of placenta.

Front 37

Prolapsed Cord Presentation Tx

Back 37

(Presents when amniotic sac ruptures)
-If umbilical cord comes out of vagina before newborn, blood supply to newborn may be interrupted.
-Requires surgical intervention
-Prevent the woman from pushing and compressing umbilical cord.
-Place patient in Trendelenburg or knee-chest position.
-Insert a gloved hand into vagina and gently push presenting part away from umbilical cord.
-Do not attempt to push cord back into vagina.
-Wrap sterile towel around exposed cord.
-Administer high-flow oxygen.
-Transport rapidly.

Front 38

Unruptured Amniotic Sac - Tx

Back 38

If amniotic sac has not ruptured by time newborn emerges, it will appear as fluid-filled sac.
This situation is serious. You may puncture the sac as newborn’s head is crowning, not before.

Front 39

Meconium Staining

Back 39

Suspect if amniotic fluid is green or brown instead of clear or has a foul odor. Meconium can cause:
-Depressed newborn
-Airway obstruction
Newborn may or may not respond to prolonged resuscitation.
Call for paramedic backup early if there is any indication of meconium staining or fetal distress.

Front 40

Nuchal Cord

Back 40

Umbilical Cord Around the Neck (Nuchal Cord)
Usually loose and easy to remove from around newborn’s neck. When wound tightly, it must be cut before delivery can continue. Situation is unusual, but always check.

Front 41

Breech Delivery

Back 41

Presentation where buttocks or both feet come out first. Usually slow, with time to transport patient
If buttocks have passed through vagina, delivery is underway.
-Prepare to assist and call for paramedic backup.
-Contact medical control if time is available.
-Generally, if the woman doesn’t deliver within 10 minutes, provide rapid transport.
-Preparing for a breech delivery is the same as for a vertex delivery.
-Allow the buttocks and legs to deliver spontaneously, supporting them with your hand.
-The head is almost always face down and should be allowed to deliver spontaneously.
-If delivery stalls, keep the newborn’s airway open.

Front 42

Limb Presentations

Back 42

Rarely, a single arm, leg, or foot presents. Must be delivered surgically
-Transport rapidly.
-If limb is protruding, cover it with a sterile towel.
Do not push it in or pull on it.
-Place patient on her back with her head down and hips elevated.
-Contact medical control and receiving hospital.
-Administer high-flow oxygen.

Front 43

Uterine Rupture

Back 43

If uterus ruptures, it will happen during labor. Patients at greatest risk:
-Women who have had several children
-Women with a scar on the uterus.
Signs and symptoms include:
-Woman in active labor complaining of weakness, dizziness, and thirst
-Initial strong, very painful contractions that slackened off
-Signs of shock

Front 44

postpartum hemorrhage S&S

Back 44

When blood loss exceeds 500 mL during the 24 hours after giving birth, it is postpartum hemorrhage

Front 45

postpartum hemorrhage Tx

Back 45

Management in the field includes:
-Continue uterine massage.
-Put newborn(s) to mother’s breast(s).
-Notify receiving hospital of mother’s status and estimated time of arrival.
Transport without delay.
-Start large-bore IV line en route and infuse normal saline wide open.
-Manage external bleeding with firm pressure.

Front 46

Pulmonary Embolism in childbirth S&S

Back 46

One of the most common causes of maternal death during childbirth or postpartum -May form from a number of sources
-Suspect if a woman experiences sudden dyspnea, tachycardia, or hypotension in postpartum state
Patient may report:
-Sudden, sharp chest pain
-Abdominal pain
-Syncope
Management of postpartum embolism is the same as for nonpregnant women.

Front 47

Prolapsed Uterus

Back 47

May be result of rapid delivery or pulling on umbilical cord prior to delivery of placenta. Attempt replacement once by using palm of hand to try to push it back inside body.
If this does not work:
-Cover with moist dressings.
-Transport while providing supportive care.

Front 48

Spina Bifida

Back 48

Developmental defect in which portion of spinal cord or meninges may protrude outside of the vertebrae and possibly the body. Easily seen on newborn’s back.
-Cover the open area of the spinal cord with a sterile, moist dressing.
-Maintenance of body temperature is important when applying moist dressings.

Front 49

A premature newborn is defined as:

Back 49

-Delivers before 36 weeks of gestation
-Weighs less than 5 lb (2.25 kg) at birth

Front 50

Premature and Small Newborns Characteristics

Back 50

-Smaller, thinner, proportionately larger head
-Missing or minimal vernix caseosa
-Less body hair
-Often deficient of surfactant
Considerations
-Positive-pressure ventilation may be difficult to perform.
-Administer oxygen through a tent above the newborn.
-Prevent bleeding and contamination.
-Use an isolette if available.

Front 51

Stillborn Babies

Back 51

Delivered newborn may have skin blisters, skin sloughing, dark discoloration depending on stage of decomposition. Head will be soft and perhaps grossly deformed.
Do not attempt to resuscitate an obviously dead newborn. Be prepared for diverse reactions.

Front 52

define Neonate

Back 52

Baby during first 28 days of life

Front 53

Define infant

Back 53

Between 1 month and 1 year

Front 54

Clinical findings of fetal distress

Back 54

Persistent cyanosis and/or bradycardia secondary to systemic hypoxia.
Hypotension
Respiratory depression or apnea
Poor muscle tone

Front 55

Newborn assessment steps

Back 55

Assessment should begin immediately following delivery.
-Is this term gestation?
-Is newborn breathing or crying?
-Does newborn have good muscle tone?
If answer to any assessment questions is no:
-Proceed with the initial steps of resuscitation.
-Determine the need for further interventions.
If the newborn does not have adequate respirations after basic interventions:
-Provide tactile stimulation using approved methods.
-Vigorous stimulation is not helpful.
take Apgar score 1 and 5 minutes following birth
(Most newborns have a 7 to 8 at 1 minute and 8 to 10 at 5 minutes.)

Front 56

Goal of initial Tx of newborn

Back 56

Aimed at stimulating newborn to begin spontaneous, effective breathing: Dry, warm, position, suctioning, stimulate.

Front 57

typical APGAR scores for neborns

Back 57

Most newborns have a 7 to 8 at 1 minute and 8 to 10 at 5 minutes.

Front 58

Follow the sequence for neonatal resuscitation if:

Back 58

the neonate
-Did not reach term,
-Is not crying or breathing, or
-Does not have good muscle tone
(Further resuscitation is based on assessment of respiratory effort, heart rate, color)

Front 59

Performing Neonatal Resuscitation - Treat heart rates of less than _________beats/min with positive-pressure ventilation and 100% oxygen, even if respirations are normal. If the heart rate is less than ________ beats/min, continue ventilation, begin chest compressions.

Back 59

100 beats/min

60 beats/min

Front 60

If newborn has cyanosis, determine if it is...

Back 60

Peripheral
-Common finding limited to hands/feet
-Requires no therapy
Central
-Cyanosis of face and trunk
-Treat appropriately.

Front 61

The first stage of labor ends when:

Back 61

the presenting part of the baby is visible.

The first stage of labor begins with the onset of contractions and ends when the cervix is fully dilated. However, since cervical dilation cannot be assessed in the field, the first stage of labor is considered over when the presenting part of the baby is visible at the vaginal opening (crowning).

Front 62

A 23-year-old woman, who is 24 weeks pregnant with her first baby, complains of edema to her hands, a headache, and visual disturbances. When you assess her vital signs, you note that her blood pressure is 160/94 mm Hg. She is MOST likely experiencing:

Back 62

Preeclampsia—also called pregnancy-induced hypertension—usually develops after the 20th week of gestation and most commonly affects primagravida (first pregnancy) patients. It is characterized by a headache, visual disturbances, edema of the hands and feet, anxiety, and high blood pressure. Preeclampsia can lead to eclampsia, a life-threatening condition that is characterized by seizures.

Front 63

You are transporting a woman who is 8 months pregnant. To prevent supine hypotensive syndrome, how should you position this patient?

Back 63

To prevent supine hypotensive syndrome, the patient must be positioned on her left side. This stops the weight of the baby from compressing the inferior vena cava, which can cause low blood pressure.

Front 64

Immediately after delivery of the infant’s head, you should:

Back 64

check the position of the umbilical cord.

Rationale: Immediately following delivery of the infant’s head, you should check the position of the umbilical cord to make sure it is not wrapped around the baby’s neck (nuchal cord). If a nuchal cord is not present, suction the infant’s mouth and nose.

Front 65

Upon delivery of the baby’s head, you note that the umbilical cord is wrapped around its neck. You should:

Back 65

make one attempt to slide the cord over the head.

Rationale: If the umbilical cord is wrapped around the baby’s neck (nuchal cord), you should make one attempt to gently remove the cord from around the baby’s neck. If this is not possible, the cord should be clamped and cut. Keep the cord moist, administer high-flow oxygen to the mother, and transport at once.

Front 66

The need for and extent of newborn resuscitation is based on

Back 66

respiratory effort, heart rate, and color.

Rationale: The need for and extent of newborn resuscitation is based on respiratory effort, heart rate, and skin color. The Apgar score is not used to determine if resuscitation is needed; the first score is not assigned until the newborn is 1 minute of age. Resuscitation, if needed, should commence immediately.

Front 67

The 1-minute Apgar score of a newborn reveals that the baby has a heart rate of 90 beats/min, a pink body but blue hands and feet, and rapid respirations. The baby cries when the soles of its feet are flicked and resists attempts to straighten its legs. You should assign an Apgar score of:

Back 67

8

Rationale: The Apgar score, which is obtained at 1 and 5 minutes after birth, assigns a numeric value to the following five areas: appearance, pulse, grimace, activity, and respirations.

A heart rate below 100 beats/min is assigned a 1;

a pink body with blue hands and feet is a 1;

rapid respirations is a 2;

a strong cry in reaction to a painful stimulus is a 2; and

resistance against an attempt to straighten the hips and knees is a 2.

Added together, the Apgar score for this infant is 8.

Front 68

The MOST effective way to prevent cardiopulmonary arrest in a newborn is to:

Back 68

ensure adequate oxygenation and ventilation.

Rationale: Cardiopulmonary arrest in infants and children (including newborns) is most often the result of respiratory arrest. Therefore, ensuring adequate oxygenation and ventilation at all times is critical. It is also important to maintain the infant’s body temperature and to prevent hypothermia.

Front 69

While assisting a woman in labor, you visualize her vaginal area and see an arm protruding from her vagina. She tells you that she feels the urge to push. You should:

Back 69

cover the arm with a sterile towel and transport immediately.

Rationale: Limb presentations do not deliver in the field—period! If the mother feels the urge to push, instruct her to stop; she should pant instead. Cover the protruding limb with a sterile towel, administer high-flow oxygen to the mother, and transport immediately. Delivery must take place in the hospital.

Front 70

A tearing sensation associated with severe abdominal pain during the third trimester of pregnancy usually indicates:

Back 70

abruptio placenta.

Rationale: Abruptio placenta most commonly occurs during the third trimester of pregnancy. A patient with abruptio placenta typically presents with severe abdominal pain, commonly described as a tearing sensation, and dark venous blood from the vagina.

Front 71

Embryonic period

Back 71

weeks 3-8

Front 72

time it takes for infant to develop in utero

Back 72

gestational period

Front 73

1st step in neonatal rescustation

Back 73

dry

Front 74

you cannot successfully deliver a _____ presentation in the field

Back 74

limb

Front 75

premature infants get O2 at a rate of:

Back 75

4 l/min

Front 76

The umbilical cord contains

Back 76

2 arteries and 1 vein

Front 77

after amniotic sac rupture fetus must deliver in ___ hrs

Back 77

24

Front 78

ventilate neonates at a rate of

Back 78

40-60/min

Front 79

Grey Turner sign is

Back 79

ecchymosis of the flanks - indicates internal bleeding

Front 80

a newborn should be positioned so that the head is ____than the body

Back 80

slightly lower

Front 81

keep the newborn below the placentia, or a delay in clamping the cord may result in

Back 81

polycythemia (abnormal high red cell count)

Front 82

after suctioning, keep the newborn _______ the mother's vagina to avoid_______

Back 82

at same level as

to avoid blood siphoning back through the cord to the placenta resulting in fetal hypovolemia.

Front 83

ductus arteriosus

Back 83

a blood vessel connecting the pulmonary artery to the aortic arch. It allows most of the blood from the right ventricle to bypass the fetus's fluid-filled non-functioning lungs. Upon closure at birth, it becomes the ligamentum arteriosum.

Failure of a child's DA to close after birth results in a condition called patent ductus arteriosus and the generation of a left-to-right shunt. If left uncorrected, patency leads to pulmonary hypertension and possibly congestive heart failure and cardiac arrhythmias. Prostaglandins are responsible for maintaining the ductus arteriosus by dilation of the vascular smooth muscles. Closure may be induced with NSAIDs because these drugs inhibit prostaglandin synthesis.

A patent ductus arteriosus affects around 4% of infants with Down syndrome. A failure to thrive is a very common sign of this condition

Front 84

massaging uterus and nursing stimulate release of

Back 84

oxytocin

Front 85

APGAR score

Back 85

Activity (muscle tone)
0 Limp; no movement
1 Some flexion of arms and legs
2 Active motion
Pulse (heart rate)
0 No heart rate
1 Fewer than 100 beats per minute
2 At least 100 beats per minute
Grimace (reflex response)
0 No response to airways being suctioned
1 Grimace during suctioning
2 Grimace and pull away, cough, or sneeze during suctioning
Appearance (color)
0 The baby's whole body is completely bluish-gray or pale
1 Good color in body with bluish hands or feet
2 Good color all over
Respiration (breathing)
0 Not breathing
1 Weak cry; may sound like whimpering, slow or irregular breathing
2 Good, strong cry; normal rate and effort of breathing