Bls 5.10 Labour

Front 1

List 4 indicators of the second stage of labour.

Back 1

1. Contractions every 2 minutes, lasting 60-90 seconds (in the multip, contractions every 5 minutes may indicate second stage labour).
2. Contractions associated with maternal urge to push or to move the bowels.
3. Heavy red show visible at the vaginal orifice.
4. Presenting part or bulging membranes visible at the vaginal orifice.

Front 2

List 4 questions you may want to document regarding labour.

Back 2

1. Onset, frequency and duration of contractions.
2. Membranes ruptured or not.
3. Urge to strain, bear down, push or move the bowels with contractions.
4. In multips - length of previous labours; problems with previous deliveries.

Front 3

What minimum physical assessments would you perform on the abdomen?

Back 3

Inspect; palpate for contractions (frequency, duration); note uterine height, obvious fetal parts/movement on palpation.

Front 4

What minimum physical assessments would you perform on the perineum?

Back 4

Inspect if indicated.

Front 5

List 3 management steps to perform.

Back 5

1. Administer high concentration oxygen if indicated.
2. Offer comfort and reassurance; attempt to preserve warmth and privacy.
3. Make decisions regarding maternal transport and infant delivery after the secondary survey (unless critical findings dictate earlier transport after he primary survey).

Front 6

List 3 times when you should initiate rapid transport.

Back 6

1. A limb is presenting at the vaginal orifice.
2. The umbilical cord is prolapsed (exception - if delivery appears imminent).
3. Pre-eclampsia is obvious/suspect (exception - if delivery appears imminent).

Front 7

List 3 times when you should make other transport decisions (delivery at scene vs. initiate rapid transport).

Back 7

On the basis of whether:
1. The patient is in the second stage of labour.
2. The mother is stable (vital signs normal).
3. Delivery appears imminent.

Front 8

List 4 times when you should initiate rapid transport and prepare for delivery enroute.

Back 8

1. Primips - presenting part not visible at any time (during or between contractions); no straining or urge to push with contractions (contractions usually 2 minutes apart).
2. Primips - presenting part visible only with "bearing down" contractions; and transport time is short (contractions less than 2 minutes apart).
3. Multips - contractions approximately 5 minutes apart; no urge to push; presenting part not visible at any time (during or between contractions).
4. If one or more complications exist, and delivery is not imminent (profuse vaginal bleeding - patient hypotensive or in shock, multiple births expected, premature labour - <35 completed weeks of gestation).

Front 9

What should you do if delivery becomes imminent enroute?

Back 9

Stop the vehicle, park in a safe place, and prepare to deliver the infant.

Front 10

List 3 times when you should prepare to deliver at scene if delivery appears imminent.

Back 10

1. Crowning or other presenting part visible.
2. Primips - presenting part is visible during and between contractions and maternal urge to push or bear down, restlessness, and contractions less than 2 minutes apart.
3. Multips - contractions 5 minutes apart or less and any other signs of second stage labour (contractions associated with urge to push or move bowels, heavy red show or presenting part/bulging membranes visible at the vaginal orifice during or between contractions).

Front 11

List 9 factors you should take into account when considering rapid transport if delivery has not occurred at scene within 10 minutes of initial assessment.

Back 11

1. Whether the patient is a multip or a primip.
2. Past history of precipitous delivery.
3. Rapidity of progress made, if any, since paramedic arrival at scene.
4. Distance to closest hospital emergency department.
5. Traffic and environmental conditions.
6. Onset and/or increase in vaginal bleeding.
7. Whether multiple births are expected.
8. Premature labour.
9. Whether the patient has symptoms/signs of pre-eclampsia.

Front 12

True or False: Primips may deliver precipitously, with little warning.

Back 12

False. Multips may deliver precipitously, with little warning.

Front 13

True or False: Primips' labours may last anywhere from 6-16+ hours.

Back 13

True.

Front 14

If multiple births are expected, when will the second child usually be delivered?

Back 14

10 minutes or more after the first.

Front 15

What will likely be required in premature labour?

Back 15

Neonatal resuscitation.

Front 16

What should you do if the infant appears to be presenting face up?

Back 16

Do not attempt delivery.

Front 17

List 3 management steps to perform if the patient is assessed as being in the first stage of labour.

Back 17

1. Undertake transport minimum return priority code 3 for primips.
2. Assist the patient with labour.
3. Monitor for signs of second stage labour and prepare for delivery if and when it becomes imminent. Be especially alert for precipitous delivery in multips.

Front 18

List 5 ways to assist the patient with labour and employ measures to help delay delivery until arrival at the receiving facility if/when transport is undertaken.

Back 18

1. If the patient is in early labour (delivery is not imminent, allow the patient to assume a position of comfort).
2. fifth e patient is in the second stage of labour, position her supine or in the left lateral position, with knees/hips flexed. Alternatively, position supine with the right buttock elevated and knees/hips partly flexed.
3. Help the patient breathe slowly through each contraction.
4. If the patient has an urge to push or beard own with contractions, discourage pushing. Encourage the patient to "pant and blow" throughout these contractions.
5. Anticipate delivery if the patient is in the second stage of labour and empties her bowels or bladder enroute.

Front 19

What should you do if there is the appearance of meconium or meconium-stained fluid at the vaginal orifice?

Back 19

Administer high concentration oxygen to the mother.

Front 20

What should you do if delivery is likely to occur enroute?

Back 20

Prepare the obstetrical (OBS) kit and neonatal resuscitation equipment.

Front 21

What should you do if delivery becomes imminent enroute?

Back 21

Pull over, stop the ambulance, park safely and prepare to deliver the infant.