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60 Cards in this Set
- Front
- Back
- 3rd side (hint)
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The parts of the uterus
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The dome shaped top of the uterus is called the fundus. Below the dome, the uterus begins to taper and narrow, forming the body. The narrowest portion of the uterus is called the cervix.
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39.4
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What is HCG?
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Human chorionic gonadotropin hormone, which sends signals to the corpus luteum then begins to produce hormones designed to support pregnancy until the placenta has developed.
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39.5
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When is the egg consider a embryo?
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3 weeks after conception
At this point it begins to form rudiments of the central nervous system, cardiovascular system, spine, and portions of the spine. Usually when the women notices the missed period. |
39.5
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When does the placenta develop? What are its functions?
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~14 days after ovulation
Serves as an early liver, taking care of the synthesis of glycogen and cholesterol, metabolizes fatty acid, and produces antibodies to protect the fetus. It also provides respiratory gas exchange, transportation of nutrients, excretion of wastes, transfer of heat, hormone production, and formation of a barrier. |
39.5
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Normally the umbilical cord contains __ artery and __ vein.
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2 arteries
and 1 vein. |
39.5
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Fetal circulation
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The umbilical vein carries oxygenated blood from the placenta to the fetus, which the umbilical arteries carry arteriovenous blood to the placenta. Fetal circulation bypasses the lungs until birth. The heart has ducts (ateriovenous) between the right and left side which allow the oxygenated and unoxgenated blood to mix and keeps the heart a low pressure system. Upon birth these ducts normally close.
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39.5-6
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Amniotic sac
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Amembranous bag that encloses the fetus in watery fluid called amniotic fluid. Volume reaches about 1 L by the end of pregnancy.
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39.6
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what is the most common blood disorder?
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anemia - blood has too little oxygen
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Physiological changes during pregnancy with the blood and heart:
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-Blood volume increases gradually to as much as 40% to 50% more. Usually 4 to 5 L.
-Heart size increases by 10 to 15% increase cardiac output to about 40% more. -Heart rate increase by an average of 15 to 20 bpm per term. |
39.6-7
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Why do pregnant women have to take prenatal vitamins?
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RBCs increase, thus so does the need for iron. If the woman does not take iron supplements, the fetus will rob the maternal stores for its need, resulting in anemia for the woman and often leading to premature labor and spontaneous abortion.
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39.6
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Physiological changes during pregnancy with the respiratory system and airway:
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-The uterus pushes the diaphragm up in toward the abdominal cavity, causing the rib to flare outward.
-The abdominal muscles weaken, allowing respirations to be more diaphragmatic. -Oxygen demand increase, and the body compensates by causing bronchio dilation, and regulating mucus production, and causing an overall decrease in airway resistnace. -Structural changes within the respiratory mucous membrane result in increased vascularity and edema. For this reasons, you should avoid nasal intubation or choose the next smaller ET tube size for oral intubation, to avoid creating additional complications from trauma to the respiratory tract. -Estrogen affects the nasal tract, making epistaxis risk increase. |
39.8
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Average weight gain:
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Average is about 27 lbs with ~ 6 to 7 lbs being extracellular fluid, 3lbs being uterine growth, 2lbs being placental growth, 7lbs bing fetal growth, and increase in breast tissue of 2 to 3 lbs.
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39.8
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Physiological changes during pregnancy with the spine:
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The hormone relaxin, release during pregnancy, causes collagenous tissue to soften and produces a generalized relaxing of the ligamentous system, especially along the spine. This contrbutes to the characteristic lordosis of latter pregnancy and increased flexion of the neck, both of which helps the pregnant patient compensate for balance. May also enlarge breast, soften cervix, and increase pelvic motility.
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39.8
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What is gestational diabetes?
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The inability to process carbohydrates during the pregnancy. Increase maternal insulin production results in increase placental production of human placental lactogen, which leads to an imbalance between the supply of the mother's insulin and glucose. Pt may be asymptomatic or have the usually diabetes mellitus symptoms.
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39.9
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What is chronic hypertension?
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A blood pressure that is equal to or greater than 140/90 mm Hg, which exists prior to pregnancy, occurs before 20th week of pregnancy, or continues to persist postpartum.
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39.9
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What is gestational hypertension?
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Hypertension that develops after the 20th week of pregnancy in women with previously normal blood pressure and resolves spontaneously in the postpartum period. May be an early sign of preclampsia, but if no other s/s manifest, it is generally benign.
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39.9
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What is preeclampsia?
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Hypertensive disorder or pregnancy which manifest after 20th week of pregnancy with a triad of symptoms of edema, usually of the face, ankles, and hands; gradual onset of hypertensions, and protein in the urine. Other symptoms include severe headache, nausea and vomiting, agitation, rapid weight gain, and visual disturbance. Can lead to chronic hypertension, which can retard growth and development of the fetus, impair liver and renal function, cause pulmonary edema, or progress to life-threatening grad mal seizures, a state called eclampsia.
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39.9
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What are risk factors for preeclampsia?
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Women younger than 20 or in advance maternal age. History of multiple pregnancies, and risk ractors of chronic hypertension, renal disease, and diabetes. Race also tends to play a factor with African-American women being most susceptible.
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39.9
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Rh factor
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A protein found on the RBCs of most people. It becomes a problem when a Rh negative women becomes pregnant by a Rh postive man which cause the fetus to inherit the factor. Usually not a problem in the first pregnancy but in later pregnancies the women will have built up anitibodies causing the immune system to attack the fetus. There is a shot, called Rhogam that prevents the woman's body from attacking subsequent Rh-positive pregnancies.
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39.10-11
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What is Group B streptococcus?
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A leading cause of life-threatening infections in newborns, yet remains one condition for which pregnant women are not routinely screened. It is a bacteria that lives in the genitourinary and gastrointestinal tracts of healthy individulas, generally withou causing any ill effects. In pregnancy, the bacteria can result in urinary tract infections, uterus infection, and stillbirth. If the infection is passed on to the newborn it can cause respirartory problems, pneumonia, septic shock, and meningitis.
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39.11
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Epilepsy in pregnancy
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Pregnancy alters the affects of seizure medications, increasing the risk of seizures. Recommended treatment is magnesium sulfate since diazepam (Valium)and phenobarbital cross the placental barrier, causing fetal distress.
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39.11
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What is cholestasis?
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A disease of the liver that occurs only during pregnancy. Hormones affect the gallbladder by slowing down or blocking the normal bile flow from the liver. When the flow is slowed, bile acids build up in the liver, then spill out into the bloodstream. The most common symptoms are profuse, painful itching, particularly of the hadns and feet. May also cause fatigue or depression, nausea, and right upper quadrant pain. May also notic color changes in waste elimination as dark urine and light gray or yellow bowel.
Only risk are multiple fetuses and history of liver damage. |
39.11-12
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Define abortion
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Expulsion of the fetus, from any cause, before the 20th week of gestation (some sources consider any loss of the pregnancy up to 28th week being abortion). Either spontaneous or induced.
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39.12
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How can you stimulate placenta delivery?
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Fundal massage
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39.13
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What is abruptio placental?
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A premature separation of a normally implanted placenta from the wall of the uterus. Typically occurs in 3rd trimester.
Caused typically by hypertension but can also be cause by trauma, or drug abuse/use. |
39.14
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S/s of abruptio placenta
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S/s are vaginal bleeding, with bright red blood, sudden onset of severe abdominal pain, and she may report that she no longer feels the baby moving. Abdomen will be tender and the uterus rigid to palpation. Fetal heart tones may be absent as the fetus blood supply is partly or completely cut off.
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39.14
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What is placenta previa?
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When the placenta is implanted low in the uterus and, as it grows, it partially or fully obscures the cervical canal. Becomes a major problem near term.
Only known risk factor is advance maternal age, 30 years being 3x more likely to develop it than women in their 20s. May cause disseminated intravascular coagulation, hemorrhage, and low fetal birth weight. |
39.14
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S/s of placenta previa
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Painless vaginal bleeding, with bright red blood. Because the blood supply to the fetus is not immediately jeopardized, fetal movements continue and fetal heart sounds remain audible. On gentle papation, the uterus is soft and nontender. If the uterus ruptures during labor she is likely to have s/s of shock with significant bleeding may or may not be obvious.
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39.15
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Drugs to delay or encourage delivery
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Tocolytics are drugs that are used to delay preterm labor, including magnesium sulfate.
Oxytocin is given to encourage uterine contrations. |
39.15
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What is a molar pregnancy?
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An egg is fertilized which triggers the normal progression of pregnancy, but there is no fetus present. A partial mole occurs when two sperm fertilize the same egg and instead of twins, a malfunction occurs resulting in an abnormal placenta and a fetus with an abnormal chromosome count.
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39.15
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Key item on shock with pregnant women
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May lose a lot of blood before she shows signs of shock. Don't wait for s/s of shock. Suspect shock from the mechanism of injury or nature of illness.
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39.16
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Define gravidity
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A uterus that contains a fetus, whatever the outcome, ie abortion, stillbirth, or live birth.
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39.16
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Define parity
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Delivery of a infant after the 28th week of gestation, irrespective of whether the infant was born alive or dead.
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39.16
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Define primigravida
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A women who is pregnant for the first time.
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39.16
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Define primipara
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A women who has had only one delivery.
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39.16
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Multigravida
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A women who has had two or more prenancies, irrespective of the outcome(s).
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39.16
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Define multipara
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A woman who has had two or more deliveries. A woman who has had more than five deliveries is referred to as "grand multipara."
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39.16
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Define nullipara
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A woman who has never delivered.
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39.16
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How should a seatbelt be worn with pregnancy?
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Both lap and shoulder harness should be used. The lap belt portion should be place under the abdomen and the iliac creast and the pubic symphysis. The shoulder harness should be positioned between the breasts.
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39.18
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Fetal heart rate
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A fetal heart rate lower than 120 bpm means fetal distress.
Normally heart rate should be between 120 and 160 bpm. |
39.19
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How should a a pregnant patient be transported?
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On her left side unless a spinal injury is suspected. This takes pressure of the vena cava. If she is backboarded palce a pillow under the right side to allow some weight to shift.
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39.19-20
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The first stage of labor
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Begins with the onset of labor pains, crampy abdominal pains that may radiate into the small of the back and reflect the contractions of the uterus. Typically at 5 to 15 minute intervals. As the uterus contracts the cevic dilates. Average length is 12 hours in nullipara and anywhere up to 8 hours in multipara. Towards the end of this stage the amniotic sac often ruptures, with a dramatic gush of fluid pouring out.
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39.21
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What is the bloody show?
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During dilation of the cervix, a mucus plug, sometimes mixed with blood is expelled from the cervix and discharged from the vigina.
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39.21
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The second stage of labor
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Begins as the baby's head enters the birth canal. Contractions are more intense and frequent, now occuring 2 to 3 minutes apart. When crowning (first part of the baby emerges) delivery is imminent. Takes about an hour in a nullipara and 20 to 30 minutes in a multipara.
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39.21
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The third stage of labor
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The peroid from delivery of the baby until the placenta has been fully expleed and the uterus has contracted. Uterine contraction is necessary to squeeze shut all the tiny blood vessls left exposed when the placenta separates from the uterine wall. Takes anywhere between 5 minutes to an hour.
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39.21
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True labor vs false labor
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Tue labor typically is regularly spaced, with intervals gradually shorter, intensity gradually increasing, no relief of pain with analgesics, and the cervix progressively dilates.
False labor has irregularly space contractions, with long intervals, and a constant intensity. Pain usuallly abolish by analgesics, and no cervical changes. |
39.22
Table 39-2 |
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What are contained with an OB kit?
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Surgical scissors, mask, and gown, gloves, and large plastic bag. 4 cord clamps, some 4x4s, a bulb syringe, 12'' lengths of umbilical tape. Also may have towels and a baby blanket.
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39.24
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What to do if the baby has a nuchal cord?
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Try to slip it gently over the baby's shoulder and head. Should this maneuver fail, and if the cod is wrapped tightly around the neck, place umbilical clamps 2" apart and cut the cord between the clamps.
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39.24
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How often should an APGAR be taken?
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1 minute from birth and every 5 miutes until above 7.
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Chapter 40
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How should the cord be cut after delivery?
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~8" from the infant's nave with two ties placed ~2" apart. Cut the cord betwen the two ties or clamps.
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39.26
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What to do with a prolasped umbilical cord?
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If the cord emerges from the uterus ahead of the baby it may shut off the baby's supply of oxygenated blood from the placenta.
Elevate the woman's hips as much as possible on pillows and instruct her to pant with contractions. This prevents contractions since the glottis must be closed to push. With two fingers gently push the baby, not the cord, back up into the vagina until the presenting part is no longer pressing on the cord. Cover the exposed cord with a moistened dressing. Keep the pressure off the cord and transport to the hospital where surgery is likely. |
39.28
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Treatment of postpartum hemorrhage
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Encourage uterine contraction and help restore circulating volume by uterine massage, breast feeding, trasport without delay, give IV NS and oxytoxcin (per protocol, often given at 20 to 30 mL/min).
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39.30
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What is meconium staining?
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Meconium is the baby's first stool, greenish-black with a tar like consistency. In fetal distress or with labor and delivery the fetus may void into the amniotic fluid and it may result in chemical pneumonia. Assume this has happen if the fluid from the amniotic sac is not clear.
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39.30
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Treatment for meconium staining?
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Be vigilant regarding the need for suctioning. Meconium aspiration syndrom can develop if the infant is allowed to take a breath before meconium is suction away. The viscosity of mecounium can block the infant's airway. Tracheal suctioning may be indicated if thick particulated matter is aspirated.
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39.30
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What is uterine inversion?
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Where the placenta fails to detach properly and adheres to the urterine wall when it is expelled resulting in the uterus literally turing inside-out. The life-threatening condition may be caused by mismangaing the third stage of labor, such as placing excessive pressure on the uterus during fundal massage or by exerting strong traction on the umbilical cord in an attempt to hasten delivery of the placenta. You may attempt once to push the uterine fundus up and through the vaginal canal by applying pressure witht he fingertips and the palm. If this fails cover with moist dressing and provide rapid transport.
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30.30-31
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Notes on Magnesium sulfate
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Acts as a CNS depressant,and is generally geven in pregnancy to manage eclampsia.
Can cause respiratory depression, hypotension, and potentially circulatory collapse. Thus why it should be administered slow. If given IM for seizures separate into two syringes and administer in different sites. |
39.31
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Notes on Calcium Chloride
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Mainly use in the field to manage hypocalcemia. When magnesium sulfate has been given in cases of eclampsia and respirtory depression has develped, calcium chloride acts as an antidote.
May cause N/V, syncope, bradycardia, and dysrhythmias, and cardiac arrest. |
39.31
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Notes on Terbutaline
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A tocolytic and sympathetic agonist. May also be used to treat pregnancy-induced asthma, as it has immediate bronchodilatory effects.
May cause hypertension, N/V, dizziness, chest pain, and cardiac dysrhythmias. Standard dose is 0.25mg SC, repeat in 30 minutes as needed. |
39.31
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Notes on Diazepam (Valium)
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A benzodiazepine that is classified as a sedative/anticonvulsant. Indicated when magnesium sulfate does not work for eclampsia. May also be given for anxiety in cases of hypertension emergencies, in preeclampsia.
Dose is usually 5 to 10 mg slow IV push for seizures and 2 to 5 mg IM or IV. |
39.31-32
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Notes on Oxytocin
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A naturallly occuring hormone that causes uterine contractions by acting on smooth muscle. Can be used to induce labor or control postpartum hemorrhage. Only used prehospital for severe postpartum hemorrhage, and only after all products of conception have been expeled from the uterus.
May cause N/V, tachycardia, seizures, and cardiac dysrhythmias. Can induce coma, uterine rupture, and hypertension if administed excessively. The dose is 3 to 10 units IM, or 10 to 20 units in a 500 or 100 mL slowly titrated to effect. |
39.32
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