Emt Obstetrics & Gynecological Emergencies

Front 1

birth canal

Back 1

vagina

Front 2

how many inches must the cervix dilate before the baby's head can pass through into the birth canal

Back 2

4 inches

Front 3

what is the placenta composed of

Back 3

both maternal and fetal tissues

Front 4

how much amniotic fluid is stored in the amniotic sac

Back 4

about 1 quart

Front 5

crowning

Back 5

when the presenting part of the baby first bulges from the vaginal opening (the presenting part can be any part of the baby's body, but is usually the head)

Front 6

normal head-first birth

Back 6

cephalic presentation

Front 7

buttocks or both feet of the baby present first

Back 7

breech presentation
aka breech birth

Front 8

what are the 3 stages of labor

Back 8

1st stage: contractions, cervix thins and dilates to full size (dilation period)
2nd stage: when the baby enters the birth canal to when he is born
3rd stage: begins after the baby is born and ends when the afterbirth is delivered

Front 9

afterbirth

Back 9

placenta
umbilical cord
some tissues from the lining of the uterus and the amniotic sac

Front 10

the name for the shortening and thinning of the cervix to the dilated shape

Back 10

effacement

Front 11

what is the range of time between contractions

Back 11

30 minutes at the start
3 minutes or less before imminent birth

Front 12

when might mild contractions and slight cervical dilation occur

Back 12

sometimes several days before the onset of actual labor

Front 13

when does the amniotic sac usually break

Back 13

as the baby moves downward and the cervix dilates

Front 14

meconium staining

Back 14

amniotic fluid that is greenish or brownish-yellow
may indicate maternal or fetal distress during labor

Front 15

how long after full cervical dilation will women giving birth for the first time remain in the first stage of labor

Back 15

16 hours average

Front 16

bloody show

Back 16

watery, bloody discharge of mucus that was in the cervix
the initial discharge of fluids during labor
it is not necessary to wipe this away

Front 17

which stage of labor can watery, bloody discharges occur

Back 17

all 3 stages

Front 18

how will you know the birth is imminent

Back 18

contractions become increasingly frequent
labor pains more severe
mother feels the need to move her bowels (baby is placing pressure on the rectum)

Front 19

how long do contractions and labor pains occur after delivery

Back 19

10 to 20 minutes until the placenta is delivered

Front 20

what is the contraction time and interval when birth is imminent

Back 20

30 seconds to 1 minute duration
2 to 3 minutes apart

Front 21

how are contractions and labor pains related

Back 21

contractions of the uterus produce labor pains

Front 22

what is the typical symptom signifying the start of labor pains

Back 22

lower back ache

Front 23

what questions should you ask of a pregnant mother during your assessment

Back 23

name, age, expected due date
obgyn?
first pregnancy? (time that labor will take)
how long & often have you been having labor pains?
has your water broken?
bleeding or bloody show?
need to move bowels?

Front 24

what should you examine the expectant mother for?

Back 24

crowning/presentation
feel for uterine contractions
vital signs

Front 25

how do you check uterine contractions

Back 25

wait for the pt to tell you she has labor pains
place your palm on her abdomen, above the navel
track duration and frequency of contractions

Front 26

supine hypotensive syndrome

Back 26

aka vena cava compression syndrome
third trimester
transport pt on left lateral
place a pillow behind the back for support

Front 27

what should you do if the amniotic sac hasn't broken as the baby's head is delivered

Back 27

puncture it with your finger
pull the membrane away from the baby's mouth and nose

Front 28

once the baby has been delivered, where should you place it and what should you do

Back 28

keep the baby level with the vagina until the umbilical cord stops pulsating
keep the baby's head slightly lower than the feet
suction the mouth and nose again
wrap in a blanket
note time of birth

Front 29

what should you do as the baby's head presents

Back 29

hold a sterile towel against the perineum to help prevent tearing as the baby's head begins to present
wipe the mouth and nose with sterile dressings
suction the mouth first
then suction the nose

Front 30

what should you do if the cord is wrapped around the baby's neck

Back 30

try to slip it over the baby's head
if this doesn't work, clamp the cord in 2 places and carefully cut it, then assist in delivery

Front 31

how should you suction the baby

Back 31

insert the bulb syringe about 1 to 1 1/2 inches into the mouth; repeat about 2 to 3 times
insert the syringe into each nostril no more than 1/2 inch; repeat once or twice

Front 32

when should you determine the APGAR score

Back 32

1 minute after birth
5 minutes after birth

Front 33

when should you begin resuscitation efforts if after suctioning, drying and warming, the baby does not breathe on his own

Back 33

30 seconds after suctioning, drying, and warming

Front 34

APGAR

Back 34

appearance
pulse
grimace (reaction to suctioning or flicking feet)
activity
respiratory effort

Front 35

what is the APGAR score for appearance

Back 35

0 blue or pale all over
1 extremities blue, trunk pink
2 pink all over

Front 36

what is the APGAR score for pulse

Back 36

0 no pulse
1 <100
2 >100

Front 37

what is the APGAR score for grimace

Back 37

0 no reaction
1 facial grimace
2 sneeze, cough, or cry

Front 38

what is the APGAR score for activity

Back 38

0 no movement
1 slight activity (flexing extremities)
2 moving normally

Front 39

what is the APGAR score for respirations

Back 39

0 no breathing
1 slow or irregular breathing, weak cry
2 good breathing, strong cry

Front 40

describe the inverted pyramid of neonatal resuscitation

Back 40

basic measures:
drying, warming, positioning, suction, tactile stimulation
oxygen
BVM
chest compressions

advanced measures:
intubation
medications

Front 41

if the baby has abnormal breathing, what should you do

Back 41

artificial respiration 40 to 60 per minute
reassess after 30 seconds

Front 42

what do you do if the baby's heart rate is less than 100/minute

Back 42

artificial resps 40 to 60/minute
if HR is less than 60/minute, initiate chest compressions

Front 43

how should chest compressions be performed on the newly born

Back 43

ensure HR is less than 60/minute
deliver compressions at 120/minute with thumbs mid-sternum (thumbs can be overlapped for a very small baby)
compress 1/3 to 1/2 depth of chest
3:1 ratios of compressions to breaths (i.e. 90 compressions, 30 breaths/minute)

Front 44

when should you use supplemental oxygen

Back 44

when using BVM
or
when adequate resps and HR > 100/min, but face and/or torso is cyanotic

Front 45

for normal birth, when should you cut the umbilical cord

Back 45

wait for the infant to breathe on his own
ensure the cord is no longer pulsating
the baby should be dried and wrapped first

Front 46

what is the protective coating on the newly born infant called

Back 46

the vernix

Front 47

what can you use instead of a clamp

Back 47

umbilical tape tied as a square knot

Front 48

how far from the baby should the first clamp be applied

Back 48

about 10 inches

Front 49

where should the 2nd clamp be applied

Back 49

closer to the baby (about 7 inches or 4 finger widths)

Front 50

once the cord is cut, where do you place the placental end of the cord

Back 50

on the drape over the mother's legs to avoid contact with expelled fluids

Front 51

what should you do if the baby end of the cord is still bleeding after cutting

Back 51

apply another tie or clamp as close to the original clamp as possible

Front 52

when can you delay clamping the cord

Back 52

when you are off-duty and definitive care will be received within 30 minutes

Front 53

if you are off-duty and need to cut the cord, what can you use

Back 53

sterilize scissors in alcohol for several minutes

Front 54

if the cord is not cut, and the placenta is delivered, where should you place the placenta

Back 54

wrap the placenta in a towel
place the placenta at the same level as the baby, or slightly higher

Front 55

afterbirth

Back 55

delivery of the placenta, amniotic sac membrances, and some of the uterine wall

Front 56

how long can transport to the hospital be delayed in order to wait for delivery of the placenta

Back 56

up to 20 minutes

Front 57

what should you do once the baby is swaddled and place on the mother's abdomen

Back 57

write mother's last name and time of delivery on the wristband and attach it to the baby

Front 58

what should you do with the afterbirth

Back 58

place it in a container, and put the container in a plastic bag
mark the bag with the mother's name and time of delivery of the placenta

Front 59

how do you control vaginal bleeding after delivery of the placenta

Back 59

place a sanitary napkin over the vagina
have the mother lower her legs and hold them together (but don't squeeze)
elevate the feet
massage the fundus (feel for a grapefruit-sized object in the abdomen) in light circular motions
allow the mother to nurse the baby unless airway may be compromised

Front 60

what is the most common abnormal delivery

Back 60

breech presentation

Front 61

how do you care for a mother with a breech presentation

Back 61

rapid transport
oxygen
elevate pelvis
keep mother's head low
support the body and place fingers in a V-position on either side of the baby's nose to prevent it from being smothered by the vaginal wall

Front 62

tx for prolapsed umbilical cord

Back 62

raise mothers hips
oxygen
check cord for pulse
keep cord warm and moist
insert fingers into the vagina to hold the baby off the cord until a physician relieves you (you will be pushing up through the cervix)

Front 63

limb presentation tx

Back 63

only place your fingers in the vagina if there is a prolapsed cord
rapid tpt
oxygen
elevated pelvis

Front 64

tx for multiple birth

Back 64

clamp the first baby's cord before the 2nd baby is delivered
same as for single birth

Front 65

premature infant

Back 65

weighs less than 5 1/2 lbs at birth
or
born before week 37

Front 66

what is the best temperature for a premature baby in the ambulance

Back 66

between 90 and 100F

Front 67

placenta previa

Back 67

placenta is formed low in the uterus and covering or close to the cervix
as the cervix dilates, the placenta tears
causes excessive pre-birth bleeding

Front 68

abruptio placentae

Back 68

separation of the placenta from the uterine wall
either partial or complete
may be caused by hypertension due to preeclampsia

Front 69

tx for pre-birth bleeding

Back 69

rapid tpt
oxygen
place sanitary napkin over the vagina; note the time of placement
remove pads as they become soaked, but save for blood loss calculation
save all tissue that is passed

Front 70

another name for fallopian tube

Back 70

oviduct

Front 71

ectopic pregnancy

Back 71

implantation of the fertilized egg somewhere other than the uterus
typically occurs in the fallopian tube

Front 72

s/sx of ectopic pregnancy

Back 72

acute lateral abdominal pain
vaginal bleeding
signs of shock due to internal bleeding

Front 73

eclampsia

Back 73

complication of pregnancy that produces seizures and coma

Front 74

s/sx preeclampsia

Back 74

edema of extremities and face
hypertension
headache

Front 75

before what week of pregnancy does the typical miscarriage occur

Back 75

28th week

Front 76

s/sx of miscarriage

Back 76

cramping abdominal pains similar to labor
moderate to severe bleeding
noticeable discharge of tissue and blood

Front 77

if a woman is having a miscarriage, typically after what week of pregnancy can a premature infant survive with intensive care

Back 77

more than 24 weeks

Front 78

how much faster is a pregnant female's heartrate than a non-pregnant female

Back 78

10 to 15 bpm

Front 79

how much can the blood volume of pregnant females increase near the end of the pregnancy

Back 79

up to 48% greater blood volume

Front 80

how much blood loss can occur before a pregnant female exhibits s/sx of shock

Back 80

30 to 35% blood loss

Front 81

how much greater are the oxygen requirements of a female in later pregnancy

Back 81

10 to 20% greater than normal

Front 82

stillborn

Back 82

a baby who dies in utero before the birth

Front 83

CPR hand position on a pregnant female

Back 83

1 to 2 inches higher on the sternum