EMT Chapter 32: Obstetric and Gynecologic Emergencies
supine hypotensive syndrome
dizziness and a drop in blood pressure caused when the mother is in a supine position and the weight of the uterus, infant, placenta, and amniotic fluid compress the inferior vena cava, reducing the return of blood to the heart and cardiac output.
Key fact 3
during normal delivery, the EMT will evaluate the mother to determine if there should be immediate transport to a medical facility or if birth is imminent and will take place at the scene.
induced abortion
expulsion of a fetus as a result of deliberate actions taken to stop the pregnancy
Key fact 4
if birth is to take place at the scene, the EMT must prepare for the worst. Have equipment ready and appropriate resources on hand. Always be prepared for the neonatal resuscitation.
Braxton-Hicks contractions
irregular pre-labor contractions of the uterus
A woman's external genitalia consist of three major structures: the labia, the perineum, and the_________:
mons pubis
mons pubis
soft tissue that covers the pubic symphysis; area where hair grows when a woman reaches puberty
labia
soft tissues that protect the entrance to the vagina
abortion
spontaneous (miscarriage) or induced termination of pregnancy.
miscarriage
spontaneous abortion
Key fact 7
stillbirth, death of the mother, and sexual assault are difficult emergencies the EMT is occasionally called upon to manage. Emotional care for these issues may be as important as medical care.
amniotic sac
the "bag of waters" that surrounds the developing fetus.
fetus
the baby from 8 weeks of development to birth.
embryo
the baby from fertilization to 8 weeks of development
vagina
the birth canal
ovary
the female reproductive organ that produces ova
umbilical cord
the fetal structure containing the blood vessels that carry blood to and from the placenta.
uterus
the muscular abdominal organ where the fetus develops; the womb
fallopian tube
the narrow tube that connects the ovary to the uterus. Aka the "oviduct"
cervix
the neck of the uterus at the entrance to the birth canal
placenta
the organ of pregnancy where exchange of oxygen, nutrients, and wastes occurs between a mother and fetus
Which of the following female reproductive organs are responsible for producing ova?
the ovaries
ovulation
the phase of the female reproductive cycle in which an ovum is released from the ovary
afterbirth
the placenta, membranes of the amniotic sac, part of the umbilical cord, and some tissues from the lining of the uterus that are delivered after the birth of the baby.
lightening
the sensation of the fetus moving from high in the abdomen to low in the birth canal.
perineum
the surface area between the vagina and the anus
labor
the three stages of delivery of a baby that begin with the contractions of the uterus and end with the expulsion of the placenta.
Key fact 6
there may also be predelivery emergencies or emergencies associated with pregnancy (such as excessive bleeding, ectopic pregnancy, seizures, abortion, or trauma to the pregnant mother) that the EMT must be prepared to treat.
limb presentation
when an infant's limb protrudes from the vagina before the appearance of any other body part.
ectopic pregnancy
when implantation of the fertilized egg is not in the body of the uterus, occurring instead in the fallopian tube (oviduct), cervix, or abdominopelvic cavity.
multiple birth
when more than one baby is born during a single delivery
crowning
when part of the baby is visible through the vaginal opening.
cephalic presentation
when the baby appears headfirst during birth. This is the normal presentation.
breech presentation
when the baby's buttocks or both legs appear first during birth.
spontaneous abortion
when the fetus and placenta deliver before the 28th week of pregnancy; aka a miscarriage.
prolapsed umbilical cord
when the umbilical cord presents first and is squeezed between the vaginal wall and the baby's head
What are the three possible findings and the scores associated with each score that are part of the "appearance" portion of the APGAR score?
-Blue or pale all over (0) -Extremities blue/trunk pink (1) -Pink all over (2)
List five signs or symptoms associated with ectopic pregnancy:
1. Acute abdominal pain, often beginning on one side or the other, which can also be referred to the shoulder 2. Vaginal bleeding (often accompanies pain) 3. Rapid and weak pulse (a later sign) 4. Low blood pressure (a very late sign) 5. Absent menstrual period, used to indicate a possible pregnancy
List the six elements contained within the inverted pyramid of neonatal resuscitation:
1. Dry, warm, position, suction, tactile stimulation 2. Oxygen 3. Bag mask 4. Chest compressions 5. Intubation 6. Medications
List four situations that would clearly necessitate the cutting of an umbilical cord:
1. If the cord is wrapped around the baby's neck and cannot be slipped over the head. 2. If delivery is impeded or the cord tightens around the neck. 3. If attachment to the cord impedes a resuscitation effort. 4. If attachment interferes with the urgent need for transport of the mother and/or the baby. -(Some systems will have protocols that require the cord be cut)
Key fact 1
Although birth is a natural process that usually takes place without complications, the involvement of EMS usually indicates something unusual has happened.
Which of the following locations is the site of the diffusion of oxygen into the blood of a fetus?
In a fetus, oxygen and carbon dioxide are exchanged with the mother's blood through diffusion in the placenta. Diffusion will not occur in the alveoli until after birth.
preeclampsia
a complication of pregnancy in which the woman retains large amounts of fluid and has hypertension. She may also experience seizures and/or coma during birth, which is very dangerous to the infant.
Name and describe several possible complications of delivery
Complications of delivery include breech presentations such as a foot, hand, or buttocks presenting first. Prolapsed cord occurs when the umbilical cord presents prior to the baby. Placenta previa occurs when the placenta blocks the birth canal and can be harmed by the presenting fetus.
placenta previa
a condition in which the placenta is formed in an abnormal location (low in the uterus and close to or over the cervical opening) that will not allow for a normal delivery of the fetus; a cause of excessive pre-birth bleeding
Which of the following is most commonly associated with an ectopic pregnancy?
Fallopian tube. Although it can be associated with a pregnancy in the uterus, an ectopic pregnancy is by far less common. The ovaries produce the egg. The vagina is not typically associated with an ectopic pregnancy.
abruptio placentae
a condition in which the placenta separates from the uterine wall; a cause of pre-birth bleeding.
You are assisting a 29-year-old female with the birth of her child. The baby frees its shoulders and slides free of the birth canal. Upon exiting, it begins to breathe vigorously and cry. You should:
Most active babies will not require suctioning. The fact that the baby is breathing vigorously and crying indicates that suction is not needed. Instead, you should dry the baby off and prevent heat loss.
A 26-year-old pregnant female is in labor. She states her contractions are fewer than five minutes apart and that her water has broken. She states she feels like she has to move her bowels and would like to use the bathroom before she leaves for the hospital. You should:
Often, the urge to push is confused with a sensation of having to move your bowels. In this case, you should not allow her to use the bathroom out of concern she might expel the baby into the toilet.
neonate
a newly born infant or an infant less than one month old
eclampsia
a severe complication of pregnancy that produces seizures and coma.
meconium staining
amniotic fluid that is greenish or brownish-yellow rather than clear as a result of fetal defecation; an indication of possible maternal or fetal distress during labor
Name and describe several possible pre-delivery emergencies
Pre-delivery emergencies include eclampsia, where seizures occur, and placental abruptions, where the placenta prematurely detaches from the uterine wall, causing massive internal bleeding.
Explain how to evaluate and to prepare the mother for delivery
Prepare the mother for delivery by controlling the scene and the mother's privacy. Ask bystanders to leave. In addition to gloves, put on a gown, cap, mask, and eye protection. Place the mother on the floor, elevate the buttocks with a blanket or pillow, and have the mother lie with her knees drawn up and spread apart. Use sterile sheets or towels to drape the area and position the obstetric kit within easy reach.
How would the changes in pregnancy alter your ability to recognize shock?
Shock may be more difficult to recognize as vital signs that typically indicate compensation (fast pulse and increased respirations) may already be present under normal circumstances.
Describe the three stages of labor:
Stage 1: start of contractions to full dilation of the cervix. Stage 2: full dilation of the cervix to birth of the fetus. Stage 3: birth to expulsion of the placenta.
premature infant
any newborn weighing less than 5.5 pounds or born before the 37th week of pregnancy.
stillborn
born dead
Key fact 2
The EMT's role at a birth is generally to provide reassurance and to assist the mother in the delivery of her baby.
Name and describe the anatomical structures of a woman's body that are associated with pregnancy.
The anatomical structures associated with pregnancy are: -ovaries: produce the ova. -fallopian tubes: transport the ova to the uterus and are the site of fertilization. -uterus: the muscular structure that houses the fetus during pregnancy. -placenta: the vascular organ that perfuses and nourishes the fetus during pregnancy. -vagina: the birth canal.
Which of the following female reproductive organs thins and dilates to allow the muscular walls of the uterus to contract and push the fetus out?
The cervix
What are your priorities in assessing and treating a neonate?
The priorities of assessing and treating a neonate include maintaining warmth while assuring airway, breathing, and circulation.
Which of the following stages of labor is characterized by the baby entering the birth canal for the first time?
The second stage of labor occurs when the baby enter the birth canal and ends when the baby is born. The third stage begins as the baby is born and ends with the expulsion of the placenta. The first stage begins with the onset of labor and ends at the full dilation of the cervix.
How should you assess the severity of a vaginal bleed? Why should you assume the worst?
The severity of vaginal bleeding may be assessed by asking the patient how many pads she has needed to use. The chief concern with vaginal bleeding is not external hemorrhage, but rather the bleeding that is occurring internally.
Key fact 5
complications of delivery represent a true emergency. An EMT must be prepared to initiate rapid transport in the case of breech presentation, prolapsed umbilical cord, limb presentation, premature birth, or meconium staining of the amniotic fluid.
Name, in the order of the inverted pyramid, the steps that may be taken to resuscitate a newly born infant.
To resuscitate a newly born infant, the baby should initially be dried, warmed, and stimulated. If that is not enough, administer supplemental oxygen. Positive pressure ventilation and chest compressions follow immediately if other initial measures are unsuccessful.
How would you expect the vital signs to change in a late-term pregnant female as result of the pregnancy?
Vital sign changes that occur with pregnancy include the following: respirations typically increase slightly, blood pressure drops slightly (but can be high), and pulse generally increases.
A 19-year-old pregnant female is in labor. Which of the following assessment findings would indicate a high probability for the need of neonatal resuscitation?
Women giving birth to twins, triplets, and quadruplets (multiple births) have an increased likelihood of requiring neonatal resuscitation. Although this event can never be fully anticipated, multiple births have a much higher rate of resuscitation than the other situations listed.
