EMT Chapter 33

The umbilical vein carries?

It carries oxygenated blood from the woman to the heart of the fetus.

What is the placental barrier?

It consists of two layers of cells, keeping the circulation of the woman and fetus separated but allowing nutrients, oxygen, waste, carbon dioxide, and many toxins and most medications to pass between the fetus and woman.

How much fluid is contained in the amniotic sac?

It contains about 500-1000 mL, which helps insulate and protect the fetus.

The female reproductive system includes which organs?

It includes the fallopian tubes, uterus, cervix, vagina, and the breasts.

What is preeclampsia/pregnancy-induced hypertension?

It is a condition of late pregnancy that involves headache, visual changes, and swelling of the hands and feet.

What is lightening?

It is a sensation felt by a pregnant patient when the fetus positions itself for delivery.

T/F Pregnant teenagers may not know that they are pregnant.

True

T/F The small mucous plug from the cervix that is discharged from the vagina, often at the beginning of labor, is called a bloody show.

True

All of the following are correct regarding post-term pregnancy except:

Ultrasounds are not accurate at determining due dates

The ___________ carries oxygenated blood from the woman to the heart of the fetus.

Umbilical vein

The amniotic sac contains about _________ to, __________mL of amniotic fluid, which helps to insulate and protect the floating fetus as it develops.

500; 1000

If a baby is born at 7:52, the second Apgar score should be calculated at:

7:57

You assess and infant after delivery and note that the child has a loud cry and withdraws to pain. The heart rate is 94 beats/min. The extremities are cyanotic, respirations are rapid, and the infant strongly resists your attempts to straighten the knees. Determine the Apgar score.

8

During delivery, after the head has been delivered and the shoulder appears:

Guide the head down slightly to deliver the shoulder

Which of the following questions is of LEAST pertinence when determining whether a mother will deliver her baby within the next few minutes?

Have you had a sonogram?

What are the signs and symptoms of preeclampsia?

Headache, seeing spots, swelling in the hands and feet (edema), anxiety, and high blood pressure.

_______________ is a developmental defect in which a portion of the spinal cord protrudes outside the veretebrae.

Spina bifida

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. Once the infants head has been delivered:

Suction the infants mouth, then the nose

Which of the following is not a reason for delivery of the fetus at the scene?

The amniotic sac has ruptured

The second stage of labor begins when the cervix is fully dilated and ends when:

The infant is born

You have been dispatched to the side of the highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. Which of the following signs tell you that the birth is imminent?

The infant is crowning

A history of pelvic inflammatory disease or tubal ligations increases a woman's risk for:

an ectopic pregnancy

Which of the following statements is false?

The leading cause of abruptio placenta is an ectopic pregnancy

After delivery, if the infant does not begin breathing after ________ Seconds, you should begin resuscitation efforts.

10-15

Ovulation occurs approximately ___________ before menstruation.

2 weeks

By the end of pregnancy, the pregnant patient's heart rate increases up to 20%, or about __________ beats more per minute.

20

You arrive at the scene of a home delivery. Upon entering the scene, the father appears upset and hands you a limp baby. The child has a weak cry, is completely cyanotic, and has a pulse of 70 beats/minute. Respirations are slow. Determine the Apgar score.

3

An infant delivered before _________ weeks is considered premature.

36 Weeks

A full-term pregnancy is from _______ to _________ weeks, counting from the first day of the last menstrual cycle.

36;40

Which of the following is not a stage of labor?

rupture of the amniotic fluid

The Apgar score should be calculated at _________ minutes after birth.

1 and 5

What are the three stages of labor?

1)Dilation of the cervix 2)Delivery of the infant 3)Delivery of the placenta

You arrive on a scene to assist another crew with delivery. Upon your arrival, the crew on scene informs you the delivery has already taken place and that you are going to be responsible for care of the infant. As you approach, you hear a very loud cry. The infant appears completely pink and moves his foot away when you flick the sole of his foot. The pulse is 120 beats/min and Respirations are rapid. Determine the Apgar score.

10

Once the infant is delivered, feel for a brachial pulse or the pulsations in the umbilical cord. If the pulse rate is below ________ beats/min, begin assisted ventilations.

100 BPM

When performing CPR on a newborn, a compression to ventilation ratio of 3:1 should be used, this will yield a total of ________ "actions" per minute.

120

A mother who is pregnant with her first baby is typically in the first stage of labor for approximately:

16 hours

When assisting ventilations in a newborn with a bag-mask device, the rate is ________ breaths/min.

40-60 BPM

You have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. Concerning the delivery of the placenta, which of the following are emergency situations? A) more than 30 minutes have elapsed and the placenta has not delivered B) there is more than 500 mL of bleeding before delivery of the placenta C) there is significant bleeding after delivery of the placenta D) All of the above

All of the above

When does ovulation occur?

Approximately 2 weeks prior to menstruation

Which of the following would not be a typical question to ask when taking a history on a woman in labor?

Are you having a boy or girl?

How much of an increase in blood volume does a pregnancy bring?

Blood volume may eventually increase as much as 50% by the end of pregnancy.

Preterm or false labor is commonly referred to as ________ _______ contractions.

Braxton Hicks

How can you prevent the perineum from tearing?

By applying pressure to the baby's head to allow the tissues to stretch and to prevent a precipitous birth. An episiotomy may be performed by the physician (incision to the perineum).

Which of the following statements regarding pregnancy is true?

By the 20th week of pregnancy, the uterus is at or above the belly button

Which of the following is not true regarding delivery with a nuchal cord?

Clamp the cord, then suction the airway before cutting the cord

You are attending to a 23-year-old female patient who is 16 weeks pregnant with her second child. The patient has apparently fallen and sustained and injury to her upper right arm. When you ask about the incident history, the patient is reluctant to explain what happened and becomes very quiet. Based on this information, you should:

Continue your care in a private area, document any details regarding the scene and the incident and reassure her as you provide

The leading cause of maternal death during the first trimester is internal hemorrhage into the abdomen following rupture of a ______________________.

Ectopic pregnancy

T/F A woman who is having her first baby is called a multigravida.

False

T/F After delivery of the head, suction the nose first.

False

T/F Crowning occurs when the baby's head obstructs the birth canal, preventing normal delivery.

False

T/F Labor begins with the rupture of the amniotic sac and ends with the delivery of the baby's head.

False

T/F Most premature infants have vernix on their skin when delivered.

False

T/F Once labor has begun, it can be slowed by holding the patient's legs together.

False

T/F The placenta and cord should be properly disposed of in a biohazard container after delivery.

False

T/F The umbilical cord may be gently pulled to aid in delivery of the placenta.

False

Where does fertilization of the egg usually occur?

Fertilization, when a sperm and egg meet, usually occurs when the egg is inside the fallopian tube.

What is a bloody show?

It is a small amount of blood at the vagina that appears at the beginning of labor and may include a plug of pink-tinged mucus that is discharged when the cervix begins to dilate.

What is a multigravida?

It is a woman who has experienced previous pregnancies.

What is primigravida?

It is a woman who is experiencing her first pregnancy.

What is the length of the vagina?

It is about 8-12 cm in length (begins at the cervix & ends as an external opening)

What is eclampsia?

It is seizures (convulsions) resulting from severe hypertension in a pregnant woman.

What is crowning?

It is the appearance of the infant's head at the vaginal opending during labor.

What is the umbilical cord?

It is the conduit connecting mother to infant via the placenta; contains two arteries and one vein.

What is a fetus?

It is the developing, unborn infant inside the uterus. (Grows for approximately 9 months/40 weeks)

What is an embryo?

It is the fertilized egg that is the early stages of the fetus.

What is the amniotic sac?

It is the fluid-filled, baglike membrane in which the fetus develops.

What is the cervix?

It is the narrowest portion of the uterus that opens in to the vagina

What is the placenta?

It is the tissue attached to the uterine wall that nourishes the fetus through the umbilical cord.

What is the birth canal?

It is the vagina and cervix

What is the endometrium?

It is when the lining of the inside of the uterus, begins to thicken and prepare for the potential fertilized egg to implant.

What happens if the egg is not fertilized within 36-48 hours after it had been released from the follicle?

It will simply die. Eventually, the lining that has thickened inside the uterus will be shed. It occurs around the 28th day of a woman's cycle

Which of the following refers to greenish or foul-smelling amniotic fluid?

Meconium staining

Which of the following is not preformed immediately following delivery of the infant?

Obtain an apgar score

A 26-year-old female who is 34 weeks pregnant is experiencing a seizure. Her husband tells you that her blood pressure has been high and that she had been complaining of a headache for the past few days. You should:

Place her on her LEFT side, administer high flow oxygen, and transport.

When cutting the umbilical cord:

Place the clamps 2" to 4" apart

After delivery, the _____________, or afterbirth, separates from the uterus and is delivered.

Placenta

A patient presents with a sudden onset of shortness of breath three days following delivery. What is likely the underlying cause of this condition?

Pulmonary embolism

The "P" is Apgar stands for:

Pulse

You have have been dispatched to the side of a highway where a woman is reported to be delivering a baby. As you approach the vehicle, you see her lying down in the back seat. If the baby is drowning and the amniotic sac has not yet ruptured, you should:

Puncture the sac away from the head and then push the sac away from the infants face

You and your partner are both make and are attending to a 28-year-old female patient complaining of diffuse abdominal pain. The patient is 34 weeks pregnant with her first child. The patient refuses to allow you to examine her, and her husband informs you that their culture does not allow males to examine or care for pregnant women. You should:

Respect the patients wishes, endure that the appropriate documentation is completed, and transport the patient

What systems are involved in changes dealing with pregnancy?

The primary systems are the respiratory, cardiovascular, and musculoskeletal systems.

As the pregnancy continues what happens to the respiratory system?

The respiratory rate increases, with decreasing minute volumes. The pregnancy also increases the patient's overall demand for oxygen as the metabolic demands increase.

Which of the following statements regarding multiple gestations is false?

There is only one placenta with the birth of twins

During the menstrual cycle how many follicles are successful at maturing and able to release an egg?

There will only be one follicle (out of 10 to 20 that attempt the process each month)

What are Braxton Hicks contractions?

They are preterm or false labor contractions.

The umbilical arteries carry?

They carry deoxygenated blood from the heart of the fetus to the woman.

T/F A limb presentation occurs when the baby's arm, leg, or foot is emerging from the vagina first.

True

T/F Abuse during the pregnancy increases the chance of miscarriage, premature delivery, and low birth weight.

True

T/F Delivery of the buttocks before the baby's head is called a breach delivery.

True

T/F Excessive bleeding after birth is usually caused by the muscles of the uterus not fully contracting.

True

T/F If called to deliver an infant who may have died in the uterus, you could notice skin blisters and dark discoloration to the infant.

True

T/F Massaging the abdomen after delivery helps to control bleeding.

True

T/F Multiple births may have more than one placenta.

True

When giving chest compressions to an infant:

Use the hand encircling technique or the two-finger texhnique

You have been dispatched to the side of the highway where a woman id reported to be delivering a baby, as you approach the vehicle, you see her lying down in the back seat. As you perform a visual exam, you note crowning. This means that:

You can visualize the baby's head

Passage of the fetus and placenta before 20 weeks is called ___________.

abortion

Premature separation of the placenta from the wall of the uterus is known as:

abruptio placenta

During your visual inspection of a 25-year-old woman in labor, you see the baby's head crowning at the vaginal opening. What should you do?

apply gentle pressure to the baby's head as it delivers.

The umbilical cord contains two ___________ and one ______________.

arteries; vein

By the 20th week of pregnancy, the uterus is typically at or above the level of the mother's:

belly button

There is a high potential of exposure due to ________ ________ released during the childbirth.

body fluids

Which of the following is not performed when caring for a mother with a prolapsed cord?

clamp and cut the cord

Which of the following is not a sign of the beginning of labor?

crowning

Once the infant is completely delivered, you should: a. dry and wrap the infant in a blanket b. keep the infant at the level of the vagina until the umbilical cord is cut c. use sterile gauze and wipe out the infant's mouth d. all of the above

d. all of the above

The third stage of labor begins with the birth of the infant and ends with the:

delivery of placenta

___________ is heralded by the onset of convulsions, or seizures, resulting from severe hypertension in the pregnant woman.

eclampsia

You should consider the possibility of a(n) ___________ in women who have missed a menstrual cycle and complain of a sudden stabbing and usually unilateral pain in the lower abdomen.

ectopic pregnancy

Fertilization usually occurs when the egg is inside the:

fallopian tube

Due to hormonal changes that cause joints in the musculoskeletal system to "loosen," a pregnant patient has a greater risk of ________.

falls

Following delivery of a full-term baby, you have properly cared for the baby and have clamped and cut the umbilical cord. During transport, you note that the mother is experiencing moderate vaginal bleeding. You should:

firmly massage the uterine fundus with a circular motion

During the delivery, be careful that you do not poke your fingers into the infants eyes or into the two soft spots, called ____________, on the head.

fontanelles

You may help control bleeding by massaging the _________ after delivery of the placenta.

fundus

The amniotic fluid serves to:

insulate and protect the fetus.

A nuchal cord is defined as an umbilical cord that:

is wrapped around the baby's neck.

The presence of meconium in the amniotic fluid indicates

that the baby's airway may be obstructed.

You cannot successfully deliver a _________ presentation in the field.

limb

When preparing a pregnant patient for delivery, you should position her:

on a firm surface with her hips elevated 2 to 4 inches.

The __________ is the area of skin between the vagina and the anus.

perineum

_________ is the condition in which the placenta develops over and covers the cervix.

placenta previa

Your 22-year-old patient is in active labor. Upon visual inspection, you note that the infant's leg is protruding from the vagina. Appropriate management of this situation includes

placing the mother supine with her head down and pelvis elevated.

Common interventions used to stimulate spontaneous respirations in the newborn include all of the following, EXCEPT:

positive-pressure ventilations

A pregnant trauma patient may lose a significant amount of blood before showing signs of shock because:

pregnant patients have an overall increase in blood volume.

____________ is a situation in which the umbilical cord comes out of the vagina before the infant.

prolapsed cord

Three days after delivering her baby, a 30-year-old woman complains of a sudden onset of difficulty breathing. Her level of consciousness is decreased and she is tachycardic. The EMT should suspect:

pulmonary embolism

In serious trauma, the only chance to save the infant is to adequately _____________ the mother.

resuscitate

The difference between preeclampsia and eclampsia is the onset of:

seizures

Which of the following is not considered a possible effect to the fetus when the mother is a known substance abuser?

spina bifida

When determining the frequency of contractions, you should time the contractions from the:

start of one to the start of the next

Low blood pressure resulting from compression of the inferior vena cava by the weight of the fetus when the mother is supine is called:

supine hypotensive syndrome

The first stage of labor begins with the onset of contractions and ends when:

the cervix is fully dilated

From what internal female organ is the fetus expelled during delivery?

uterus

When handling a delivery involving a drug- or alcohol-addicted mother, your first concern should be for:

your personal safety.