OB/GYN- EMT Prep

How do you manage a shoulder dystocia in the field?

You can attempt to deliver the shoulder by positioning the mother on her left side with her knees to her chest. then try to guide the infants head downward to try to let the anterior shoulder deliver. Then attempt to rotate the shoulders at an angle to allow the posterior shoulder to deliver.

What components make up the Pediatric Assessment Triangle?

- Appearance - Work of breathing - Circulation The PAT is a rapid assessment tool based on your general impression of the patient when you first walk in the room. It shouldn't take more than a few seconds and is used to determine a critical patient.

What additional questions should be asked of a pregnant patient?

- Are you pregnant and if so, what's the due date? - Have you been receiving prenatal care? - Are you expecting multiple births (i.e. twins) - Has this been a normal pregnancy up until this point? - Have you been told that this was going to be a complicated birth? - Do you have any previous children and how were they delivered (i.e. vaginal, cesarean)? - Do you have any abdominal pain or vaginal bleeding? - Are you having contractions? How long do they last? What is the time in between contractions?

Describe the 3 stages of labor.

- First Stage: This stage begins when the mother starts having contractions and ends when the cervix is completely dilated. - Second Stage: Starts when the child enters the birth canal and ends when they are born. - Third Stage: Also known as the Afterbirth Stage, this is when the placenta is delivered.

Name 5 anatomical differences that pediatric patients have compared to adults?

1) Head is larger in proportion to their body 2) Airway structures are generally smaller 3) Bones are softer and more pliable 4) Respiratory rates are much faster than adults 5) Their tongue is proportionately larger

Explain the significance/ role of each structure: Perimetrium, Myometrium, Endometrium, Fundus of Uterus, Ovary, Cervix, Vagina, Uterus

1) Perimetrium: thin layer of epithelial cells than surround/envelop the uterus 2) Myometrium: this is the smooth muscle layer of the uterus 3) Endometrium: lining of the uterus 4) Fundus of Uterus: the top portion of the uterus 5) Ovary: produces the ova 6) Cervix: muscular opening of the cervix 7) Vagina: also known as the birth canal, provides lubrication and sensation 8) Uterus: a hollow muscular organ that houses the development of offspring

Define the 4 following obstetrical emergencies: 1. Placenta Previa 2. Abruptio Placenta 3. Uterine Rupture 4. Ectopic Pregnancy

1. Placenta Previa- the placenta attaches to the uterus close to or over the cervical opening 2. Abruptio Placenta- the placenta separates from the uterine wall 3. Uterine Rupture- a tear in the wall of the uterus 4. Ectopic Pregnancy- the egg is implanted outside of the uterus, most often in the Fallopian tube

What is the normal blood loss during childbirth?

300-500 ml

At full term, how much fluid can the amniotic sac hold?

500-1000mL

You have just helped deliver a healthy infant on the side of a highway. The mother's husband was driving her to the hospital when they had to pull over and call 911. You load the patient onto the gurney and initiate transport. During transport, the placenta delivers. Following placental delivery, the patient continues to experience vaginal bleeding. The bleeding persists despite performing a fundal massage. A blood loss of more than how many mL is considered life-threatening in this setting?

500mL

What is a Prolapsed Cord and why is it an emergency?

A prolapsed cord is when the umbilical cord proceeds the fetus into the birth canal. the fear is that the cord can become compressed between the infant's head and the birth canal, reducing blood flow to the baby.

What is shoulder dystocia and how do you recognize it?

A shoulder dystocia is when the fetal shoulder is wedged against the mothers pubic symphysis. This allows the head to deliver but not the shoulders and can be recognized when the head continues to advance slightly with pushing, but then retracts again at the end and no advancement is made overall. This is also called the turtle sign.

What is a shoulder presentation and how do you manage it in the field?

A shoulder presentation means that the shoulder is overlying and opening and a hand or arm may be presenting. This cannot be delivered in the field and requires a cesarean section. Place the mother in left lateral recumbency if tolerated, administer oxygen as needed and place an IV. Monitor airway, breathing, and circulation and transport rapidly.

What does the term "nullipara" mean?

A woman who has never given birth.

What is cephalopelvic disproportion and how is it managed in the field?

Cephalopelvic disproportion means that the head is too large to fit through the pelvis or the pelvis is unusually small. This is characterized by frequent strong contractions without movement of the fetus as the head is unable to fit through the pelvis. This is managed by administering oxygen as needed, placing an IV, fluid resuscitation as needed, and rapid transport

What is the compression/ ventilation ratio for children and infants during CPR?

Children and infants are the same. One-rescuer: 30/2 Two-rescuer: 15/2

What is a cord presentation and how do you manage it in the field?

Cord presentation means that a part of the umbilical cord has prolapsed and is being compressed against the presenting part of the fetus. You can manage this by applying pressure to the presenting part and attempting to push it back into the vagina thereby relieving pressure on the cord. You must then keep your hand there to keep pressure off the cord and rapidly transport. You can also place the mother in Trendelenburg or knee to chest position to further attempt to relieved pressure on the cord. Administer oxygen to the mother and place a moist sterile dressing on the cord.

A woman brings her 5-year-old son into the ER. He is pale in appearance and slightly sweaty. His fingers are starting to show signs of cyanosis. His blood pressure is much lower than normal and pulse is much higher. Which of the following would most likely account for his symptoms?

Dehydration.

Approximately half of the blood that enters fetal circulation is filtered by the liver. The other half bypasses the liver through which vessel?

Ductus Venosus The ductus venosus allows for blood to bypass the liver and go directly to the inferior vena cava.

What type of breech is the most common?

Frank breech is the most common type of breech, followed by incomplete breech, and then complete breech.

If an expectant mother tells you she's had one miscarriage and one live birth, how would you describe her history using the gravida/para system?

Gravidea 3, Para 1 Gravida is the number of times the woman has been pregnant (regardless of outcome). Para is defined as the number of viable live births. This mother is currently pregnant, had one miscarriage, and delivered one child = G3. She has delivered only one child = P1.

How do you manage a breech birth in the prehospital setting?

If birth is imminent prepare the mother by assisting her into an appropriate position for delivery and draped. Allow the delivery of the legs and support with your palm and arm until umbilicus is visible. Then attempt to extract 4-6 inches of umbilicus cord to keep it from pulling as the infant is delivered. When the arms come into view gently guide downward to deliver the posterior shoulder and then upward to deliver the anterior shoulder. The head should then deliver, if it does not do so easily and rapidly make a v with the index and middle fingers and place on either side of the nose to enable the infant to breathe and rapidly transport. A second rescuer can attempt to apply suprapubic pressure to deliver the head.

What is meconium staining and what is it indicative of?

Meconium is the first stool of the infant. Meconium staining is a green, brown, or yellow tinged amniotic fluid that is a result of the infant defecating during labor, or even a considerable time before. This could be a sign of distress in the infant and requires rapid treatment.

What are some factors that could present themselves on scene that would indicate neonatal resuscitation could be imminent?

Meconium staining when the mother's water breaks. History of delivery problems. Multiple births, such as twins or triplets. A baby who is premature. History of recreational drug use by mother.

You notice that your 10-month-old patient is performing belly breathing. This signifies which of the following?

Normal breathing. Don't assume anything with this patient, EXCEPT the information it has provided you. In the absence of sternal or intercostal retractions, belly breathing is completely normal.

What is Nuchal Cord and why is it an emergency?

Nuchal cord occurs when the umbilical cord has wrapped itself around the newborn's head. Most often, it can be slipped over the head and if needed, can be clamped and cut in place. the fear is that the cord can become compressed, cutting off the blood supply to the newborn.

What does occiput posterior presentation mean?

Occiput posterior presentation means that the baby is facing up with delivery instead of sideways or down.

You suspect PID during the assessment of a 28-year-old female. What is PID and what are the signs/symptoms?

Pelvic inflammatory disease is an infection of the female reproductive organs. Signs/ symptoms include lower abdominal pain, fever, irregular menstruation, pain during urination/ sex, vaginal discharge.

What are the signs and symptoms of preeclampsia/eclampsia? Why is eclampsia considered an emergency?

Pre-eclampsia presents itself as hypertension, protein in the urine, and pitting edema. It is considered eclampsia when the mother also has a seizure. Most often, 911 is called when the mother has a seizure and this is a true emergency. The fear is that blood flow will be reduced to the placenta and cause harm to the fetus.

You are called to an OB emergency. Dispatch information indicates that the woman's water has broken and it had a brownish-yellow tint. Upon a visual examination, you note crowning. What should you do?

Proceed with the delivery and assure proper suction of the newborn's airway to prevent aspiration Meconium staining is a sign of stress in the fetus, mother, or both. Aspiration is the most serious risk to the fetus, which can be prevented by good suctioning. However, it is not serious enough to transport or call medical direction immediately. There is no excessive bleeding, so there is no reason to massage the mothers uterus.

What is SIDS?

Sudden infant death syndrome is the unexplained death of a child 1 month to 1 year of age. It most often occurs during sleep and there is no definitive evidence of the cause.

What is the APGAR score used for, when is it used, and describe the components of it?

The APGAR score is a tool used just after the birth of a baby that measures how they're doing and if further intervention is needed. It's made up of Appearance, Pulse, Grimace, Activity, and Respirations. It is used at 1 minute after birth and 5 minutes after birth. Appearance: 0- cyanotic all over 1- pink core, cyanotic extremities 2- pink all over Pulse: 0- pulseless 1- < 100 (under) 2- > 100 (over) Grimace 0- little or no response 1- minimal response to stimulation 2- responds vigorously, crying Activity 0- none 1- flexed arms and legs 2- active Respirations 0- not breathing 1- slow or irregular breathing 2- adequate breathing

What is a fontanelle and how do you assess it?

The fontanelle is the "soft spot" found in patients from birth to 18 months of age. When assessing, look for a flat surface when the patient is crying and upset. If you find that the fontanelle is sunken, it can be an indication that the patient is dehydrated. If you have a trauma patient with a bulging fontanelle, this can be an indication of increased intracranial pressure.

The last stage of labor is called?

The placental stage.

What are the three types of breech presentations and how do they differ?

The three types are Frank, Incomplete, and Complete. Frank breech is a presentation where the legs are extended upwards towards the face and the buttocks are presenting. Incomplete breech one or both legs are flexed and often presents with a foot. Complete breech has both legs flexed and the buttocks presenting.

What is supine hypotensive syndrome and how does it pertain to pregnant patients?

The weight of the uterine and abdominal contents pushing on the inferior vena cava. This can lead to the mother feeling dizzy, weak, and she may even lose consciousness. The reason the patient feels weak is due to a lack of blood returning to the heart, which affects cardiac output.

How is occiput posterior presentation managed in the field?

This position can often result in difficult labor and delivery and may require a cesarean section. This is managed by administering oxygen as needed, placing an IV for possible fluid resuscitation, and rapid transport.