EMT- Chapter 37: Obstetrics and Care of the Newborn

Targeted SpO2 after birth for a newborn?

-1 min after birth == 60-65 increase by 1 min == +5%

estimating age based on fundal height?

-20 weeks: fundus is felt at the umbilicus -38 weeks: the fundus is at the xiphoid -40 weeks: the fundus drops below the xiphoid as the fetus moves into position

S+S of a depressed newborn?

-RR >60 -HR >180 or <100 -obvious trauma -poor or absent muscle tone -respiratory arrest or severe distress -meconium staining -cyanotic -Apgar <4

2nd or 3rd trimester complications of vaginal bleeding?

-placenta previa -abruptio placentae -ruptured uterus

1st trimester complications of vaginal bleeding?

-spontaneous abortions -ectopic pregnancies

Upon arrival at the home of a woman in labor, a midwife on scene tells you that the pt is 7 cm dilated and is complaining of painful contractions. Which stage of labor is the pt in?

1st stage full dilation of the cervix is 10 cm

Infants born before ____ weeks are considered premature.

37

During pregnancy, maternal blood volume increases by _____ %.

45

What would the min expected preductal SpO2 reading be at one min after birth?

60%

Post-term pregnancy?

> 42 weeks causes postmaturity syndrome: a deterioration of conditions necessary to support the fetus; placenta begins to decline

When placed with a limb presentation during delivery, the EMT should? A. place the patient on oxygen and transport immediately. B. try to reinsert the limb C. remain on scene and complete delivery. D. begin transport and try to turn the infant

A. place the patient on oxygen and transport immediately.

Which statement made by the EMT indicates an understanding of the relationship b/w seizures and pregnancy? A. "Prolonged seizures can easily cause the mother and baby to become hypoxic." B. "A short seizure in the pregnant female with a seizure history generally does not require transport." C. "Seizure activity in the pregnant female is typically not life threatening unless the patient has had seizures in the past." D. "If the pregnant patient is seizing, the EMT must quickly make a decision to administer or withhold her antiseizure medications."

A. "Prolonged seizures can easily cause the mother and baby to become hypoxic."

The cervix is fully dilated at A. 10 centimeters. B. 6 centimeters. C. 8 centimeters. D. 12 centimeters.

A. 10 centimeters.

Appox 80% of spontaneous abortions occur prior to the ____ week of gestation. A. 12th B. 14th C. 18th D. 22nd

A. 12th

How many newborns will require a level of care that falls below the top tier of the neonatal resuscitation pyramid? A. 20 percent B. Approximately half C. One in twenty D. 80 percent

A. 20 percent

Postpartum hemorrhage is the loss of _____ mL of blood following delivery? A. 500 B. 1000 C. 100 D. 250

A. 500

When cutting the umbilical cord, it should be cut ____ inches from the infant A. 6 B. 2 C. 4 D. 10

A. 6

A 31 y/o pt is in labor. After ensuring her ABC, you assess her perineum and observe the umbilical cord protruding from the vagina. However, the baby is not visible. Your next action would be to: A. Place the patient in a knee-chest position B. Carefully place the cord back inside the vagina C. Place a saline-soaked dressing over the cord D. Gently pull the cord to assist in delivery

A. Place the patient in a knee-chest position

Your pt is 28 y/o in her 3rd tri who complains of vaginal bleeding with no pain. What is the most likely cause? A. Placenta previa B. Abruptio placentae C. Miscarriage D. Labor

A. Placenta previa

You are assessing a 29 y/o pt who has signs of imminent delivery. Her PMH includes HIV infection. Compared to a pt with no infectious disease, how will standard precaution differ for this pt? A. Gloves, a gown, and goggles will be used for this patient; only gloves and a gown are required for a healthy patient in labor B. Gloves are needed for a noninfectious patient in labor; goggles and gloves must be worn for the patient with HIV C. A HEPA filter mask should be used for the patient with HIV, but not for the noninfectious patient D. Gloves, a gown, and eye protection should be worn for both the patient with HIV and the noninfectious patient

D. Gloves, a gown, and eye protection should be worn for both the patient with HIV and the noninfectious patient

Why is the uterus essential to a healthy pregnancy and childbirth? A. It permits the excretion of waste from the baby to the mother B. It protects abdominal organs during fetal growth C. It manufactures specific blood cells needed for fetal immunity D. It powerfully contracts to force the fetus from the mother's body following gestation

D. It powerfully contracts to force the fetus from the mother's body following gestation

You are in the process of performing a field delivery and have just delivered the baby's head. What should you do next? A. Turn the baby clockwise and continue delivery B. Check the neck for the umbilical cord C. Suction the baby's nose, and then the mouth C. Suction the baby's mouth, and then the nose

B. Check the neck for the umbilical cord

When treating a pt whom you believe has an ectopic pregnancy, you know that the primary threat to the pt's life is: A. Infection B. Hemorrhage C. Severe pain D. Pelvic organ damage

B. Hemorrhage

As soon as the baby is delivered from the vaginal canal, it is critical that the EMT immediately: A. Clamp and cut the umbilical cord B. Initiate drying and warming of the newborn C. Perform the Apgar assessment D. Obtain a pulse oximetry reading from the newborn's right hand

B. Initiate drying and warming of the newborn

You have been dispatched to a resident for a F pt who is dizzy and passing out. An EMR meets you at the door and reports that the pt is lying in bed and is 9 mo pregnant. Her pulse is 112 and her BP is 84/50. RR are 24 and she has a room air pulse ox of 97%. What should yo do ASAP? A. Recheck the blood pressure B. Roll her onto her left side C. Determine any complications of the pregnancy D. Start positive pressure ventilation

B. Roll her onto her left side sounds like supine hypotensive syndrome

Assessment indicates that a term newborn's RR is 38 and his HR is 80 after administration of supplemental blow-by O2. The EMT should A. Administer high-concentration oxygen via a pediatric nonrebreather mask B. Start positive pressure ventilation with supplemental oxygen C. Continue to monitor the baby for another 30 seconds D. Start chest compressions at a rate of 120 compressions per minute

B. Start positive pressure ventilation with supplemental oxygen HR <100, PPV

Which action shows that the EMT is properly caring for the umbilical cord after delivery? A. The cord is cut 1 inch from the baby's abdomen B. The clamps are removed from the cord after cutting C. The cord is clamped but not cut until arrival at the hospital D. A 6-inch segment of cord is still connected to the baby

D. A 6-inch segment of cord is still connected to the baby

Which of the following is (are) sign(s) of severely depressed newborns? A. Pulse rate less than 100/minute B. Respiratory rate greater than 60 bpm C. Diminished breath sounds D. All of the above

D. All of the above

You have arrived at the side of a 35 y/o who is 37 weeks pregnant and in labor. You exam reveals crowning with contractions 60 s apart. Your immediate action would be to: A. Place the patient on the cot in the left lateral recumbent position, and then proceed with emergency transport B. Have the patient hold her legs together, and then move her to the ambulance for delivery of the baby C. Obtain vital signs, and then move the patient to the ambulance for a nonemergency transport D. Place the patient on her back, and then open and prepare the OB kit

D. Place the patient on her back, and then open and prepare the OB kit

You are completing the delivery of a near term baby boy when you notice that the fluid expelled with the baby is greenish-brown. At this point you should A. Immediately begin positive pressure ventilation B. Suction the nose and mouth C. Administer high-concentration oxygen D. Quickly suction the nose and mouth only if the newborn's condition is depressed

D. Quickly suction the nose and mouth only if the newborn's condition is depressed

An EMT is presenting a continuing education class on the care of pregnant females. When discussing the amniotic sac, he is correct to emphasize which one of the following points? A. The amniotic sac contains fluid and surrounds and protects the uterus B. The amniotic sac contains a fluid called Wharton's jelly that protects the baby while in the uterus C. The amniotic sac must rupture during the second trimester of pregnancy for the third trimester to progress D. The amniotic sac protects and insulates the baby during gestation

D. The amniotic sac protects and insulates the baby during gestation

When faced with the possibility of delivering twins, the EMT must remember that: A. There will be only one umbilical cord that needs to be cut B. Twins are typically born after 40 weeks gestation, making them larger C. Both babies are typically in the vaginal canal at the same time D. The second infant may be born breech

D. The second infant may be born breech

Which finding is of greatest concern when assessing a 33 y/o F who is 8 mo pregnant? A. Shortness of breath when lying flat B. Recent onset of a fever of 99.3°F C. Daily contractions that are irregular and painful D. Vaginal bleeding not associated with pain

D. Vaginal bleeding not associated with pain bleeding with no pain (3 tri) = placenta previa

3 stages of labor?

Dilation: cervix is fully dilated at 10 cm; contractions are usually aching in the back and then become cramp-like; can be 30-60s, 10-20 min apart; can last up to 18 hours (avg 8-10); dilation stage ends when the contractions are at reg 3-4 min intervals, about 60s each Expulsion: contractions are closer together (<2 min) and last 60-90s; stage typically lasts 50-60 min Placental delivery: the placenta is usually delivered in 5-20 min

3 layers of the uterine wall?

Endometrium (innermost), myometrium (middle; smooth muscle that contract during labor), perimetrium

EMC for a newborn if HR <60?

chest compressions and PPV with 100% O2 until HR reaches 60, wean off O2 to achieve the right SpO2 compressions: 130/min, 3:1 ratio

clamping the umbilical cord?

delayed cord clamping (DCC): wait at least 30 s place two clamps, approx 4 fingers (6 inches) from the infant abd, the second is 2-3" from the first conduct an Apgar score 1 min and 5 min following birth Apgar: appearance, pulse, grimace, activity, respiratory effort

spontaneous abortion/ miscarriage?

delivery of the fetus and placenta before the 20th week; 80% happens before the 12th week S+S: cramp-like lower abd pain; moderate-to-severe vaginal bleeding; passage of tissue or blood clots most sig danger is severe bleeding; assess for shock

Braxton-Hicks contractions?

false labor, are painless, short, irregular that can be as early as 13 weeks

Pre-embryotic stage?

first 14 days after conception

What position do you place the pt with a prolapsed cord?

knee-chest

Postpartum hemorrhage?

loss of >500 mL of blood following delivery; most common cause is the failure of the uterus to regain its muscle; manage with O2 and fundal massage

Cervix?

neck of the uterus

Para?

number of completed pregnancies beyond 20 weeks

Intrapartum emergencies?

on that occurs during the period from onset of labor to the actual delivery

Embolism?

postpartum emergency postpartum pt is at greater risk for an embolism bc of the increased blood volume can coagulation properties can lead to pulmonary embolism: SOB, syncope, tachycardia, sharp chest pain, hypotension, cyanosis, pale/cool/clammy skin amniotic fluid embolism (AFE): amniotic fluid, fetal cells, hair, or other material enter the mother's circulation; can lead to anaphylactic reaction

ectopic pregnancy?

pregnancy outside of the uterus (usually the fallopian tube); predisposing factors: PID, adhesions from surgery, tubal surgery, intrauterine device S+S: dull, aching pain that is poorly localized and becomes sudden, sharp, or "knife-like" to one side of the abd; shoulder pain from blood in the abd cavity (Kehr's sign); vaginal bleeding; lower abd pain; palpable mass in the abd

abruptio placentae?

premature separation of the placenta; causes a reduction in blood flow from the placenta thru the umbilical cord for the fetus; mom experiences severe bleeding 2 types: complete; partial S+S: vaginal bleeding; constant abd pain; pain in the lower back; uterine contractions

Preterm labor vs preterm birth

preterm labor: labor between 20-37 week; does not necessarily result in birth of the baby preterm birth: birth at <37 weeks

Gravida?

refers the pregnancy, not necessarily if it was completed

Ovaries?

secretes estrogen and progesterone

hyperemesis gravidarum (HG)?

severe nausea and vomiting during pregnancy

Uterus?

site of development of the fetus

EMC for a newborn if HR <100?

suction and PPV with room air PPV = 40-60/min

Prolapsed cord?

the cord can get compressed and reduce nutrients to the fetus; instruct the pt to "pant like a dog" to prevent contractions; tell the pt to be on the stretcher in the "knee-chest" position; cover the cord with a moist, sterile dressing; transport asap

Fallopian tubes?

tubes which carry eggs from the ovaries to the uterus ; where fertilization occurs

Nuchal cord?

umbilical cord around the head

Compound presentation?

when an arm or leg enters the birth canal and present the head or butt

Breech birth?

when the fetal butt or lower extremities are presenting first 3 types of presentations: -frank: hips are flexed and the knees extended -complete: hips and knees flexed -incomplete: hips are flexed and either or both feet are the presenting part

Shoulder dystocia?

when the fetal shoulders are larger than the head: retraction of the head is called "turtle sign"; generally past the due date (>42 weeks) place the mother in McRoberts position

Meconium staining?

when the normally clear amniotic fluid is greenish/ brownish-yellow from bowel movements from difficult labor; indication that the fetus experience a hypoxic event; the fetus can aspirate the fluid and get an infection or pneumonia

ruptured uterus?

when the uterine wall ruptures, the fetus can go into the abd cavity, resulting in severe maternal hemorrhage and fetal distress

Supine hypotension syndrome?

when the weight of the fetus compresses the inferior vena cava when the mother is in supine S+S: decreased BP, tachycardia, pale, cool, clammy skin

When cutting the umbilical cord, how should the baby be positioned? A. Six inches below the vaginal opening B. Upright and on the mother's chest (if possible) C. Level with the mother's uterus D. Prone and in a head-down position

C. Level with the mother's uterus

After successfully delivering the baby, the EMT notes that the protruding umbilical cord is lengthening and a small gush of blood came from the vagina. The appropriate action would be to: A. Massage the patient's uterus B. Apply a sanitary pad over the vaginal opening C. Prepare for delivery of the placenta D. Open the vaginal canal using obstetric forceps

C. Prepare for delivery of the placenta

The EMT shows that he understands the seriousness of a prolapsed umbilical cord when he states: A. "The priority when treating a patient with a prolapsed umbilical cord is keeping the cord moist." B. "A prolapsed cord that is pinched can stop the flow of oxygen to the baby and must be addressed immediately." C. "If the cord is observed protruding from the vagina, it should be clamped and cut immediately." D. "A baby can bleed to death inside the uterus if the cord is compressed for more than 10 minutes."

B. "A prolapsed cord that is pinched can stop the flow of oxygen to the baby and must be addressed immediately."

The EMT shows that he can accurately differentiate placenta previa from abruptio placentae when he states: A. "Abruptio placentae typically occurs in the first and second trimesters; placenta previa occurs in the third trimester." B. "Bleeding associated with abruptio placentae is typically associated with abdominal pain; bleeding associated with placenta previa is painless." "C. Abruptio placentae rarely results in the death of the baby; the mortality rate of placenta previa is high." D. "The blood lost with placenta previa is dark red; the color of blood associated with abruptio placentae is bright red."

B. "Bleeding associated with abruptio placentae is typically associated with abdominal pain; bleeding associated with placenta previa is painless."

A 25 y/o pt presents with abd pain. She appears thin and healthy but in obvious distress. Of the many questions the EMT may ask, which one should the EMT ask early? A. "How many times have you been pregnant?" B. "Is there any possibility you are pregnant?" C. "Are you having any vaginal discharge?" D. "Are your menstrual periods regular?"

B. "Is there any possibility you are pregnant?"

Which pt should the EMT be most suspicious of having a spontaneous abortion? A. A 16-year-old woman, 24 weeks pregnant, with painless contractions B. A 21-year-old woman, 6 weeks pregnant, passing vaginal blood clots C. A 32-year-old woman, in the third trimester, passing foul-smelling and bloody vaginal discharge D. A 38-year-old woman, 36 weeks pregnant, having abdominal pain with painless vaginal bleeding

B. A 21-year-old woman, 6 weeks pregnant, passing vaginal blood clots spontaneous abortion usually occurs in trimester 1

Which neonate is premature? A. A baby weighing 8 pounds 6 ounces born at 39 weeks B. A baby weighing 7 pounds 4 ounces born at 36 weeks C. A baby weighing 6 pounds 2 ounces born at 38 weeks D. A baby weighing 8 pounds 6 ounces born at 41 weeks

B. A baby weighing 7 pounds 4 ounces born at 36 weeks premature = <37 weeks

Which statement by the pt best indicates that the pt is in the second stage of labor? A. "The contractions are beginning to hurt now." B. "I think that my water just broke." C. "I feel like I have to move my bowels." D. "It feels good not to have to push anymore."

C. "I feel like I have to move my bowels."

You arrive at the resident of a physician who informs you that his pregnant wife requires immediate transport to the hospital bc she is bleeding and has a history of abruptio placentae. You should recognize that the greatest threat to the baby is: A. Infection B. Maternal shock C. Hypoxia D. Fluid loss

C. Hypoxia baby cannot get O2 without the placenta

McRoberts position?

Legs flexed to chest to maximize pelvic outlet

Premature rupture of membranes?

PROM spontaneous premature rupture of the amniotic sac prior to onset of true labor and before the end of the 37th week; increased risk of infection

Preeclampsia/ eclampsia?

Preeclampsia: an abnormal condition associated with pregnancy, marked by high blood pressure S+S: pregnancy-induced hypertension (PIH, >140/90); pulmonary edema Eclampsia: a more severe form of preeclampsia; an unexplained coma or new onset of generalized tonic-clonic seizures

placenta previa?

abnormal implantation of the placenta over or near the opening of the cervix 3 types: total (completely covers the os); partial; marginal S+S: bleeding with no pain (3rd tri)

Perineum?

area of skin b/w the anus anus and vagina

EMC for a newborn if HR >100?

assess SpO2 and RR and tidal volume

A pt tells you that she is 38 weeks pregnant. Where would you expect to palpate the top of the uterus during your exam?

at the level of the xiphoid process

Antepartum?

before childbirth

Precipitous delivery?

birth of the fetus after less than 3 hours of labor; usually in pts that have multipara; rapid delivery has an increased risk of trauma and tearing of the umbilical cord