Obstetrics Unit

ectoderm layer

will become the skin and the nervous system, including the spinal cord and the brain.

In the case of breech or limb presentation, provide the following emergency care:

1) Administer high-flow oxygen to the mother via non-rebreather mask. 2) Position the mother supine with her head lowered and buttocks elevated.

In the case of a prolapsed cord, provide the following emergency care:

1) Administer high-flow oxygen to the mother via non-rebreather mask. 2) Position the mother supine with her head lowered and buttocks elevated. This uses gravity to lessen the fetus' pressure on the cord in the birth canal. 3) Insert sterile-gloved fingers into the vagina and push the presenting part of the fetus away from the cord. This alleviates the fetus' pressure on the cord. Avoid the fontanelles. Monitor the pulsations in the cord. Note that this is the only situation in which you insert your hand into the vagina. 4) Wrap the exposed cord in a warm, moist, sterile towel.

Problematic bleeding may be caused by the following:

1) Ectopic pregnancy 2) Spontaneous abortion 3) Abruptio placenta 4) Placenta previa

Secondary Assessment of Obstetrical Patient includes:

1) Obtaining a focused history 2) Performing a physical examination 3) Obtaining baseline vital signs

Physiological Changes in Pregnancy

1) Reproductive changes include enlargement of the uterus and breasts. 2) Respiratory changes include increased oxygen consumption and increased breathing rate. 3) Cardiovascular changes include increased blood volume, cardiac output, and heart rate and decreased blood pressure during the second trimester. 4) Muscular and skeletal changes include a tilted pelvis and arched back for balance and increased flexibility of the joints and ligaments in the pelvis. 5) Digestive changes include decreased gastrointestinal motility.

How many Apgar points is a baby with no breathing given?

0

Approximately how many weeks pregnant is the patient?

38

embryo

lasts through the 8th week of prenatal development

Is the patient in labor?

yes

Prenatal development is divided into three stages:

zygote, embryonic, and fetal.

Questions to Ask about her pregnancy and labor:

1) When is your baby due? 2) Is this your first pregnancy? If not, how many babies have you had? 3) Are you having more than one baby? 4) Are there any known complications? 5) Do you have any vaginal bleeding? 6) Are you having contractions? If yes, when did they begin? How long do they last? How far apart are they? 7) Have you experienced bloody show? If so, when? 8) Did your water break? If so, when? What color was the fluid? 9) Do you feel as if you are having a bowel movement? If yes, do not let the mother go to the bathroom, and do not hold her legs together. 10) Do you feel the need to push?

Activity, or muscle tone

2 points - Active movement 1 point - Extremities flexed with little movement 0 points - No movement and limp

Respiration, or breathing

2 points - Breathing rate greater than 40 breaths/minute and crying 1 point - Shallow, slow, or irregular breathing 0 points - No breathing

Appearance, or skin color

2 points - Central and extremities acrocyanosis, or pink coloration of the skin due to adequate oxygen 1 point - Central acrocyanosis but extremities cyanosis, or blue or gray coloration of the skin caused by low oxygen 0 points - Central and extremities cyanosis

Grimace, or reflex irritability noted while suctioning or flicking feet

2 points - Coughing, sneezing, or pulling away 1 point - Grimace 0 points - No response

Pulse, or heart rate

2 points - Heart rate greater than 100 beats/minute 1 point - Heart rate under 100 beats/minute 0 points - No pulse

When does the fetal stage of prenatal development occur?

9th week to birth

What do the healthiest babies have?

A high Apgar score

Which predelivery emergency in the third trimester of pregnancy causes internal bleeding?

Abruptio placenta

what predelivery emergency is occurring? #2

Abruptio placenta

Based on the scenario, what emergency medical care should the EMT provide?

Alleviate the fetus' pressure on the umbilical cord

The Apgar categories are scored as follows:

Appearance, or skin color, Pulse, or heart rate, Grimace, or reflex irritability noted while suctioning or flicking feet, Activity, or muscle tone, Respiration, or breathing

If a newborn baby's heart rate is less than 100 beats/minute but greater than 60 beats/minute, what should first be done?

Artificial ventilations should be provided

When is a pre-term baby delivered?

Between the 20th and 36th weeks of pregnancy

What delivery complication increases the risk of delivery trauma to the mother?

Breech and limb presentation

Describe a baby who is given 2 Apgar points for grimace.

Coughs, sneezes, or pulls away

What predelivery emergency involves seizures?

Eclampsia

Which predelivery emergency in the first trimester causes internal bleeding?

Ectopic pregnancy

Describe a baby who is given 1 Apgar point for activity.

Flexes extremities and moves a little

what delivery complication is occurring?

Meconium staining

Meconium Staining

If the amniotic fluid is greenish or brownish-yellow, the fetus has had a bowel movement.

What does premature rupture of membranes (PROM) increase the risk of?

Infection

In what position should a pregnant woman in the third trimester of pregnancy be placed?

Left lateral

What is the process of the shedding of the uterine lining and the unfertilized ovum from the body?

Menstruation

If a newborn baby has central cyanosis with adequate breathing and heart rate, what should first be done?

Oxygen should be administered

Based on the scenario, what predelivery emergency is occurring?

Placenta previa

What predelivery emergency in the third trimester of pregnancy causes vaginal bleeding with no pain?

Placenta previa

Which lasts approximately 38 weeks from conception to birth?

Prenatal development

Based on the scenario, what should you do?

Prepare for delivery on site

Based on the scenario, what delivery complication is occurring?

Prolapsed cord

What delivery complication is the only situation in which you can insert your hand into the mother's vagina?

Prolapsed cord

If the amniotic sac is not broken when a baby's head delivers, what should you do?

Puncture or tear the amniotic sac

In the case of a nuchal cord, what should first be attempted?

Slipping the umbilical cord over the baby's head

What is the leaking of amniotic fluid known as?

Rupture of membranes

What emergency medical care should you provide the baby?

Stimulate her

what emergency medical care should the EMT immediately provide as the baby is born?

Suction the baby

When delivering a baby, what should be suctioned first?

The baby's mouth

What is the afterbirth?

The placenta

afterbirth

The placenta, including the umbilical cord, is usually delivered 5 to 20 minutes following the birth of the baby.

What are contractions the tightening and relaxing of?

The uterus

To inspect for crowning, what should you do?

Visually inspect the vagina

When should the umbilical cord be cut?

When it stops pulsating

When can you expose, examine, and touch a woman's vaginal area?

When your partner is present

After delivery, who/what should be transported to the hospital?

all of the above

What is an example of a high-risk pregnancy?

all of the above

What reduces vaginal bleeding after delivery?

all of the above

When evaluating contractions, what should be determined?

all of the above

When should you inspect for crowning?

all of the above

what emergency medical care should the EMT provide?

all of the above

Contractions

are the tightening and relaxing of the uterus. When the uterus tightens, the abdomen becomes hard, and when it relaxes, the abdomen becomes soft. Contractions cause the cervix to dilate so that the fetus can pass from the uterus into the vagina for delivery.

crown

become visible at the vaginal opening

first trimester

begins with the first day of the last menstrual period and lasts until the 12th week of pregnancy. During the first trimester, fertilization occurs, implantation in the uterus occurs, the placenta and amniotic sac develop, and the major body structures and organs form.

Supine hypotensive syndrome

can occur in the third trimester of pregnancy if the mother lies in the supine, or face-up, position

birth canal

consists of the cervix and vagina. During the second stage of labor, contractions are very intense, last 45 to 90 seconds each, and come at two- to five-minute intervals.

fetus

continues through birth. During this time, body structures and organs continue to grow and develop until the fetus is able to survive outside of the uterus.

If contractions last 60 seconds or more and occur less than five minutes apart, the mother has time to be transported to the hospital.

false

When the afterbirth appears, it should be pulled from the mother's vagina.

false

Braxton Hicks or "false" labor contractions

feel like tightening in the abdomen. They do not become stronger, longer, and more frequent, as in the case of "true" labor.

The female reproductive cycle consists of three phases:

follicular phase, ovulatory phase, luteal phase,

Symptoms of preeclampsia may include:

headaches, changes in vision, sudden weight gain, and edema in the face and extremities.

Preeclampsia

is a condition characterized by hypertension and excess protein in the urine after the 20th week of pregnancy.

Nuchal Cord

is a condition in which the umbilical cord is wrapped around the baby's neck.

Prolasped Cord

is a condition in which the umbilical cord presents through the birth canal before the head or other presenting part

post-term baby

is delivered after the 42nd week of pregnancy. Post-term babies are often large

premature baby

is delivered pre-term, or between the 20th and 36th weeks of pregnancy, or weighs less than 5½ pounds at birth

first stage of labor

is known as the dilation stage. This stage begins with the onset of contractions and ends with the cervix fully dilated at 10 centimeters

second stage of labor

is known as the expulsion stage. This stage begins when the fetus enters the birth canal and ends with birth

third stage of labor

is known as the placental stage. This stage begins with the placenta separating from the uterine wall and ends with the delivery of the placenta.

Pre-term Labor

is labor that occurs between the 20th and 36th weeks of pregnancy. Pre-term labor may result in the delivery of a premature baby. Medication, if given early enough, may slow or stop pre-term labor.

Eclampsia

is preeclampsia with seizures. If a pregnant patient has a seizure, treat her the same as any other seizure patient. If she is in the third trimester of pregnancy, place her in the left lateral position.

rupture of membranes

is referred to as "breaking water."

spontaneous abortion

is the natural death of a fetus before the 20th week of pregnancy. A spontaneous abortion is also called a miscarriage.

Labor

is the process of childbirth.

Abruptio Placenta

is the separation of the placenta from the uterus during the last three months of pregnancy.

perineum

is the skin between the vagina and the anus, begins to bulge

second trimester

lasts from the 13th to the 27th week of pregnancy. During the second trimester, the body structures and organs continue to grow and develop.

third trimester

lasts from the 28th to the 40th week of pregnancy. During the third trimester, the body structures and organs continue to grow and develop until the fetus is able to survive outside of the uterus. The cervix, or the bottom, narrow section of the uterus that opens into the vagina, begins to dilate, or stretch, and efface, or thin. And the fetus descends into the pelvis, which is known as lightening.

Fetal Death

occurs after the 20th week of pregnancy. If, following delivery, the baby shows no evidence of life, such as breathing, beating of the heart, pulsation of the umbilical cord, or movement of voluntary muscles, do not attempt resuscitation

Pre-term premature rupture of membranes (PPROM)

occurs prior to the 37th week of pregnancy. It is the leading cause of pre-term births.

Premature Rupture of Membranes (PROM)

occurs prior to the beginning of labor. It increases the risk of infection

Limb presentation

occurs when a limb, or extremity, protrudes from the birth canal

Conception, or fertilization

occurs when an ovum and sperm unite to form a zygote

Breech presentation

occurs when the buttocks or lower extremities are the presenting part and, as a result, the first part of the fetus to be delivered

Placenta Previa

occurs when the placenta implants in the lower part of the uterus and partially or completely covers the cervix

How many Apgar points is a baby with central acrocyanosis and extremities cyanosis given?

one

bloody show

pink-, brown-, or red-tinged mucous

lateral

place the mother on the left side

Apgar scale

rates appearance, pulse, grimace, activity, and respiration

obstetrical or pregnant, patient

reassure and calm the patient by showing confidence and using a compassionate tone of voice.

Cephalic presentation

refers to normal birth in which the head is the presenting part of the fetus.

umbilical cord

the cord that attaches the placenta to the baby, begins to lengthen.

placenta

the organ that supplies nourishment and oxygen and disposes of waste and carbon dioxide, begins to develop

Ectopic Pregnancy

the ovum sometimes starts to develop outside of the uterus

precipitous labor

the time from the beginning of labor to the birth of the baby is less than three hours. A precipitous labor may put the fetus and mother at increased risk of delivery trauma.

menstruation

the uterine lining breaks down and is shed from the body along with the unfertilized ovum through the vagina.

In what trimester of pregnancy can supine hypotensive syndrome occur?

third

Why should a newborn baby be wrapped in a blanket?

to protect the baby from heat loss

Based on the scenario, the EMTs should treat the patient for shock.

true

If crowning is present, delivery is imminent.

true

If there is any doubt as to whether a baby is dead, resuscitation should be attempted.

true

If vaginal bleeding continues or is excessive after delivery, the mother should be treated for shock.

true

The patient is experiencing bloody show.

true

How many Apgar points is a baby with a heart rate greater than 100 beats/minute given?

two

endoderm layer

will become the digestive system, lungs, urinary system, and glands.

mesoderm layer

will become the muscles, skeleton, cardiovascular system, and other organs.