Chapter 34: Obstetrics & Neonatal Care Mastery Part 3

It is a developmental defect in which a portion of the spinal cord or meninges may protrude outside of the vertebrae and possibly even outside of the body, usually at the lower third off the spine in the lumbar are

It is a condition of infants who are born to women who consume alcohol during pregnancy; characterized by growth and physical problems, mental retardation, and a variety of congenital abnormalities.

Changes occur in respiratory, cardiovascular, musculoskeletal, gastrointestinal systems.

Primigravida - 1st-time delivery labor longer

Multigravida - 2nd-time delivery labor shorter

Woman's urge to move her bowels means infant is coming.

Crowning - means stay

Obese Women Resolves on its own Increased production of the hormones progesterone + estrogen Pre-eclampsia - hypertension of hands/feet/face + protein in urine, seeing spots, headache Damages mother's liver Eclampsia - seizures

Prepare for imminent delivery

Standard Precautions, OB Kit.

Provide reassurance, give oxygen, view of the vagina to see crowning, contractions

Uterus/Abdomen will be firm during contraction + relaxed when not contracting.

Take short breaths in between contractions.

As soon as the head is delivered, stop pushing.

Nuchal Cord when the cord is wrapped around baby's neck.

Place 2 clamps 2" apart. Cut between two clamps.

Suction mouth 1st then nose.

Infants are Obligate Nose Breathers, suctioning nostrils will stimulate a gasping response making infant aspirate amniotic fluid.

More fluid can be retrieved from mouth.

Keep baby warm, adequate breathing. respiratory/heart rate/skin color dry warming positioning suctioning stimulation

Heart rate 80 beats/min cyanosis, hypoxemic needs supplemental oxygen Infant remains cyanosis up to 24 hours after birth Palpate brachial pulse. 12 pulsations, 6 seconds = 120 beats/min Ventilate newborn 40 to 60 breaths/min for 30 seconds keep warm, transport

Slow bleeding massage mother's abdomen with firm, circular motion. This stimulates uterus to contract.

Treat mom for shock/sanitary pad by vagina, elevate legs 6' to 12". high flow oxygen, keep warm. vital signs.

NEWBORN SCORE = 9

Appearance - Pink Body, Blue Extremities 1
Pulse - Heart Rate 130 beats/min 2
Grimace/Irritation - Moves Foot Away 2
Activity or Muscle Tone - Resists Leg Straightening 2
Respirations 40 to 60 breaths/min 2

lining of the inside of the uterus begins to thicken + prepare for fertilized egg to implant

If egg is not fertilized in 36 to 48 hours, lining sheds.

It occurs the 28th day of each month in females.

Extend from uterus Egg travels through fallopian tubes to uterus Fertilization with sperm meets egg inside fallopian tube.

developing, unborn infant

vagina + uterus (via cervix)

uterus contains mucous plug that seals uterine opening to prevent contamination

allows nutrients, oxygen, waste, carbon dioxide, toxins, medications between fetus + pregnant woman.

Increased respiratory rate
Decreased minute volume (amount of gas inhaled)
Increased demand for oxygen

Increased blood volume Preparing for blood loss during child birth Blood Volume passes through uterus every 8 to 11 minutes/increase of 50% during pregnancy Red Blood Cells increases = pregnant women need to take iron Blood Clotting factors change to prepare for childbirth. Heart Rate increases 20% or 20 beats per min.

Stomach moves upward for pregnancy Pregnant Trauma results in vomiting/aspiration secretion into stomach Manage airway

Joints more loose Change in body's gravity/more prone to fall

Dilation of Cervix Delivery of Infant Delivery of Placenta

Fetus enters birth canal Cervix is dilated Longest stage of labor usually lasting 16 hours

Contractions of uterus Bloody Show/Rupture of Amniotic Sac/Water Breaking Uterine contractions last about 30 to 60 seconds.

false labor

Months before due date Patient put on bed rest/doctor care

Deliver baby at scene or transport to hospital Fetus moves to birth canal Contractions are closer + last longer Pressure on rectum/mom thinks she needs a bowel movement.

Placenta must completely separate from uterine wall. Contractions continue. Takes 30 minutes. Standard Precautions for fluids.

• Internal hemorrhage into abdomen following rupture of ectopic pregnancy
  symptom: *

• missed cycle

• stabbing unilateral pain in lower abdomen

• Direct effect on fetus

• Risk of falls: loosened up joints, the weight of uterus displacement of abdominal organs

• 3rd trimester: significant blood volume

• Shock will develop quickly with blood loss

• Blood to fetus is reduced/goes to mom

• Uterus enlarges/rises out of the pelvis

• Uterus has rich blood supply

• Hypoxic (insufficient oxygen) or shock or hypovolemia (decreased blood)

• Signs:vaginal bleeding/pain

• Treatment: rapid transport, high flow oxygen, airway,

• Sanitary pad by the vagina, put patient on (L) side, ALS backup.

• Lap under abdomen + over hip bone

• Shoulder between the breasts

• To save the infant, you have to save mom.

• CPR, transport, call hospital

• Hospital may do emergency cesarean section

• Open Airway

• High Flow Oxygen

• Adequate Ventilation

• Assess Circulation

• Transport

• Top of uterus grown to belly button

• Aid in assessment of pregnant woman's abdomen

• Some cultures may not allow a male to examine a female patient.

• Some cultures view pregnancy as achieving status in the family unit others consider it a drop in self-esteem.

• Respect + honor requests.

• Your responsibility is to provide care + transport.

• Patient can refuse treatment.

Respect privacy/do assessment away from parents.

• Safety

• Standard Precautions: gloves, eye protection

• Gown, Mask

• Remain calm + professional.

• Get additional resources.

• Rapid Scan for ABC's.

• Chief Complaint: Baby is Coming.

• Vaginal Bleeding/Seizures/Evaluate 1st/Then assess impact on fetus

• AVPU: Alert, Verbal, Pain, Unresponsive

Place blanket under (R) side of backboard