KEY VOCABULARY

· Abortion: The expulsion of an embryo or fetus from the uterus before the 20^th week; can occur spontaneously or through a medicalprocedure

· Abruptio placentae: Sudden separation of the placenta from the wall of the uterus

· Amniotic sac: Fibrous sac that is filled with a clear to straw colored fluid, also called “bag of water”; protects the fetus

· APGAR: Scoring system used to evaluate the condition of a newborn after one and five minute(s) of life

· Breech birth: A birth in which the presenting part of fetus is either the buttocks, foot, or leg of the fetus

· Cervix: Neck of the uterus which dilates during labor to allow passage of the baby into the vagina (birth canal)

· Crowning: Bulging of the perineum when birth is imminent and the presenting part is visible at the vaginal opening

· Eclampsia: Predelivery increase in blood pressure which ultimately results in seizure activity

· Fallopian tubes: Paired canal approximately four inches long connecting the ovary to the uterus

· Gravida: Total number of pregnancies

· Gynecology: The study of diseases of womens reproductive organs

· Labor: Regular uterine contractions that increase in frequency and intensity that propel the fetus from the uterus

· Meconium: Fetal intestinal contents that stains the amniotic fluid green or black; fetus may expel contents of bowels before birth due to stress; indicates a birth complication

· Menstruation: The periodic sloughing of the uterine lining, which is comprised of blood, issue, and cells

· Mucous plug: An accumulation of mucus that forms and interlocks with the capillaries of the cervix during pregnancy; acts as a protective barrier between the cervix and the vagina for the length of the pregnancy

· Obstetrics: The branch of medicine that deals with the management of women during pregnancy, childbirth and 42 days after the expulsion of all contents of pregnancy

· Ovaries: Paired, almond-shaped organs suspended by ligaments in the left and right lower quadrants of the abdomen that release a mature egg once a month in women and girls from the approximate ages of 9 to 50 years

· Ovulation: The release of a mature egg from an ovary once a month

Total number of viable (20 weeks or greater) births

· Perineum: Space located between the vaginal opening and the anal opening

· Placenta: Highly vascular dishlike structure that links the tissue of the mother with that of the fetus. The placenta exchanges oxygen and carbon dioxide between the fetus and mother, transports nutrients and waste by-products, and serves as a temporary source for hormone production necessary to sustain pregnancy

· Placenta previa: Condition in which the placenta implants itself either on or near the opening of the cervix; severe bleeding in late pregnancy occurs when the cervix begins to dilate in early delivery

· Presenting part: The part of the fetus that protrudes initially during the birthing process

· Prolapsed cord: Premature expulsion of the umbilical cord

· Trimester: A 3-month period; there are three 3-month periods, or three trimesters, during a pregnancy

· Tubal pregnancy: Pregnancy in which the fertilized egg implants in a fallopian tube; also known as an ectopic pregnancy

· Umbilical cord: Fibrous, whitish cord that connects the fetus to the placenta

· Uterine rupture: Rupture of the uterus caused by trauma or previous cesarean scarring

· Uterus: Single, pear-shaped, muscular organ located between the rectum and the bladder that houses the fetus during fetal development

· Vagina: Fibromuscular sheath that lead from the uterus and extends to the vaginal opening

KEY CONCEPTS

The following section provides information and space for taking notes on the key concepts discussed by the instructor.

ANATOMY AND PHYSIOLOGY

Female Reproductive Anatomy

•         Ovaries

•         Fallopian Tubes

•         Uterus

•         Cervix

•         Vagina

•         Perineum

Specialized Structures of Pregnancy

•         Fetus

•         Placenta

•         Umbilical cord

•         Amniotic sac

•         Amniotic fluid

•         Mucus plug

Physiologic Changes During Pregnancy

Cardiovascular

•         Hypervolemia

•         Increased perfusion of the uterus

•         Anemia

•         Decreased venous return

•         Amniotic sac

Respiratory

Abdominal

•         Decreased Response to peritoneal irritation

•         Bladder elevated out of pelvis

•         Decreased peristalsis

Musculoskeletal

•         Softening of most joints

•         Relaxation of sacroiliac joint

•         Widening of the symphysis pubis

FOCUSED HISTORY AND DETAILED PHYSICAL EXAMINATION

(after initial assessment completed)

•         Last menstrual period

•         Due date

•         Prenatal care

•         Prior pregnancy history

•         Medical problems

•         Rupture of membranes

Physical Assessment

•         Vital signs

•         Mucus plug/bag of waters

•         Vaginal bleeding/spotting

•         Abdominal/back pain

•         Abdomen rigid or hard

•         Feeling as though bowels need to move

•         Bulging perineum

•         Presenting part visible

•         Contractions

•         frequency/duration/intensity

Transport vs. Field Delivery Considerations

•         Number of pregnancies

•         Signs of imminent delivery

•         Presence of complications

DELIVERY PROCEDURE

Stages of Labor

•         First Stage: From the first contraction, until full dilation of the cervix

•         Second Stage: From dilation of the cervix, to the birth of the child

•         Third Stage: From the birth of the child, until the delivery of the     placenta

Assisting with Normal Delivery Process

Preparation

•         Universal precautions

•         Position mother on her back with her knees bent and spread apart

•         Elevate the patient’s buttocks with a towel or blanket

•         Create a sterile field around the vaginal opening if possible

•         Place a gloved hand on the presenting part and apply slight pressure to prevent an explosive birth

Delivery of Fetus

•         If the amniotic bag has not broken, use a clamp to puncture a hole in the membrane

•         Tear the membrane away from the head and mouth of the infant

•         Once the head has delivered, feel to ensure that the umbilical cord is not wrapped around the neck

•         Aggressively suction the mouth and nose of the infant

•         Place both hands on either side of the bay’s head and apply gentle downward pressure to deliver the upper shoulder; then gently apply upward pressure to deliver the lower shoulder

•         Support the head and shoulders carefully; the baby will be very slippery

•         The rest of the baby will deliver quickly, usually within the next two contractions

•         Once the baby is delivered, wipe the blood and mucus from the mouth and nose and suction again

Post-delivery Care of the Mother

•         500cc blood loss is normal for vaginal delivery

•         Do not pull on the umbilical cord

•         Placenta will usually deliver within 20 minutes

•         Wrap placenta in a towel and place in a plastic bag; take placenta to hospital

•         Place a sterile pad over vaginal opening and lay mother’s legs flat

•         If after delivery of the placenta bleeding is excessive, massage the fundus or encourage mother to breast-feed the newborn; this causes the uterus to contract and may slow bleeding

Post-delivery Care of the Newborn

•         Dry off the baby and wrap in a warm blanket

•         Keep the baby level with the vagina until the umbilical cord is cut

•         Once the cord has stopped pulsating, place one clamp approximately four inches away from the baby’s belly

•         Place the other clamp two inches away from the first, towards the placenta

•         Using sterilized scissors, cut between the two clamps

•         Perform APGAR at one and five minutes post-delivery

APGAR Scoring System

SIGN

Appearance

(Skin Color)

Blue, pale

Body pink, blue extremities

Completely pink

Pulse Rate

(Heart Rate)

Absent

<100/minute

>100/minute

Grimace

(Irritability)

No response

Grimace

Cough, sneeze, cry

Activity

(Muscle Tone)

Limp

Some flexion

Active motion

Respiration

(Respiratory Effort)

Absent

Slow, irregular

Good, crying

COMPLICATIONS OF PREGNANCY

First Trimester Complications

Ectopic Pregnancy: Occurs when an ovum implants at a site other than the

uterus, most often in a fallopian tube

Signs and Symptoms

•         History of missed or scanty menstrual period

•         Possible vaginal bleeding

•         Unilateral abdominal pain

•         Possible positive orthostatic vital signs

•         Possible syncope

Miscarriage/Abortion: Any embryo or fetus that is expelled from the

uterus before the 20^th week; whether by nature or choice

Signs and Symptoms

•         Vaginal bleeding; may be mild or profuse

•         Cramp-like pain or pain in the back

•         Possible history of passing tissue

•         Fever (due to sepsis)

Field Treatment for First Trimester Complications

BLS

•         Supplemental oxygen

•         Place sterile pad or sanitary napkin over vagina

•         Count saturated pads; bring tissue or clots, that may have been passed, to the hospital

•         Shock position as needed

ALS

•         IV access

•         Fluid resuscitation as needed

Second Trimester Complications

Pregnancy Induced Hypertension-Preeclampsia

Signs and Symptoms

•         Occurs during the 2^nd or 3^rd trimester

•         More common in primigravidas

•         May be mild or severe

•         Headache/visual disturbances/seeing “spots”

•         Weight increase/facial and dependent edema

•         Hypertension

•         Anxiety

Eclampsia: Sequela of Preeclampsia with seizure activity

Signs and Symptoms

• Seizure with a history of Preeclampsia

• Seizure activity is the only differentiating factor between preeclampsia and eclampsia

Field Treatment for Pregnancy Induced Hypertension

BLS

•         Monitor airway, breathing, and circulation

•         Provide patient safety

•         Administer supplemental oxygen

ALS

•         Advanced airway as needed

•         Cardiac monitor PRN

•         Establish venous access

•         Administer medications as ordered by base

Third Trimester Complications

Placenta Previa: Painless vaginal bleeding; occurs when the placenta is

attached too low in the uterus

Signs and Symptoms

•         Sudden onset of bleeding

•         Occurs as the cervix dilates during labor

•         Blood is bright red in color

•         Abdomen soft on palpation

Placenta Abrupto: Sudden separation of placenta from uterine wall;

may occur spontaneously, or may be caused by trauma

Sign and Symptoms

•         Vaginal bleeding may or may not be present

•         Blood will be dark red

•         Abdominal pain

•         Abdomen will be hard and rigid on palpation

•         Hypotension

•         Tachycardia

Uterine Rupture: Rupture of uterus caused by trauma or previous cesarean scarring

Signs and Symptoms

•         Tearing-like abdominal pain

•         May occur during labor or due to trauma

•         vaginal bleeding may or may not be present

•         Firm, rigid abdomen; occasionally, fetus can be palpated

•         Hypotension

•         Tachycardia

BLS

•         Monitor airway, breathing, and circulation

•         Supplemental oxygen

•         treat for shock

•         Apply sanitary napkin for vaginal bleeding

•         Position patine in shock position on left-lateral side if indicated

ALS

•         Establish venous access

•         Rapid transport

Field Management for Third Trimester Complications

COMPLICATIONS OF DELIVERY

Abnormal Presentations

Breech

•         The buttocks will be the presenting part

•         Deliveries are usually slow

•         If buttocks and legs are delivered, use your fingers to keep the wall of the vagina away from the baby’s mouth and nose during transport or until the head is delivered

Limb

•         Foot, arm, or leg are the presenting part

•         Transport immediately

•         Usually requires surgical intervention

•         Place a sterile towel over the presenting part

Umbilical Cord

•         Do not attempt to push the cord back into the vagina

•         Transport immediately

•         Keep the baby’s head from compressing the cord

•         Transport the mother on a backboard with her hips elevated or kneeling, leaning forward, and face down

•         Wrap a sterile towel around the exposed cord

Multiple Births

•         Twins occur in one out of every 80 births

•         The infants are usually smaller than single birth babies

•         May require resuscitation

Meconium

•         Occurs when the fetus is under stress

•         The fetus has a bowel movement in the amniotic sac

•         Requires aggressive suctioning upon delivery

Newborn Distress

•         Multiple births

•         Drug addicted mother

•         Delivery prior to the seventh month

•         Prolonged labor

•         Abnormal presentation

•         Presence of meconium

•         Compromised respiratory status

•         Decreased heart rate

•         Cyanotic chest and abdomen

Home | Index | Next