1define a newborn.
infant within first few hours
2define a newly born
24 hours or more, but less then 30 days
3define antepartum?
period before labour + delivery
4defien intrapartum
peroid during labour + delivery
5define a cold stress
body unable to warm itself
6what are 3 common things that should be done for every newborn
- mainitinig tempature
- suction airway
- mild stimulation
7What increases antepartum risk factors?
- gestational age < 36 weeks + > 41 weeks
- multiple gestations
- bad prenatal care
- preeclmapsia, eclampsioa, hypertension, diabetes melitus
-maternal age (under 16, over 35)
- Drugs/medication
- fetal anemia
8what increases intrapartum risk factors?
- emergency c-section
- meconium staning
- opiods in last 4 hours
- abnormal presentation
- shoulder dystocia
- abnormal fetal heart rate
- maternal anesthesia
- infection of fetal membrane
-prolonged labor
- prolapsed cord
- hemorrhage
9what defines a premature baby?
born before 37 weeks + less then 5 lbs
10what is the youngest age babies are able to survive?
22 weeks
11what are the risk factors that increases the likelyhood of a preterm birth?
- preganacy complications
- high or low maternal age
- low social status
- previous premies
- smoking/subtance abuse
- multiple fetuses
12what are physical factors that premature babies are at risk of?
- repsiratory depresssion
- hypothermia
- lack of lung surfactant
- blood glucose + electrolyte fluctionation
- Bp changes
- brain injury (hypoxia)
13What physical findings may be present on a premature baby that wouldn't be present on a full term baby?
- large trunk short extremities
- less fat
-translucent skin
- lanugo (thin body hair)
- folded + small + pinned ear cartilage
-extended extremities
14what are crucial prehospital treatments for preterm babies?
- monitor ABC
- less squeeze on BVM
- KEEP THEM WARM (swaddles, plastic bad, hat, warm ambulance)
15what are the three major changes that need to happen when a baby is born and needs to survive?
1. emptying fluid from lungs
2. changing circulation patterns
3. maintiaing body temperature
16what happens on a physiological level to allow a baby to empty the fluid from there lungs.
- vitamins rush and clear 1/3 or lungs
- labor compresses chest and forces fluid out
- big breath opens alveoli
17what happens on a physiological level to allow a baby to change its circulation after being delivered?
- cord clamps -> increased blood flow in lungs
- foramen ovale begins to close (from 02 dilations to lungs)
18wha is a normal Spo2 for a newborn in the first 1,2,3,4,5 and 10 minutes of life and where should the oximeter be placed>
1 min: 60–65%
2 min: 65–70%
3 min: 70–75%
4 min: 75–80%
5 min: 80–85%
10 min: 85–95%
- right upper extremity ( medial palm)
19what are causes of hypoxia post delivery?
- cord compression
- difficult labor
- maternal hemorrhage
- maternal drug use
- airway obstruction
- hypothermia
- immature lungs
-cardio anomolies
20what are babies at high risk for hypothermia?
- large body surface area
- decreased tissue insulation
- immature temp regulation
- cool, wet birth
21What is the golden minutes after birth and what does it cover?
The minute after delivery, you need to identify whether the newborn needs resuscitation or any other interventions
22What three things are you checking in the first 30 seconds after a baby is born?
-respirations
- heart rate
- oximetry reading
23what are the three questions that need to be answered 30 seconds after birth and what happnes if the answer it yes or no do any of the questions?
- is the baby to term
- is there good tone
- are they breathing/crying
yes: dry, place skin-to-skin, warm, position airway, observe breathing
no: warm, dry stimulate, ventilate, chest compressions, suctions, meds
24what is the timeline for compression to be done post birth and the threshold for them?
> 30 second + HR < 60
25what is a newborns ideal body tempature?
36.5-37.5 C (97.7-99.5 F)
26if a baby is _____ weeks they should not be dried off, but put into a warming bag with there head uncovered?
< or = 32 weeks
27what are the 5 steps that prevent complications for newborns?
0 - ask important questions + intervine
1- prevent heat loss
2- clear the airway
3-tactile simulation
4- eveluate again
28A baby come out not breathing (HR > 100) what are the 3 steps that need to be started ASAP?
1. position airway in sniffing position ( place towel under if large baby)
2. suction the airways (mouth then nose)
3. use PPV
29how long should each suctioning attempt be on a newborn?
< or = 5 seconds
30what is meconium staining, what are its risk to the baby and how do we fix it?
- first bowel movement that occurs inside the mother instead of outside ( pea-soup)
increased risks: hypoxia, pnemothorax, aspiration pneumonia
- suction the staining, before stiumlating baby to breath
31at what heart rate should you start using the PPV?
< 100 bpm
32what are appropriate form of tactile stimulation, and when should they be done?
GENTLY rubbing back, trunk, extremities
- < or = 30 seconds
33what are the 4 methods that can be used to determine a newborns heart rate?
1. palpating base of the cord
2. brachail pulse
3. auscultation
4. 3 lead ecg
34what should a newborns skin conditions present like post birth, and what do some differences idicate?
- pink all over
- pink in the trunk, blue in the limbs (peripheral cyanosis)
_ blue all over ( decreases o2 + low hemoglobin)
35Newborn should have respiratory rate/effort or crying enough to:
- improve colour
- reach target SPo2
- keep HR > 100 bpm
36who invented the apgar score?
Dr Virgina Apgar in 1953
37A newborn is delivered at term. Walk through the Neonatal Resuscitation Program (NRP) algorithm from initial assessment (yes and no), next assesment (yes, no), and HR paramiters
Initial check — Term gestation, good tone, breathing/crying?
Yes → Routine care with mother
No → Warm, position airway/clear secretions if needed, dry, stimulate (within 1 minute)
Next assessment — Apneaasping or HR < 100?
Yes → PPV, SpO₂ monitor, consider ECG
No, but labored breathing or persistent cyanosis → Position/clear airway, SpO₂ monitor, supplemental O₂ as needed, consider CPAP
If HR < 100 after PPV → Check chest movement, ventilation corrective steps (MR. SOPA), ETT
If HR < 60 → Intubate if not done, chest compressions coordinated with PPV, 100% O₂, ECG monitor
If HR still < 60 → IV epinephrine; if persistently < 60, consider hypovolemia and pneumothorax
38what are the indications for PPV?
apnea, gasping, bradycardia, HR <100 post 30 seconds
39when should o2 be given to a newborn and how should it be delivered?
- breathing + spo2 dont imporve + central cyanoisi
- blow by o2( not dirently on face)
40what is the PPV rate?
40-60 breaths a min or 1;3 ratio
41In neonatal resuscitation, what's the primary measure of success during PPV, and how do you check and respond to HR at each interval?
Primary measure of success: Prompt rise in HR
Check HR in the first 15 seconds of PPV, then at 30 seconds of PPV that moves the chest
HR rising → continue PPV, reassess after another 15 seconds
HR not rising, but chest moving → continue PPV that moves the chest, reassess after 15 seconds
42what is Mr Sopa and when does it apply?
if ventilazions are inadequate consider:
M- mask ajsutment
R- reposition airways
S - sunctions mouth+ nose
O- open mouth and lift jaw forward
P- pressure increase
A- alternative airway
- review Mr Sopa before intubation or drug admin
43what is the compression rate for a newborn and how should you be preforming compressions?
3:1 at 120 per min
- use two thumbs pressing 1/3 of chest just below nipple line
- continue for 30 then reases
44what complications can occur post resucitations and there signs?
- diminished breath sounds, return of bradycardia, increased ventilation resistance
45what does DOPE stand for and what is its significance?
- intubated babyes o2 stats drops/status morsens
D - dislodgement (misplaced: right mainstem, esophagus)
O - obstruction (secretions)
P - pneumothorax (decreased/absent breath sounds one side)
E - equipment failure (vent malfunction/disconnect)
46what are causes of cardiac arrest/dysrythmia in newborns?
- hypoxia
- resp arrest
- primary/secondary apnue
- unresolved bradycardia
- persistant fetal cirulation
- maternal drugs
asphyxia
47when can resusitation of a newborn be stopped or withheld?
- parents wishes
- baby > 22 weeks
48if you cannot tell the gestational age of a newborn in the feild what is your treatment?
begin resus + consult med direction ( base hospital)
49what is primary apnea and what does it respond to?
temporary cessation of breathing occurring immediately after initial rapid breathing, with a newborn with O2 deprivation
-tactile stimulation
50what is secondary apnea?
no spontaneous breathing > 20 seconds, following a few gasps
- no responce to tactile stimulation
51what is the sequence from primary to secondary apnes and what damage can it do?
rapid breathing -> primary apnea -> irregular gasping -> seconary apnea
- hypoxemia, bradycardia
52what is the most common cause of respiratory distress in a newborn, what are the signs and how do we manage them?
prematurity, lung/heart disease, pneumonia
signs: tachypnea, paradoxical breathing, intercostal retraction
managment: stimulate, reposition airway, oxygenate, intubate
53what are the most common causes of hypovolemia in a newborn, what are the signs and how to we manage it?
- dehydration, hemorrhage, trauma, sepsis
signs: mottled/pale cool skin, tachycardia, weak pulses, delayed cap refil
managment: fluid
54what are newborn seizures, waht causes them and how do we manage them?
- drugs, hypovolemia, intracranial hemorrhage, meningitis
Management: ABC + BGl check, maintain temp, give meds if needed
55what is a fever defined as, what is our care and what can cause them?
- rectal 38.0/100.4
- delay cooling, immediate transport
-limited temp control or dehydration
56what is hypothermia defined as in a newborn
core temp <95 (35c)
57how is hypoglycemia defined in a newborn?
40 mgl (2.2 mmol/l)
58what are the symptoms of newborn hypoglycemia, when should it be checked and how do we treat it?
-twitching, seizure, limp, pethargy, eye rolling, irregular respirations
- after inital resus, sick infant
- support ABC, IV dex
59what is normal vs abnormal vomiting in a newborn, what are the types and how to we manage it?
normal: occasional, vomiting muvus, 5-6 stoolds a day
abnormal: persistant
types: persistane, projectile, bilious (dark green), dark blood
managment: keep airway clean, IV fluids
60what is neonatal abstinence syndrome (NAS) what causes it and what are the symptoms?
- withdraw exposure to drugs or alcohol
symptoms: high pitched cry, seizures, fever, vomiting, diarrhea
61what causes persistent diarrhea in newborn and how do we manage it?
-bacterials, cystic fibrosis, NAS
care: vitals, IV fluids
62what are the signs of dehydration in a newborn?
-decreased urination
- increased thirst
- dry skin/mucous memebranes
- tachycardia
- sunken eyes/fontanells
63what are the signs of newborn sepsis?
- temp instability
- resp distress
- feeding changes
- GI symptpms
-CNS symptoms
64when would you use an oral airway in a newborn?
defects that effect the airway and cannot maintain there own
65what is a cleft lip/cleft palate and why does it occur?
lip: split in upper lip
palate: fiddre along midline hard/soft
why: fissure fail to fuse
66what is pierre robin sequence and why does it occur?
small mandible + tongue placed far back
why: small jaw pushes tongue back -> obstructed airway
67what are congenital heart deffects (CHD)
structural deffects of the heart
68what is left to right shunt and why does it matter?
oxygenated blood from left shunts to right side
why: blood gets oxygenated again -> issues ( foramen ovale may not have closed)
69what is ASD and why does it matter?
opening between atria
why: opening persists blood flows between both atria
70what is VSD and why does it matter?
opening between ventricles
why: opening persists blood flows left to right instead of too aorta
71what is patent ducuts arteriosus (PDA) and why does it occur
fetal vessel between pulmonary artery + aorto stays open
why: doesn't close at birth
72what is a valvular defect and why does it matter?
defect in valve
why: valves dont fullt open, valves dont fully close
73what is a single-ventricle defect?
one ventricle is underdevelped
74what is pulmonary atresia
no pulmonary valve
75what is tranposition of the great arteris (TGA)
aorta comes off R ventricle
76compare gastroschisis and omphalocele?
g : organs spill out of babies body
o: ongans outisde of babies body in a sac
77what is spina bifida
neural tube deffect + improper spinal formation
78what is tetrology of the flow?
four heart defects combines ( only lived because all four are present)
79Define gravida?
total number of pregnancies, including the current one
80define para?
number of births, post 20 weeks (stillbirths count too)
81define nullipara?
never delivered a child
82what is ECD?
estimated date of confinement/delivery
83what is naegeles rule?
last normal period ( 3 months + 7 days)
84what is the developmental process between week 1-9 (terms)?
zygote -> morula -> blastocyte -> embryo (1-8) -> fetus (9-birth)
85what is a bloody show?
mucus plug expelled from cervix as it dilates
86what is a precipitous delivery, in what instances does it occur and what risks does it present?
labor -> birth in less than 3 hours
- grand multipara and little maternal soft tissue
-perineal tears, uterine rupture, cerebal trauma
87what is partuition?
process of the fetus being born
88what is locia and how long is it normal for?
noraml postpartum vagina bleading/mucus (normal for 2-4 weeks)
89what is the fundus and what is its importance?
the top of the uterus which extends while baby grows
90how do you determine the due date if unknonw?
9 months + 1 week from first day of last period
91what are the 5 functions of the placenta?
1. transfer of gases (o2 from mom goes to baby and Co2 can be filtered out)
2. transport of nutrients (K, NA, Cl, fatty acids, glucose goes to baby)
3.excretion of waste (urea, uric acid, creatinine go from baby to mom to be excreted)
4. hormone production (temporary endocrine gland, secrete estrogen/progesterone)
5. formation of a barrier (partially protects baby from harmfull mathernal substances)
92what precentage does fetal glucose run at and why is that important?
20-30 % lower than mom (if mom goes low baby goes LOW)
93which substances can cross the placenta barrier?
steriods, narcortics, opiods, anesthetics, antibiotics
94what is different about fetal circulation then ours?
two umbilical arteries ( carry DEOXYGENATED blood away from fetus to placenta)
one umbilical vein (carry OXYGENATED blood from placenta to fetus)
-circulation is seperate from moms
95what are the three shunts that fetuses use to bypass their imature live and fluid filled/collapsed lungs)?
1. ductus venosus
2. foramen ovale
3. ductus arteriosus
96what is the ductus venosus ?
continuation of umbilical cord that allows placental blood to bypass "liver" leading it to empty dirently in inferior vena cava
97what is the foramen ovale?
opening betwen right and left atria that shunts blood away from "lungs"
98what is the ducuts arteriosus?
connects the pulmonary artery directly to the aorta
99What happens to the ductus venosus, foramen ovale, and ductus arteriosus after a baby is born?
the close and seal with tissue
100how is mean arterial pressure calculated?
(2x diastolic + 1x systolic) ÷ 3
101what timeline defines gestation?
about 40 weeks from fertilization ot delivery (divided into trimesters)
102which weeks are critical for organ development for a fetus?
weeks 4-8
103what are the dangers associated with the use of NSAIDS in the third trimester ?
-can cause prematue closure of ductus arteriosus
- cna lead to too little amniotic fluid
-fetal renal imparment
-pulomnary hypertension
-prolonges bleeding time
104what is GTPAL and what is its use?
Gravida : number of pregnancies
Term: number of term deliveries
Preterm: number of preterm deliveries
Abortions: number of spontaneous/induced (pre week 20)
Living: number of living children
Used to alert hospital of pertinant information on the patient to also predict how this labour will go
105How much growth occurs in the uterus during pregnancy?
from 70g (nongravida) -> 1000g/ 14x OG size
106when does the uterus become palbale suprapubically?
week 12
107By what point does the fundus reach the umbilicus?
week 20
108what change occur in the vagina during pregnancy?
-increased vascularity
-increased thickness/secretions
-drop in pH (3.5) -> reduced growth of pathogens
109what changes occur to the breats during pregnancy?
-tender
-nipples darken +enlarge
110when does morning sickness begin and end and why does it occur?
stars week 6 -> week 14
- occurs from high gonadotropin levels (maybe)
111what GI risks increase due to pregnancy and why ?
- GERD from liver moving
- Increased aspiration risk (if unconcious)
- Constipation from decreased GI tone/motility
112How does cardiac output change during pregnancy, by when has it changed and what can happen physiologically due to it?
- increased by 30% by week 34
- pulse can rise 15-20 bom above baseline
-heart murmurs can occur
113what changes can occur to blood pressure during pregnancy, when do they occur and why?
-drop 10-15 mmhg in 2nd trimester
- decreased peripheral resistance
114what risk arrise from less venous return to legs due to uterine enlargement?
-ankle edema
-hemorrhoids
-varicose veins
115what can occur between the first and second trimester if a pregnant patient lays in the supine postion and why?
fainitng from uterine compression of vena cava + decreased CO/cardiac filling
116how should a pregnant patient always be transported and why?
left lateral recumbent position
-if not but pressur on vena cava -> reduced flow
117what risk increases in pregmancy due to fibrinogen and leukocyte counts rising?
venosu thromboembolish (4-5x)
118what changes can occur to the repiratory system from preganancy and at what stages?
-tidal volume increase
-maternal O2 increase
- PCo2 drops 10 mmhg
119what symptoms can occur from decreased Pco2 during pregnancy?
dizziness, shortness of breath
120what changes occur on a metabolic level during pregnancy and why?
- weight gain (15-30 lbs)
- increased water retension/edema
- higher caloric + protien demand
-lower iron + calcium (if not supplemented/kept up with)
121What is gestational diabetes mellitus, how does it occur and what is a distinc sign of it?
diabtes that has occured due to excess glucose from the babies production leading to insulin resistance in mom.
- glucose in the urine (trying to pump excess out)
122how is gestational diabetes mellitus managed?
- regular monitoring
- diet modificaitions
- exercise
- insuling (sometimes)
123how is gestational diabetes mellitus managed pre-hospitally?
- glucose testing
- hypo -> IV fluids + dextrose or glucagon
- hyper -> IV fluids + insulin
124what history questions MUST be asked in relation to delivery?
- how many weeks are you
- when is your EDC
- gravida/para #
-has your water broken
- was there any green stayning in your water
-how far apart are your contractions and how long do they last
-do you feel the need to push
- are you bleeding at all or passing anything unusual
-do you have any pain unrelated to the delivery
- any use of subtances in the last 4 hours or during the pregnancy
125What screening questions should you to a pregnant patient about the pregnancy itself?
- did you take any drugs or drink during this pregnancy
- do you have a doctor (who)
- have you had prenatal care
- is there expected issues
-do you have any medical problem (pregnacy related or otherwise)
- is there a posibility of multiple births
126what needs to be physically assesed on a pregnant patient?
- skin colour/condition
-abdo palpation for masses, ditension, peritoneal irritation
-vitals (high HR, low BP normal)
127where does the fundus sit at 12, 16, 20, 28-32, and 40 weeks of pregnancy?
12 weeks- just above symphysis pubis
16 weeks- midways symphisismbilicus
20 weeks- at umbilicus
28-32 weeks- towards xiphoid process
40 weeks- in pelvis
128what is a normal fetal heart rate and when does it become tachycardia and bradycardia?
normal- 120-160 bom
tachy; > 160 for 60+ seconds
brady: < 100 for 60+ seconds
129what is MEOWS and how is it used?
Modified early obstetric warning system
- pregnant 20 weeks -> 6 weeks postpartum
-parameters for normal/abnormal for baby and mom
-prediction for things
130what should occur it birth IS NOT imminent?
-Transport in left lateral recumbent position
- give care to ABS's
-monitor vitals + ECG
131what is hyperemesis gravidarum (in pregnancy), what are its symptoms, when is its time of onset + stops, what are some contributing causes and how is it managed?
- severe nausea/vomiting (severe morning sickness)
symptoms: weight loss, ketosis, electrolyte disturbance
onset: 2-5 weeks
ceases: before 20 weeks
cause: hormone imbalance, GERD, infection, motion sickness, stress
management: fluids + vitamins
132what is Rh sensitization and when does it occur?
Rh (-) mom with Rh (+) dad = Rh (+) baby
- baby 1 has no issues ( sensitization only occurs at birth/abortion/ectopic and become an issue in the future)
- baby 2 has risk have getting Rh disease (from previous sensitization)
133what is Rh disease, what are the symptoms associated and how can it be prevented and treated (mom + baby)?
Rh disease: Rh (+) from mom attacks fetuses Rh (-)
symptoms: anemia, jaundice, edema (hydrops fetalis)
prevention: WinRho injection at 28 weeks + 72 hours postpartum (if baby positive)
treatment: mom (early c-section), baby (blood transfusions)
134what is gestatinal hypertension, when does it resolve and what can it be an early sign of?
bp > or = 140/90 after 20 weeks
- resolve postpartum
-warnign sing of preeclampsia
135what is preeclampsia and what are the risk factors towards developping it?
gestational hypertension + proteinuria (protein in pee) OR abnormality
risk factors:
- first pregnancy
- geri pregnancy
-hypertension/kidney disease
-diabetes
136what is the classic triad presentation of preeclampsia?
- edema (face, hands, ankles)
- gradul onset of hypertension
-protiein in urine
137what BP can be defined as severe preeclamsia ?
SBP > 160 or DBP > 110
138what are the 4 p's of labor?
Power (strengthegularity of contractions)
Passenger (fetal position/health)
Passage (pelvic shape/anatomy)
Psyche (mindset/comfort)
139what makes preecmplasia dangerous and when is it resolved?
-rapid progression
-early signs can be missed
- resolves postpartum
140what is eclampsia and who is it most likely to affect?
-preeclampsioa + seizures
- healthy, normotension, first time pregnant
141what is eclampsia most common onset, duration and resolution?
onset: after 28 weeks (seizures start)
duration: week 28 - 48 hours postpartum
resolution: 23 days postpartum
142what complications come with eclampsia?
-abruptio placentae
- hemolytic anemia
- pulmonary edema
- kidney failure
- premature birth
143what is HELLP syndrome, who does it affect what are the symptoms associated wirh it and what is the only treatment for it?
Hemolysis, elevated liver enzymes, low platelets
- OB emergency (sudden increase in intra-abdominal pressure)
- preeclampsia/eclampsia
Symptoms: headache, worsening nausea/vomimitng, RUQ/epigatric pain, vision disturbance
Treatment: prompt delivery
144what are the 2 biggest risks associated with HELLP syndrome if a baby is not delivered?
-subscapural liver hematoma rupture
- hypovolemic shock
145what is the treatments for severe preeclampsia + eclampsia prehospital (PCP)?
- left lateral recumbent position
- handle gently
- low sensory stimulation
- high concentration 02
-monitor vitals + spo2
- place an IV
- prep for seizure (suction+bvm+ airway ready)
146what is the treatment for severe preeclampsia + eclampsia in hospital or ACP?
mag sulfate + antihypertensives + diazepam (if seizing)
147define macrosomia?
large baby
148what is a TORCH infection, what complications can occur form it and how can it be prevented?
toxoplasmosis, other, rubella, cytomegalovirus, herpes
complications:miscarriage, anemia, congenitla defects, pneumonia, devlopmental delay
prevention: immunization, hygine, safe sex
149why is ther an increase risk of PE in pregnancy/postpartum, what are the sings of one and how do we care for it?
- venous stasis, hypercoagulability, vessel injury, amniotic fluid (post)
signs: sudden dyspnew, chets pain, tachycardia, crackles, hemoptysis
care: ABC support, ECG monitoring, rapid transport
150what is a premature rupture of membranes (PPROM) when can it occur, what are the signs assicoated with it and what is the treatment?
-rupture of amniotic sac before lab onset (regardless fo fetal age)
- < 37 weeks or < 34 weeks (higher risk)
signs: trickle or suden gush of vaginal fluid
treatment: delivery + antibiotics
151what is a complication what can occyr from PPROM, when does the risk become greater and what are the signs of it?
Chorioamnionitis (membrane infection)
- 24 hours + since rupture
signs: maternal fever, chills, uterine pain
152what are all the sources of vaginal bleeding in pregnancy?
- spontaneous abortion
- ectopic pregnancy
- abruptioa palcentae
- placenta previa
- uterine rupture
- postpartum hemorrhage
153what is the most freequent cause of vaginal bleeding?
spontaneous abortions
154what is a spontanious abortion and when does it occur?
non-induced termination of pregnacy
- before 20 weeiks
-commonly before week 10
155whay are the causes of a spontaneous abortion and how can a patient present?
cause: maternal illness, toxic substance exposure, fetal abnormalities
presentation: axious, cramping pain, bleeding
156what are crucial questions that must be asked suspecting a spontaneous abortion?
time of pain
bleeding onset
amount of blood
tissues/clotting present
157what is the prehospital management for a spontaneous abortion?
-observation
-monitor vitals
-IV fluids
-O2
-emotinal support
158what is an ectopic pregnancy?
fertilized ovum implants somewhere other then the uterus
159what are the predisposing factor of an ectopic preganancy?
PID
prior sugery/adhesions
tubal ligation
previous ectopic
IUD
160when do must ectopic pregnancies rupture and what can they mimic?
2-12 weeks (6-8 most common)
mimic: rupture ovarian cyst, PID, appendicitis, abortion
161what is the classic presentation of an ectopic pregnanciy and its additional symptoms?
triad: abdo pain, vaginal bleeding, amenorrhea
other: referred shoulder pain, nausea/vomiting, syncope, shock signs
162what is the prehospital management for an ectopic pregnancy?
-ABC support
-IV fluids (lots)
-rapid transport
163what is abruptio placentae?
partial or full detachment of the placental > 20 weeks
164what are the risk factors for abruptio placentae?
-hypertension
-meth use
-cocaine use
- trauma
-previous abruption
165what bleeding occurs from abruptio placentae and the pain levels associated with it?
-dark heavy blood (may be concealed behind placenta)
- sudden severe abdo pain
166what does the abdo exam of a abruptio placentae look like?
-tender, rigid uterus
- slow fetal HR
167what is placenta previa?
placental implantation in lower uterine segment (partial or complete covering of cervical opening)
168what are the increased risk factors in placenta previa?
-previous c-sections
- increased maternal age
-multiple pregnancies
-recent intercourse
169what bleeding occurs from placenta previa and the pain levels associated with it?
-bright red
- in episodes (once in 2nd, once in 3rd, severe at labor)
- painless
170what is the abdo exam like on a placenta previa patient?
-non-tedner
-present fetal heart tones
171what is a uterine rupture?
spontaneous/traumatic rupture of the uterine wall
172what are the risk factors of a uterine rupture?
-previous c-section
-prolonged/obstructed labor
-direct trauma
173what bleeding occurs from a uterine rupture and the pain levels associated with it?
-possible bleeding (may not be vissible)
-severe, sudden, tearing pain
174what is the abdo exam of a uterine rupture like?
-diffuse tenderness
- sudden cessation of labor
-brady fetal HR
175what needs to be done for a uterine rupture immediatly?
delivery, under one hour (under 37 minutes if optimal)
176how is third trimester bleeding (abptrio, placenta previa, uterine rupture) treated prehospitally?
- OPQRST (bleeding + pain)
- check for grey turners + cullen sign
-ABC support/management
-postion in left latereal recumbent
- LOTS of IV fluids
-monitor vitals
177what should never be done on a pregnant patient in the third trimester when presenting with vaginal bleeding?
-try to stop bleeding with handandage
- do a physical vaginal exam
178define parturition?
near end of pregnancy uterus has contractions that grow more and more until labor begins
179what is the definition of early labor, how frequent are the contractions, what is the pain like and how long does this stage normaly last?
def: 0-3 cm dilated
-contraction every 5-20 min (30-45 sec)
pain: backache/ mild discomfort
duration: 8-20 or 6-8 hours
180Define primips and multips?
prmips: presenting part stays visble between contractions
multips: water broken+ strong contractions + active pushing
181what is the definition of active labor, how frequent are the contractions, what is the pain like and how long does this stage normaly last?
def: 4-8 cm dilated
contraction: every 4-5 min (60 sec)
pain: intense, trembling
duration: 1-2 hours
182what is the definition of trasition labor, how frequent are the contractions, what is the pain like and how long does this stage normaly last?
def: 8-10 cm dilated
contractionas: every 2-3 min (60-90 sec)
pain: rectal presssure, membrane rupture, intense
duration: 15-30 minutes
183what is the definition of delivery, how frequent are the contractions, what is the pain like and how long does this stage normaly last?
def: full dilation
contractions: 2-3 min
pain: bearing down, tahcycardia, diaphoresis, bloody show
duration: 1-2 hours or < 30 min
184what is the definition of placental delivery, and how long does this stage normaly last?
delivery of newborn -> placeta expelation
duration: 5-60 min
185define the frequency and lenght/duration of a contraction.
frequency: begeinning of one contraction to beginning of next one
lenght/duration: begining to end of SAME contraction
186what are the 3 stages of labour and there subsections ( if applicable)?
1. cervical dilation/ contractionds (early, active, transition)
2. delivery
3. placental delivery
187what symptoms can present when transitions labor is occuring?
vomiting, shaking, increased bloody show
188what are the signs of imminent delivery of a baby?
- regular contractions (45-60 seconds, 1 min intervals)
- mother has urge to bear down/poop
- large bloody show
-crowning
189when can you assume delivery is NOT immeninent based patient assesment time?
10 minutes of initial assesment
190define vertex and its importance?
-baby is positioned head-down with top/crown of head leading into birth canal
- uncomplicated birth should occur
191how should you prep for a delivery?
- provide privacy
- call for ALS
- put mom on long bed/table/stretcher
- put pads under her
-keep area clean (as possible)
-mom on bakc with knees flexed + widely seperated
192what are the steps of delivering a baby and which steps should be documented?
1. observe precaution
2. whe crowning starts apply counterpressure to head (if amniotic still intact break it)
3.after head delivers check if cord is around neck (slip off if it is) (clap + cut if absolutly necesary)
4. wipe secretions from babies mouth/nose
5.support babies head when is rotates to deliver shoulders
6.guide shoulders (go lateral then up)
7.support baby as they emerge
8. dry them and clean them
9.clean airway with steril gauze
10. place skin to skin with mom
11. record time + sex of birth
12. clamp cord after 2 minutes
document ( crowning + time of birth)
193in the case of a nuchal cord what are the three things that can be done?
-slipp cord from around neck
- somersault baby out
- clamp + cut ( last resort)
194What are the postions a baby goes through in an uncomplicated birth?
Descent: head moves down into pelvis until birth
Flexion: chin to chest → smaller presenting diameter
Internal rotation: back of head turns to front of pelvis
Extension: head, face, chin born
Restitution (external rotation): head turns to line up with shoulders
Birth: shoulders and body emerge
195what needs to be ready after a baby is born in case of complications?
-suctions
-PPV
-blanket
196what is an APGAR score and when is it calculated?
- evaluate a newborn baby's physical condition and overall health
-1 minute and 5 minutes after birth
197what are the components of an APGAR score ?
A – Appearance: Skin color
P – Pulse: Heart rate
G – Grimace: Reflex irritability or response to stimulation
A – Activity: Muscle tone
R – Respiration: Breathing effort and rate
198how does the APGAR scoring work?
- each factors gets a 0/1/2, max of ten overall
10 = best possible.
7–10 = generally normal (most newborns score 7–9; some sources say 8–10).
4–6 = moderately depressed.
0–3 = severely depressed.
199what earns a 0,1,2 in apperance in APGAR?
0- blue/pale
1 - body pink, extremities blue
2- completly pink
200what earns a 0,1,2 in pulse in APGAR?
0- absent
1 - < 100 bpm
2- > 100 bpm
201what earns a 0,1,2 in grimace in APGAR?
0- no responce
1 - some flexion
2- active motion
202what earns a 0,1,2 in respirations in APGAR?
0- absent
1 - slow/irregular
2- good/crying
203In what situations do you need to clamp the cord immediatly post birth?
-Resuscitation is needed
- mother is unstable/hemmorhaging
204what are the steps to clamping the cord postpartum?
1. wait till is stops pulsating (2 minute ish)
2. clamp 15 cm from newboarn and 5 cm from first
3. cut between clamps
4.check both ends for bleeding
205what are the signs the placenta is ready to be delivered and what is the timeline for it?
- contractions resuem
- palpable rise of uterus
- cord lenghtens
- suden gush of blood
5-60 min post birth
206how can you aid the placental being delivered?
controlled cord traction ( gently pull while gaurding uterus with other hand)
207what needs to be done after the placenta is delivered?
- place in plastic bag
-examin vagine for tears
-consider oxytocin
208how much blood is normal too lose during childbirth?
up to 500 mL
209what is an external method to stop bleeing after birth?
fundal message
210How often should you assess patients' fundus after placental delivery?
every 5 min for the first 15 min
211what is cephalopelvic disproportion and what is our prehospital care for it?
-newborns head too large for mom birth canal
care: o2, IV acess, rapid transport
212define shoulder dystocia and the risks associated with it?
-baby shoulders wedge againts moms symphisis pubis after head delivers
dangers: brachial plexus injury, clavicle fracture, fetal anoxia, asphyxia, pneumo
213what is turtle sign and what is it associated with?
head retracts againts moms perinum in birth (shoulder dystocia)
214what is intrapartum?
precipitous labor, prolonged labor
215what is the pneumonic used to try and help relive a shoudler dystocia?
A- ask for help ( need 2 people)
L- McRoberts ( out+up traction)
A- Adduct ( suprapubic pressure) ( do between contractions)
R- Roll over (gaskin)
M- delivery of poterior arm
216what needs to be document during a shoulder dystocia and how many attemps do you have at it?
- time of head
- time of each manoeuvre
- 2 attemps < 10 minutes ( switch medics between attemps_
217whens does irreversible hypoxia set in during a complicated birth?
8 min after head delivers
218Define a breech presentation, when does it most commonly occur, what complications can arrise from it and what are some identifiyng factors of it?
- feet or buttocks present first
- with multiple births + before 32 weeks
- prolapsed cord , hyperextended neck, hypoxia, fractures
- meconium at perineum
219what increases the likelyhood of a breach prensentation?
-previous breach
- prematurity
- multiple pregnancies
- congenital abnormalties
220what are the 4 different kinds of breach presentations?
complete ( everything flexed)
frank ( hips flexed, legs extended)
footling ( one or borth feet present)
knee presentation ( hips extended, knees flexes, knee(s) present)
221what do we do when a baby presents breach if fetus is not vissible or only legsut vissible?
- DO NOT PUSH
- rapid transport
- o2 administration
- gloved hand (attempt to delay delivery)
222what do we do if a baby presents breach it the delivery is immenent and you CANNOT transport?
- let buttocks/trunk/feet deliver
- do not assist until umbilicus is visible
- support body as head delivers ( gently rotate if stuck)
- DO NOT pull on newborn
- asses for prolapsed cord
223what two times need to be document during a breach presentation and should those times be?
- umbilicus presentation ( 4 from birth)
- hairline presentation (1-2 min)
224what is a shoulder (transverse presentation) and what is our care for it?
- shoulder/ arm presents first
- CANNOT deliver ( pant through pain)
care: O2, ventilation, circulatory support, rapid transport
225what are the two most common complicatins from a transverse presentation?
-prolapsed cord
- uterine rupture
226what are the types of malpresentation?
transverse lie, shoulder presentation, oblique lie, untable lie
227what two types of delivery can we NOT do?
- transverse (shoulder) presentation
- prolapsed cord
228Define cord prolapse?
cord passes through cervix ahead of head or alongside it
note: can compresses + deminishes fetal oxygenation
229what are predisposing factors for a prolasped cord?
-breech presentation
- lack of prenatal care
- twinning
- GDM with a large baby
- Preterm labor
230what are the steps after viewing a prolaplsed cord?
1. gently push presenting part off cord with gloved hand
2. relplace cord into vagina ( if possible)
3. maintain hand postion through rapid transport
4. position the mother hips elevated (trendelenburg)
5. administer 02
6. have patient pant with contraction to avoid bearing down
231what defines a premature birth and what are the increased risks for it?
- born before 37 weeks
- low birth weight < 5.5 lbs
increased risk: hypothermia, cardiorespirtory distress
232when is a premature baby viable from?
22-26 weeks
233what is the care for a premature baby after they are born?
- keep warm + dry
- wrap in blanket or foil blanket
-suction secretions
- monitor cut cord
- administer blow by O2
-protect from contanimation
- gently transport
234what risks increase with multiple gestations?
-premature labour
- PROM
- abruptio
- postpartum hemorrhage
- abnormal presentation
- twin to twin transfusion syndrome
235compare fraternal to identical twins and there blood supplies.
fraternal : two ova/sperm
- seperate placentas
identical: one fertilized ovum
- may share placenta + sac
236what are special things about twin delivery?
- 1st twin delivers normal
-clamp and cut the cord
- 2nd twin can be normla or complex
-both come out before placenta
237what are signs that there is an undiagnosed twin and what should be done if that occurs?
-smaller baby then expected, fetal parts palpable, strong contractions, baby presenting
- document how baby 2 presents
- decided load and go ( malpresentation), or stay and play ( normal presentation)
238what timeline defines postpartum?
placental delivery -> 6 weeks post
239Define a postpartum hemorrahage, when its most common, and the causes associated with it?
- bleeding after the delivery of the placenta
-3 hours after is most common
causes: uterine atony/contraction, retained placental fragement, vaginal/cervical tears
240what is the leadin cause of maternal death?
postpartum hemorrhage
241what are the fours t's of postpartum hemorrage and what are the significance?
Tone- unterin atony (failure to contract)
Tissue: retained placental or placental fragments
Trauma: laceration, inverted uterus, rupture uterus
Thrombin: clot
242define APH and IPH?
- excessive vag bleeding after 20 weeks
- excessive bleeding during labor
243What is the management for postpartum hemorrhage prehospitality and the steps if it doesnt stop?
- put newborn to chest
- fundus message
-place a sanitary pad over vagina
DOESNT STOP
-100% o2
- elevate legs
- keep mom warm
- IV fluids
- external bimanual compression ( unstable)
-consider oxytocin
244if the placental is undelivered but PPH occurs, is fundal message oK?
no, can create fragments = worsening
245what is a unterine inversion, what can cause it and what are the signs?
- uterus turns inside out after birth
assciated: excessive cord traction, fundal message, high placental implantation
signs: profuce postpartum hemorrhage, sudden severe lower abdo
246what is the management of a uterine inversion prehospital?
- ABC
- do not revome placenta if hasn't delivered
- cover protruding tissues with moist steril dressing
-rapid transport
247define baby blues and postpartum depression.
Blues: mild and resolves within 2 weeks
Depression: severe and more then 2 weeks
248what is a amniotic fluid embolism and its signs and symptoms?
- amniotic fluid enters maternal circulation and obstructs a pulmonary vessel
- same signs as PE
249what is a postpartum infection and its signs?
- incision infection, uterine infection, endometritis
signs: infection + foul smelling discharge
250what are the causes and there associated risk of trauma in pregnancy?
-MVC (seat-belt signs)
- Pelvic fracutre (high fetal death rate)
-Placental seperation
- Maternal shock
- Uterine ruptre
- Fetal head injury
-abruptio
251what are the prioritys when a trauma has occured to a pregnant patient and where do you transport them?
- Control hemorrhage
- Ensure ABCS are good
- Spinal precautions
-High flow O2 (above 95 SPO2)
- IV fluids
- monitor vitals CLOSELY
-secure penetrating objects/any factures
- Transport on left lateral side (put towels or pillows under spinal board)
destinations: go OB if no major trauma, go trauma if trauma PT
252Compare fetal heart acceleration and deceleration?
accelaration: stress + high heart rate
deceleration: hypoxia + bradycardia
253what are the main causes of cardiac arrest in pregnancy and the mnemonic for it?
- amniotic fluid embolism
- aspiration penumonitis
- drug toxicity
- emclampsia
BEAU - CHOPS
254What are the CPR modifications when you patient is pregnant?
- put on left lateral with pilows under to hold them
- compression higher on stermun them usual
- IV higher then diphram
- prepare for a difficult airwasy
- manage vitals
- shock whenever possible
255what is the mauriceau-smellie-veit manoeuvre and when it is used?
- combo of neck flexion, pelvic traction, and suprapubic pressure ( document)
- used when fetal head is delayd during breach
256define occipitoposterior(op)
babies sunny side up
257define SROM?
spontaneous rupture of memebranes