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Flashcards in Obstetrics Emergency Deck (112):
1

Habitual Abortions

3 or more consecutive pregnancies that end in miscarriage

2

Measuring fundus

Length in centimeters corresponds to length of gestation
Measure from top of pubic bone to top of fundus

3

Woman's GI tract relaxes due to progesterone causing

Decrease in moving stomach contents causing heartburn and burping

4

Respiratory Disorders in Mom

Usually dyspnea due to physical changes of pregnancy
Asthma, most common, may occur first time during pregnancy
Attacks render fetus and mother prone to hypoxia
Pneumonia, leading indirect causes of maternal death in USA because the immune system of Mom is already depressed

5

Renal Disorders

Urine increases by 25-50%

6

Episiotomy

Incision of the perineum

7

Cephalon Presentation

Face first.
If cannot deliver, support mom and baby and transport!

8

Valium

Eclamptic seizures when Mag Sulfate does not respond
Or anxiety in preeclampsia patients

9

Umbilical cord

Contains Wharton jelly which keeps umbilical cord from becoming knotted
Contains one vein and two arteries

10

Labor

When fetus and placenta are expelled from vagina

11

Pregnant Trauma

If trauma occurs and Mom is bleeding, blood will shunt from fetus and be used for Mom.
When signs of shock present, fetal mortality is 70-80%
Normal fetal heart rate is 120-180
If transported supine, elevate right hip 6 inches, if not recumbant position is necessary or elevate backboard underneath

12

Cytomegalovirus

Member of herpesvirus family
Newborn succeptible to lung problems, blood, liver, and poor weight problems

13

Heart of Mom

Displaced upward and to the left with a slight rotation in its long axis, which causes apex of the heart to shift laterally

14

True Labor vs Flase Labor

True:
contractions regularly spaced
Interval between shortens
Intensity increases
Analgesics don't help
Progressive dilation
False:
Opposite of above

15

Blood Volume

Before about 4-5L of blood
After increases 40-50% in blood

16

Second Stage of Labor

Begins as head of fetus descends and enters birth canal
Then head rotates inside cervix to position properly
More intense contraction 2-3 minutes apart
Crowning begins to occur meaning delivery is imminent
Takes 30-60mins

17

Hyperemesis Gravidarum

Persistent nausea and vomiting during pregnancy
Leads to dehydration and malnutrition
Most common in first pregnancies, obese and multiple gestation

18

Primipara

Only one delivery

19

Abruptio Placenta Assesment

Vaginal bleeding, bright red blood, sudden abdominal pain
No longer feel fetus moving
Signs of shock
Abdominal wall tender and uterus ridged to palpation

20

Luteinizing Hormone

Which stimulates the process of ovulation

21

Amniotic fluid

Reaches about 1liter by birth
Provides weightless environment

22

Weight gain

Partly due to increased blood flow and increase in intra and extra cellular fluid, uterine growth, placental growth, and increased breast tissue (2-3lbs)

23

Corpus Luteum

What is last of follicle after egg has been released which in return secretes progesterone
Embryo to a fetus

24

Vagina cavity

Inside is acidic owing to the breakdown of glycogen ( in the vaginal mucosa ) which creates a low pH environment inhibiting growth of bacteria.
This acid harms sperm killing off many because sperm is alkaline in nature.

25

Each female is born with all the eggs that will ever release

Approximately 400,000 in a lifetime

26

TORCH Syndrome

Stands for
Toxoplasmosis
Other Agents
Rubella
Cytomegalovirus
Herpes Simplex
- refers to infections that occur in neonate as a result of organisms pass g through placenta barrier from woman to fetus

27

Threatened Abortion

Abortion trying to take place characterized by bleeding

28

Ectopic Pregnancy

Fertilized ovum becomes implanted somewhere other than the uterus
Normal symptoms of pregnancy with severe abdominal pain
All females with lower abdominal pain should be suspected of ectopic pregnancy

29

Rh Sensitization

Rh is a protein found on RBC's of most people.
When woman who is Rh neg becomes pregnant by a man that is Rh positive, and the fetus inherits the factor, the fetal blood can pass into the woman's circulation and produce maternal antibody isoimmunization to the factor. (The fetus will and can be attacked by Mom)

30

Cephalopelvic Disproportion

Big Ass Head Baby

31

Shoulder Dystocia

Difficulty in delivering shoulders
Fetus cant breath if compacted with shoulders
-Use McRoberts maneuver knees to the chest
-apply pubic pressure on lower abdominal wall and may need to gently pull on patients head

32

Rubella

"German measles" viral infection

33

Assisting Delivery

-crowning, gentle pressure on newborns head
-support head when head exiting, do not pull on newborn. If membrane is still covering, tear membrane with hands
-slip finger down neck to check for Nuchal cord
-if nuchal cord, gently slip over head, if can't cut cord
-clear airway with suction as soon as head exits
-gently guide head upwards and downward for shoulders
-delivered, maintain same level as vagina
-wipe blood or mucus from newborn, suction mouth and nostrils,
-dry newborn with towels, stimulate, suction and wrap with towels
-record time of birth

34

Supine Hypotensive Syndrome

When mom lays in supine position the uterus comprssses the inferior vena cava and can occur sitting.
Takes 3-7 minutes before symptoms become apparent
Nausea, dizzy, dyspnea, syncopated episode
Place in left lateral recumbant position

35

Prolapsed Umbilical Cord

Cord emerges first before fetus
-supine mom with hips elevated
-100% oxygen
-pant with each contraction decreasing bearing down
-push presenting part (not cord) back into vagina until no longer presses on cord
-cover exposed portion of cord with dressings moistened in saline
-maintain position and transport fast

36

Amniotic Fluid Embolism

When amniotic fluid and fetal cells enter woman's pulmonary and circulatory system

37

Delivery of Placenta

Bear down to expel placenta when following contractions occur
Place placenta in plastic bag
Examine perineum for lacerations and apply pressure to tears

38

Uterine Inversion

Placenta fails to detach and adheres to uterine wall when expelled resulting in prolapsed uterus
-keep recumbent
-100% oxygen
-two IV lines with saline and titration
-treat for shock
-oxytocin to help hemmorage
Attempt once to push uterus easily back inside.
If this fails, cover portruding uterus with saline wet dressing

39

Placenta Previa Management

Left Lateral Recumbent
100% oxygen NRB 15lpm
Fluids
Place loose trauma pads over woman

40

Management of Hyperemsis Gravidarum

1) 100% oxygen NRB
2) Fluid bolus of 250ml
3) Diphenhydramine 10-50mg IV/IM
4) BGL
5) Orthostatic Vitals

41

Imminent Abortion

Spontaneous abortion that can not be prevented

42

HIV in Mom

Fetus can contract from breastfeeding, during pregnancy, delivery.

43

Multipara

Two or more deliveries

44

Terbutaline

Tocolyitc! Relaxes the uterus and can stop contractions, especially for cord prolapse
Also can treat pregnancy-induced asthma with bronchodilator effects.

45

Duphenhydramine

Used to treat hyperemesis gravidarum

46

Toxoplasmosis

Parasite from contaminated food the fetus gets causing an infection

47

Magnesium Sulfate

Management of eclampsia
Beta blockers used for BP if still hypertensive

48

Breech Presentation

Butt first or limb first
-flex knees of Mom
-don't pull, but let butt deliver
-once legs are out, support body
-lower newborn to hang legs so body weight pulls itself
-grab legs when head is visible lift up and down of legs and head should exit easily
-if no head after 3 minutes, newborn in danger of suffocation. Insert v shaped fingers of newborns nose and mouth pressing against the vaginal canal until head is delivered
-do not pull. If still not delivered rapidly transport maintaining newborns airway

49

Gravid

Number of times pregnant

50

Blood Pressure of mom

Usually decrease around 5-10mmHg around 12th week and returns normal around 36th week

51

Postpartum Care

Massage fundus after delivery will help with bleeding
Cover Mom with blankets to prevent hypothermia

52

Nullipara

Has never delivered

53

Gestational Period

Time it takes for fetus to form and develop which usually takes 38 weeks

54

Oxytocin

Postpartum hemmorage causing uterus to contract and shunt bleeding
3-10 units IM

55

Chronic Hypertension

BP > 140/90mmHg prior to pregnancy

56

First Stage of Labor

Contractions early at 5-15 minutes apart
Later Phase the cervix begins to dialate
Last until cervix is fully dilated (10cm), usually between 8-12 hours

57

Cholestasis

The accumulation of bile can put stress on the fetus

58

Release of an egg

Is called an ovum

59

Eclampsia

When the patient experiences a seizure from result of hypertension

60

Birthing positions

Standing Birth
Semi-Fowlers position
Kneeling Birth
Side Lying Position

61

Placenta begins to form on the..

The fourth week after conception

62

Twins

Identical if share the same placenta

63

Abruptio Placenta

Premature separation of placenta from uterine wall
Usually occurs during last trimester of pregnancy
Hypertension most common cause followed by trauma

64

Fallopian tubes

Tubes in which the ovum passes through

65

Placenta Previa

Placenta is implanted low in the uterus, and as it grows, it partially or fully obstructs cervical canal.
C/o painless vaginal bleeding of bright red blood
DO NOT PALPATE ABDOMEN DEEPLY in any woman with third trimester bleeding

66

Diabetes in Mom

Gestational Diabetes is inability to process carbohydrates during pregnancy.
Pregnancy hormones can effect insulin production
Oral hypoglycemic agents can cross the placental barrier

67

Hydraminos

Too much amniotic fluid

68

White blood cell during pregnancy

Triple in count

69

4th-8th week of embryonic development is

Critical for embryonic development
Major organs and body systems start to form
Where birth defects are made during the development phase (smoking, drugs, alcohol)

70

Precipitous Labor and Birth

Baby delivered before EMS arrival

71

Multigravida

Had two or more pregnancies

72

FSH (follicle-stimulating hormone)

When the oocyte matures and responds to FSH which is released by anterior pituitary gland stimulated by the release of GnRF from the hypothalamus

73

Each follicle contains an ____

Oocyte (egg)

74

Placenta Previa Assessment

When did it start? What were you doing ? How much blood? Abdominal Pain?
Look for Grey Turner or Cullen Sign

75

Kidney size in woman..

Increase up to 30%

76

Postpartum

After delivery

77

Uterus enlarges causing

Pressure on the lower end of the intestine and rectum causing constipation

78

Placenta

Respiratory gas exchange
Transport nutrients
Excretion of wastes
Transfer of heat
Hormone production
Formation of a barrier

79

Prenatal vitamins

Body increases RBC's by 33% which demands more iron and other nutrients

80

Incomplete Abortion

Part of fetus expelled but some remain inside
Can try fundus massage

81

Fetal lungs

Blood bypasses the lungs until birth because the baby receives oxygen from the placenta

82

Preeclampsia

Occurs in 8% of women
Risk: <20y/o first pregnancy
Manifests after 20th week gestation
Symptoms leading to eclampsia:
Facial Edema, ankles and hands, gradual onset of hypertension, and protein in urine

83

Lithotomy Position

Mom laying supine with her knees spread apart, or feet in stirrups

84

Calcium Chloride

Antigone to magnesium sulfate
Can cause bradycardia, syncope and dysrhythmias
May be repeated every ten minutes

85

Linda Nigra

Dark line of pigment down middling of stomach is normal

86

Umbilical arteries

Carries arteriovenous blood to the placenta

87

Herpes

Infection of genitals by herpes type 1 or type 2

88

Preterm Labor

Labor, begins between 20-37th week of gestation

89

Complete Abortion

When all parts have been expelled

90

Pregnancy-induced Hypertension

Develops after 20th week gestation with normal BP before pregnant
May be early sign or preeclampsia

91

Third Stage of Labor

When the placenta separates from the uterine wall
Last from delivery until Placenta is expelled from vaginal canal
5-60 minutes

92

At end of pregnancy the uterus and placenta prodcues

Prostaglandins that, along with oxytocin, will signal the uterus to contract and labor will begin

93

Uterus

Muscular, inverted pearshaped organ that lies between the urinary bladder and the rectum

94

Hormone Relaxin

Causes collagenous tissue to soften and produce a generalized relaxing of the ligament out system, especially along the spine.
Helps lordosis of spine and increased flexion of the neck
Also loosens pelvic joints

95

Uterus changes after conception

From 10ml of fluid in uterus to 5,000ml before conception
Rarely returns to normal size after pregnancy

96

Primigravida

Pregnant for the first time

97

Each ovary contains

200,000 follicles

98

Abortion

Expulsion of the fetus before the 20th week of gestation
-Spontaneous (1in5pregnancies) and Elective Abortions

99

Nuchal Cord

Slip finger under and over fetus head
Cut if too tight

100

Female reproductive organs

Ovaries, Fallopian tubes, vagina, uterus, mammary glands

101

Hypertension of

Greater than
Systolic of 160-180
Diastolic of 105
In prescence of other symptoms may require administration of emergency hypertension medications (lebatalol)

102

Cervix

Narrowest portion of the cervix that opens into vagina

103

Para

Number of live births

104

Conception causes woman to lose _____ of blood

500-1000ml of fluid/blood

105

Diaphragm of Mom

Displaces up about 1 and 1/2 inches

106

Ovum if not fertilized

The ovum dies and degenerates

107

Imminent delivery

Vitals
Estimate gestational age
Listen for fetal heart tones (<120/min=distress)

108

Umbilical vein

Carries oxygenated blood from placenta to fetus

109

Post-Term Pregnancy

If fetus hasn't been born after 42 weeks

110

OB Kit Prep

Maintain sterility
Gown and Mask up
Drape mother with towels
Emesis Basin and Portable suction
Oxygen if high risk pregnancy
Oxytocin available
ECG
IV Fluid if hypotensive

111

Heart begins to beat on..

The third week after conception

112

Seizure with Mom

Two patients
Benzodiazepines cross the placental barrier and effects fetus
Magnesium sulfate is preferred, especially with eclampsia
High Flow supplemental oxygen needed for both patients to counteract hypoxia of seizure