Obstetrics & Neonatal Care

Anatomy Review Ovaries Fallopian Tubes Uterus Cervix Vagina Produces eggs Fallopian Tubes Funnels egg toward uterus Usually where fertilization takes place Uterus Muscular organ where the fetus grows Endometrium/ Lining thickens to prepare for implantation monthly Cervix Neck of uterus that leads into birth canal Contains a mucous plug to seal uterine opening during pregnancy Vagina

Structures of Pregnancy Placenta A disk like structure that serves as a source of nutrients, oxygen and removal of wastes from developing fetus Umbilical Cord Attaches fetus to placenta Amniotic Sac Fluid filled bag that contains 500-1000mls of fluid Helps insulate and protect fetus

Changes in Pregnancy Hormone levels increase to support pregnancy Rapid uterine growth Exposes fetus to risk of injury Impedes respiratory system Increased respirations Decreased minute volumes Cardiovascular system Blood volume increases up to 50% Heart rate increases Red blood cells increase Weight Gain Center of Gravity Changes

First Stage Of Labor Dilation of Cervix Longest stage can last up to 16 hours Stretches and thins to become large enough for fetus to pass through Bloody show / mucous plug is released Amniotic sac ruptures / water breaks Primigravida (first pregnancy) longer labor Multigravida (has had previous pregnancies) shorter labor Mother may report lightening, fetus descends into pelvis easing respiratory discomfort

Second Stage of Labor Fetus enters birth canal and ends with delivery of infant. Decision time? Deliver on scene or head to hospital. Signs of imminent birth Mother urge to push Bulging of perineum Crowning

Third Stage of Labor Begins with birth of infant Ends with delivery of placenta May take up to 30 minutes Contractions continue to detach placenta and close blood vessels to reduce blood loss. Don’t delay transport waiting for placenta delivery

Complications of Pregnancy Hypertensive disorders Preeclampsia or pregnancy induced hypertension Headache Seeing spots Edema hands and feet Anxiety High BP Eclampsia Seizure Treatment Place pt on left side (supine hypotension Syndrome) Maintain airway ALS intercept

Complications of Pregnancy Bleeding Ectopic Pregnancy Miscarriage (spontaneous Abortion) Abruptio Placenta (painful bleeding) HTN and Trauma Placenta Previa (painless bleeding) Cervix dilation Any bleeding is of concern and should be transported promptly with ALS intercept

Complications of Pregnancy Diabetes Care for as any other diabetic patient May only be gestational diabetic Check glucose levels and treat accordingly

Trauma and Pregnancy Uterus susceptible to blunt force or penetrating trauma Maternal death = fetal death Supine hypotensive syndrome concern when immobilizing Joints are weaker and looser due to increased hormone levels Increased heart rate and blood volume delays symptoms of shock

Teenage Pregnancy Physical and psychological development may be an issue in addition to pregnancy concerns

Normal Delivery Management How long have you been pregnant? When are you due ? Is this your first baby ? Contractions, how far apart, how long do they last? Do you feel like you have to have a BM? Any bleeding or spotting? Has water broken? Any previous C-sections Have you had problems with a previous pregnancy? Do you use drugs, alcohol or take any medications? Multiple births? Prenatal care?

Delivery Position patient supine knees bent Drape pt to provide privacy Open sterile OB kit Be alert for precipitous delivery Coach patient and reassure Deliver head suction and guide for shoulder delivery Body delivers use caution baby will be slippery. Keep baby at level of vagina until cord cut Cut cord clamp 4 fingers from baby then another clamp 2-4’’ from first cut between

Delivery When head delivers if amniotic sac not ruptured must remove it. Feel around babies neck for cord if wrapped around neck unwrap before body continues to deliver

Postdelivery Care Stimulate baby by drying and warming Assess APGAR score at this time Wrap baby up covering head and allow mother to hold. Heart rate Greater than 100 warm dry and transport 60-100 assist ventilations with BVM and o2 Less than 60 CPR call for ALS

APGAR Perform at 1 min and 5 min Appearance Pulse rate Grimace Activity Respiratory Rate Score is 0 – 1 - 2

Delivery complications Breech presentation (butt first) Can have normal delivery but at risk for injury Limb presentation Prompt transport, surgical delivery required Prolapsed umbilical cord Position pt in trendelenburg Use gloved hand to relieve pressure from cord and transport

Complications Spina bifida Abortion Multiple births Abuse Birth defect with lumbar portion of spine exposed Cover with sterile moist dressing Abortion Termination of pregnancy before 20 weeks gestation Multiple births Abuse Substance abuse Premature vs post term Fetal demise Postpartum hemorhage