1. Obstetrics & Neonatal Care

2. 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

3. 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 mls of fluid
Helps insulate and protect fetus

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

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

13. 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?

14. 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

15. 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

16. 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
assist ventilations with BVM and o2
Less than 60 CPR call for ALS

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

18. 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

19. 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