NREMTP Review-Drew 🚑🚒 "OB/Neonatal"
OB & Neonatal Emergencies 🍼🚼
Prolapsed cord
Shoulder Dystocia
Abruptio Placenta
Ectopic Pregnancy
Pre-eclampsia
Eclampsia
HELLP Syndrome
Breech Births
Diaphragmatic Hernia
Preterm Neonates
Meconium
Uterus
Must contract and clamp down during labor
The top of the uterus=Fundus
Must also clamp down and contract after birth to prevent post-partum hemorrhaging
oxytocin comes from the pituitary gland, causing the uterus to contract
Post-partum bleeding (1. Fundal massage 2. get the baby to the breast to start breast feeding 3. Initiate an Oxytocin infusion)
Abruptio Placenta (seen late 2nd/3rd trimester)
An abrupt (Acute) tearing of the placenta from the uterine wall
May or may not have vaginal bleeding****
Always will have pain***
Pelvic or lower abdominal pain
Dark red bleeding****
Abdominal rigidity***
Onset of Hypovolemic shock
Neonatal Distress=Bradycardia
Most common cause=Trauma
Also caused by methamphetamine & cocaine use
HTN (Pre-eclampsia)
Left lateral, oxygen, treat for shock, fluids, keep Mom warm, emergent transport to an OB facility
Prolapsed Cord-when the cord is coming out of the vagina first
Biggest concern-The baby is lying on their own cord, cutting off blood supply
May also happen w/ a breech birth or a Macrosomia baby >9 lbs.
Immediately elevate the hips***
Knees to chest position***
Check to see if the baby is on the cord, if so, move that part off the cord (Move the presenting part off the cord)
Do not remove your hands, keep them off that cord throughout transport
May also place Mom in an all-fours position
Moist sterile dressing over the cord
Shoulder Dystocia
The baby's shoulder gets wedged/stuck against Mom's pelvis (Symphysis Pubis)
"Turtle Sign or "Tortoise sign"
Elevate the hips***
Knees to chest****
McRoberts maneuver (knees to chest, then place firm pressure into the pelvis, in an attempt to dislodge the baby's shoulder)
Modified Trendelenburg
Attempt to deliver the anterior shoulder/posterior shoulder
Place mom on all 4's
Ectopic Pregnancy
Occurs in the 1st trimester (Weeks 6-9)
Often, Mom does NOT know she's pregnant
Look out for a missed period
Unilateral pelvic or lower abdominal pain
Spotting
Dizziness
Pain may radiate to the shoulder
Hypovolemic Shock
PID-Pelvic Inflammatory Disease
Umbrella term for STDs
Gonorrhea
Chlamydia
Vaginosis
Midline pelvic pain
Fever
Chills
Foul smelling vaginal discharge
"PID" shuffle-shuffling gait due to the discomfort
Tachycardia
Gestational Diabetes-Diabetes during pregnancy
The high glucose levels cause a large baby (>9 lbs.)-Macrosomia
Gestational HTN-HTN during pregnancy
Pre-eclampsia-occurs after 20 weeks-"Remember the number 4!!!!
HTN >140/90
Proteinuria (frothy urine, incontinence)
Edema to the face/hands/feet/ankles
Hyperactive Reflexes (Clonus)-muscle twitching
Severe Pre-eclampsia (Pre-eclampsia w/ severe features)
HTN >160/110
Signs & Symptoms r/t the HTN (tinnitus (ringing in the ears), blurred vision, visual disturbances, epistaxis)
Time for mag sulfate!!!!!!
3-4 gm
Eclampsia
Onset of SZ
Magnesium Sulfate-Electrolyte
Smooth muscle relaxer
Relaxes the vessels causing vasodilation=lowers the BP
Relaxes muscles in the body from a seizure
Monitor respiratory status=may suppress the diaphragm
Reversal for Mag OD=Calcium Chloride
Syndrome
A collection of conditions
"1 of the most dangerous conditions in pregnancy!!!!!! HIGH MORTALITY
HELLP Syndrome (Related to pre-eclampsia)-occurs after pre-eclampsia
Hemolysis-Destruction of the RBCs (Dyspnea, low spo2, anemic)
Elevated Liver Enzymes-RUQ abdominal pain, hepatomegaly
Low Platelets-Unable to clot-bruising, purpura (larger purple dots), petechiae rash (small purple dots)-indicates bleeding
Initial Steps of Resuscitation
Dry, warm, and stimulate
perform deep suctioning
perform blow by or PPV
Norms of Pregnancy
Normal Gestation
37-41 weeks
3 Trimesters
Each trimester is 13 weeks
The last thing to develop on a neonate
LUNGS!!!!!!-37 weeks
Surfactant=keeps the alveoli open and the lungs strong
Prematurity=less than 37 weeks-#1 concern-RDS-respiratory distress syndrome
Normal neonatal V.S-Birth-1 month
HR-110-160 bpm....HR less than 100=Neonatal Bradycardia (Most common cause=Hypoxia)
RR-30-60/min
SBP-70-80s
Spo2-95-100%
Glucose-Normal->40-45 mg/dl----Hypoglycemia=less than 40 mg/dl
If HR is less than 100 bpm=Immediate stimulate/O2 or PPV
If the HR is less than 60 bpm=Chest compression
Example
VS-BP=72/42, HR-158, RR-52, Spo2-95%, BGL-52 mg/dl=NORMAL!!!
Most common cause of neonatal bradycardia=Hypoxia
MECONIUM
Meconium-A baby's first B.M (should occur 24 hrs. after birth)
Meconium Staining
The baby's body is stained with it, or it is present in the amniotic fluid
Meconium Aspiration
Initial steps of resuscitation=Warming, Drying, Oxygen, PPV,
Must intubate if PPV does not improve!!!!
ROP-Retinopathy of Prematurity
Blindness due to prolonged & overuse of oxygen!!!!
Using hi amounts of oxygen over a long period of time, destroys the blood vessels in the retina of the eye, leading to blindness
Diaphragmatic Rupture (Trauma) & Congenital Diaphragmatic Hernia
At birth-Congenital Diaphragmatic Hernia
Trauma-Diaphragmatic Rupture
Congenital Diaphragmatic Hernia
Hole in the diaphragm
all the bowels/stomach are pushing up into the chest cavity
Bowel sounds in the left side of the chest
Heart sounds on the right
Severe SOB/Dyspnea
Low spo2
Cyanotic
Tachycardia
Compressing the left lung=absent/diminished L.S on the left
Scaphoid Abdomen (Flat abdomen)
Barrel chest
Tracheal shift
BE CAREFUL!!!!! This presents similar to a tension pneumothorax!!! But of course...it is not!!!!
Intubate immediately!!!!!!!!!!!
Neonatal Apnea
Primary Apnea-The baby is not breathing, but starts to breath after stimulation and PPV
Secondary Apnea-The baby is NOT breathing, and still does NOT start to breath, despite PPV
Blood vessels of the umbilical cord
AVA=1 vein, 2 arteries
Precipitous delivery
A labor/delivery in under 3 hrs.
Normal Adult Tidal Volume
6-8 ml/kg
200 lbs., how much tidal volume would you deliver to the pt
100 kg x 6=600 ml
Neonate
4-6 ml/kg
The baby is 9 lbs. =4 kg x 4=16 ml
Minute Volume
Tidal volume x RR=mV
20 second Rule
A neonate has to have NO breathing for at least 20 seconds, for them to be considered apneic
Differentiate between normal periodic breathing and true actual apnea
BREECH BIRTHS
Breech Birth-The butt or legs are coming out first
Frank Breech-"F" is for feet at the forehead
Complete Breech-"C" is for crisscrossed-The baby's legs are crossed below them
Incomplete Breech (Limb presentation=Footling)
Unable to deliver in the field
STAT emergent C-Section
Concerns w/ a breech birth
Nuchal Cord-Cord wrapped around the neck
Prolapsed Cord-The cord is coming out of the vagina first
Compressed cord-The baby is lying on the cord
Adults=D50W
Children=D25W
Neonates/Infants=D10W
2ml/kg
Post-partum Hemorrhaging
Fundal Massage (top of the uterus)
Place Baby to breast for breastfeeding!!!-causes Mom's pituitary gland to release oxytocin
Oxytocin infusion-20-30 units
Oxygen
Normal Openings in the heart, before birth
Ductus Arteriosus
Opening between the Aorta & Pulmonary artery
Closes within 24 hours after birth
Foramen Ovale
Opening between the left & Right atriums
rH Incompatibility or rH sensitization
Blood Types
ABO
The + and - of a blood type is called the rH factor
Example-B+=+ rH factor A-=rH negative
In this condition, Baby is a danger to Mom
This occurs when Baby has a + blood type, but Mom has a - blood type
Baby is B+, but Mom is B-=Incompatibility
Mom is NOT in immediate danger; she will be in trouble if she decides to get pregnant again
Subsequent pregnancies are in danger, Antibodies will attack Mom's system
Mom needs Rhogam!!!!!