Chapter 40: Obstetrics

Obstetrics- the branch of medicine that deals w/the care of women throughout pregnancy. Prenatal period (pre-birth period)- is the time from conception until delivery of the fetus. A & P of Obstetric Patient Ovulation- the release of an egg from the ovary Placenta- the organ that serves as a lifeline fro the developing fetus. Afterbirth- the placenta and accompanying membranes that are expelled from the uterus after the birth of a child. Umbilical cord- attaches the placenta to the fetus. o 2 umbilical arteries- return relatively deoxygenated blood to the placenta. o 1 umbilical vein- transports oxygenated blood to the fetus Amniotic sac- the membranes that surround and protect the developing fetus throughout the period of intrauterine development. Amniotic fluid- clear, watery fluid that surrounds and protects the developing fetus. Physiologic Changes of Pregnancy o Reproductive system Estrogen causes the vaginal mucosa to thicken, vaginal secretions to increase,, and the connective tissue to loosen to allow for delivery. The breasts enlarge and prepare for lactation By end of pregnancy reproductive system weighs 2lbs/1000g and has a capacity of 5000ml and contains about 16% of total blood volume. o Respiratory system 20% increase in O2 demand 40% increase in tidal volume o Cardiovascular system 45% increase in maternal blood volume, which can cause anemia. To combat the anemia pregnant women take Iron supplements. HR increase of 10-15bpm. B/P initially drops but returns to normal late in pregnancy. Cardiac output increases and peaks @ 6-7L/min o Gastrointestinal system n/v caused by hormones o Urinary system- increase urination o Musculoskeletal system- pelvic joints loosen due to hormones Fetal Development Estimated date of confinement (EDC)- the approximate day the infant will be born. Usually 40weeks, 280days, 10lunar months, or 9calendar months from mothers last menstrual cycle. Fetal Circulation 1. Oxygenated Blood from the placenta to the Umbilical vein to the Inferior VenaCava by way of the ductus venosus.

2. Oxygenated Blood from Inferior Vena Cava to Right Atrium through a hole connecting the right & left Atrium called the foramen ovale 3. Oxygenated blood is taken to the tissues of the body 4. Deoxygenated/waste blood is returned after traveling through the liver to the umbilical arteries and exits the fetal body. Fetal circulation changes immediately at birth as soon as the baby takes its 1st breath OB Terminology Gravidity the number of times a woman has been pregnant Parity number of pregnancies carried to full term Primi- (Prefix) woman on first pregnancy Multi- (Prefix) woman who has had 1< pregnancy Complications of Pregnancy Trauma- transport all trauma patients @ 20weeks or more gestation. Anticipate the development of shock. Medical complications o Hypertensive disorders Preeclampsia- pregnancy toxemia resulting in hypertension,, edema, headache, vision disturbances. Patient transported on Left Lateral Recumbent, dim the lights, no lights no sirens. Eclampsia- Pregnancy toxemia resulting in SEIZURES Chronic Hypertension o Supine Hypotensive syndrome- compression of the inferior Vena Cava by the uterus, which blocks blood flow. o Gestational diabetes- consider hypoglycemia when encountering a pregnant patient w/altered mental status. Diabetogenic effect of pregnancy- early in pregnancy hormone increases insulin production. Later on the placenta hormones cause an increased resistance to insulin and decreased glucose tolerance. This causes catabolism of stored fats that release ketones which help increase the likelihood of ketoacidosis and diabetes. Bleeding in Pregnancy o Abortion/Miscarriage (Spontaneous Abortion)- termination of pregnancy before the 20th week of gestation. o Ectopic Pregnancy- (a life threatening condition) the implantation of a developing fetus outside of the uterus, often in a fallopian tube. o Placenta previa- occurs as a result of abnormal implantation of the placenta on the lower half of the uterine wall, resulting in partial or complete coverage of the cervical opening. Painless Red bleeding o Abruption placentae- (potentially a life threatening condition) premature separation of a normally implanted placenta from the uterine wall.

 Sharp pain, with or without bleeding Braxton-Hicks Contractions- false labor o Effacement- the thinning and shortening of the cervix during labor. Preterm labor- premature birth o Tocolysis- the process of stopping labor The Puerperium- the time period surrounding the birth of the fetus. Labor- the time and processes that occur during childbirth; the physiologic and mechanical process in which the baby, placenta, and amniotic sac are expelled through the birth canal. 1. stage One (Dilatation Stage) o Crowning- the bulging of the fetal head past the opening of the vagina during a contraction. Crowning is indication of impending delivery. 2. stage Two (Expulsion Stage) the cord is clamped first @15cm from fetus then the second clamp 10cm from fetus or 5cm from the first clamp cut the cord between the 2 clamps suction the mouth & nose as needed keep infant warm cold shock #1 killer of newborns APGAR Appearance/Color- blue=0, pink body/blue extremities=1, pink=2 Pulse rate- none=0, <100=1, >100=2 Grimace- no response=0, Grimace=1, cough/sneeze/cry=2 Activity- limp=0, some flexion=1, Active motion=2 Respiratory effort- absent=0, slow/irregular=1, strong cry=2 Total score <=10 If the infants respirations are <30 and tactile stimulation doesnt increase the rate to a normal range, immediately assist ventilations w/BVM and high flow O2. If the HR is <80 and does not respond to ventilations, initiate chest compressions. 3. stage Three (Placental Stage) Abnormal Delivery Situations Breech presentation Prolapsed cord- occurs when the umbilical cord precedes the fetal presenting part. Causing the cord to be compressed between the fetus and the bony pelvis, shutting off fetal circulation. Tx: insert 2 fingers of a gloved hand to raise the presenting part of the fetus off the cord. At the same time , gently check the cord for pulsations, but do not compress the cord. Limb presentation Occiput posterior Other Delivery Complications Multiple births

Cephalopelvic disproportion- when infants head is to large to pass through the maternal pelvis easily. Precipitous delivery- is a delivery that occurs after less than 3hours of labor. Shoulder dystocia- when infants shoulders are larger than its head. Meconium staining- occurs when the fetus passes feces into the amniotic fluid. Maternal Complications of Labor and Delivery Postpartum hemorrhage- is the loss of more than 500cc of blood immediately following delivery. Uterine rupture- is the actual tearing, or rupture, or the uterus Uterine inversion- is a rare emergency when the uterus turns inside out after delivery and extends through the cervix. Pulmonary embolism- is the presence of a blood clot in the pulmonary vascular system. It is one of the most common causes the maternal death. Effect more Csections than vaginal births.