1. TRANSITION SERIES Topics for the Advanced EMT CHAPTER Obstetrics (Antepartum Complications) 44

2. Objectives Review rates for complications seen during pregnancy. Discuss specific pathology related to certain antepartum complications. Review assessment parameters and current treatment standards for a patient with antepartum complications.

3. Introduction Antepartum refers to the period of pregnancy prior to the onset of labor. Emergencies that occur during this time may be benign or even life-threatening. The goal of the Advanced EMT is to differentiate between these and provide safe, and occasionally lifesaving, treatment to these patients.

4. Epidemiology 4% of all pregnancies develop 3 rd trimester complications. –22% are placenta previa cases. –31% are abruptio placentae cases.

5. Pathophysiology Placenta Previa –Placenta implants over the internal cervical os (the opening of the cervix). –Types include complete, marginal, and partial.

6. Placenta previa

7. Pathophysiology (cont’d) Abruptio Placentae –Placental lining separates from the uterus. –The expanding collection of blood continues to force the placenta away, which increases bleeding. –Complete and partial abruption occurs.

8. Abruptio placentae

9. Pathophysiology (cont’d) Ectopic Pregnancy –Pregnancy in which the ovum implants outside the uterine cavity. –Still the leading cause of pregnancy- related deaths in the first trimester. –Almost 100% result in fetal death.

10. Ectopic pregnancy

11. Pathophysiology (cont’d) Preeclampsia and Eclampsia –Preeclampsia has hypertension, edema, protein in the urine, visual disturbances, and headaches.  Hypertension >140/90. –Eclampsia is all the above, but in addition the patient has now developed seizures.

12. Pathophysiology (cont’d) Spontaneous Abortion –Loss of pregnancy before the age of viability. –Spontaneous means abortion was unintentional, involuntary, and due to some natural cause. –Patient will commonly have abdominal cramping, discharge, and expulsion of tissues of conception.

13. Types of Abortion

14. Assessment Physical exam should follow the standard primary and secondary assessments.

15. Assessment (cont’d) Patient interview should include a focus on: –When was last menstrual period? –Have you been pregnant before? –Are you experiencing any pain or discomfort? –Are you having any vaginal discharge? –Any prenatal care? –When is your due date?

16. Antepartum Complications and Associated Signs and Symptoms

17. Emergency Medical Care Assess and maintain the airway. Determine breathing adequacy. –High-flow via NRB with adequate breathing. –High-flow via PPV @ 10-12/min if inadequate. Assess circulatory components. –Check pulse, skin characteristics. –Control major bleeds.

18. Emergency Medical Care (cont’d) Position patient left lateral recumbent tilted to the left side. Provide supportive care for seizures. Expedite transport. Initiate intravenous access en route. Reassess and reassure while en route.

19. Summary Antepartum emergencies can be the reason for the EMS call, or a consequence of some other trauma or medical problem. In many instances, there are two lives at stake—the mother and the unborn child.

20. Summary (cont’d) Treatment is largely supportive, and rapid transport to the hospital is often warranted.