Obstetrical Conditions Reference BLS Section 5

Terminology Gravida Parity Number of times a woman has been pregnant All pregnancies count regardless if carried to term Current pregnancy included in the count Number of >20 week gestation week births Including nonviable & viable Births consisting of multiples in considered ONE

DOCUMENTATION Nulli (gravida/parity) indicates a woman who has never been pregnant/given birth Primi (gravida/parity) indicates a woman who has been pregnant one time, pregnant for the first time/has given birth once. Multi (gravida/parity) indicates a woman who has been pregnant or given birth more than once. G2P1 = Patient has been successfully pregnant twice but has only given birth once (or is still pregnant now). G2P1= Multigravida Primiparous HINT to remember the difference between Para and Gravida. The letter G comes before P in the alphabet. One can’t give birth before getting pregnant.

Braxton Hicks Uterine contractions that start around week 6 & last until weeks before delivery A woman probably won't feel them until around week 28 (if at all). They promote blood flow to the placenta, soften the cervix and tone the uterine muscles for labour.

Braxton Hicks Continued…. Won’t increase in intensity Irregular, infrequent and unpredictable Most common in Third Trimester Contraction may subside when patient’s position is changed or when the patient walks around Usually last 30-60 seconds

Getting A Good Hx is Key Due date Problems with the present pregnancy (e.g. Infections, bleeding, diabetes) Pain and contractions or bleeding and discharge with onset of current condition (timing and intensity of contractions, severity of bleeding) Gravida and Parity Previous durations of labours and previous complications. Palpate uterus Questions to consider in an emergency with an obstetrics patient………. Due Date (calculated from the date of the last menstrual period) = LNMP – 3 months + 7days

Assess only when… Palpating Abdomen Inspecting Perineum Abdominal pain/bleeding Weakness, SOB Headache, nausea MVC Suffered a fall Blunt trauma In between contractions Ruptured membranes Prolapsed cord or limb Urge to push Vaginal bleeding is heavy Decreased level of conscious near term

Physiological Changes of Pregnancy to consider during an emergency call…….. Increases in blood sugar, breathing and cardiac output are all required to ensure the fetus is provided for. Second trimester, mother’s heart at rest is working 40% harder with an increased heart rate Blood volume increases progressively 6-7L of blood pumps per minute throughout the body instead of 5L Consume 10-20% more oxygen at rest

SHOCK! Maintain a high index suspicion of shock Symptoms & signs maybe masked by physiological changes of pregnancy With an increase in blood volume an OB patient can lose 30-35% of her blood without showing signs and symptoms of shock

Stages of Pregnancy Divided into 3 trimester Pregnancy is considered full term at 37- 42 weeks gestation Infants delivered <37 weeks are considered premature Miscarriages are considered at anytime before 20 weeks gestation Stillbirths are considered at anytime after 20 weeks gestation

First Trimester (week 1-13) The first trimester is the most crucial for fetal development. By the end of the third month, the fetus has developed all of its vital organs. Most miscarriages and birth defects occur during this period. Normal Symptoms: Polyuria, morning sickness, extreme fatigue, spotting

Second Trimester (week 14-26) At 24 weeks gestation fetus is viable The second trimester of pregnancy is often called the "golden period" because many of the unpleasant effects of early pregnancy disappear. However, more serious complications may arise. An increase in blood pressure during this trimester At 24 weeks gestation fetus is viable Somewhere between 16 weeks and 20 weeks, the fetus might begin to be felt by the mother. Fetal heart sounds will be heard through a stethoscope.

Third Trimester (week 27-40) Preparation for labour and delivery Normal Symptoms: Shortness of breath, hemorrhoids, urine incontinence, varicose veins, sleeping problems Decrease in blood pressure during this trimester These symptoms arise from an increase size in uterus (2oz-2.5lbs) It’s normal for the fundal height to drop slightly a few weeks prior to delivery

Complications During Pregnancy Spontaneous abortion – Unexpected termination of pregnancy before 20 weeks gestation Usually suspected in the first trimester - Pain, cramps, back pain, blood loss with tissue, Ectopic Pregnancy – abdominal implantation of a fertilized egg (outside of the uterus) Usually suspected in the first trimester Most commonly diagnosed in the fallopian tube Begins as diffuse tenderness leading to sharp localized pain A rigid lower abdomen with pain that may refer to the shoulder. Preeclampsia – Pregnancy induced hypertension >140/90 Usually begins in the second trimester Headache, tinnitus, epistaxis, tremors, blurred vision, n/v Rapid weight gain, generalized edema Seizures (may stimulate premature labour)

Complications Continued…. Placenta Previa – abnormal placenta implantation (covers cervix) Usually occurs in the third trimester Painless bright red blood Abruptio Placenta – premature separation of placenta from uterine wall (partial or complete) Partial -> bleed and no increased pain Central -> most commonly diagnosed, internal hemmorhage, sharp tearing pain, rigid abdomen Complete -> massive hemmorhage

Stages of Labour Dilation (8-10hours) Onset of true contractions and ends with complete dilation of the cervix (10cm) At the end of this stage contractions will last 60seconds and occur every 2-3mins Expulsion (50-60mins) imminent delivery Begins at complete dilation and ends with delivery Contractions are 60-90seconds every 2minutes “urge to push”, heavy red show, bulging membranes Crowning – vertex position (head first, face down), when fetus is visible at contraction Placenta (5-20mins) Gush of blood (sign of placenta separating from the uterus) Lengthening of umbilical cord from vagina

Stay N’ Play Crowning (vertex position) OR Primips Multips part is visible between contractions AND urge to push AND contractions < 2minutes apart Multips contractions 5 minutes apart or less AND any other sign of second stage of labour Unless placenta becomes visible within minutes of birth, initiate transport

Load N’ Go A limb is presenting Cord is prolapsed Pre-eclampsia Primips No signs of second stage labour Presenting part only visible when bearing down with a transport time of <10 minutes Multips Contractions 5 minutes apart with no urge to push or part presenting Vaginal bleeding Multiple births Premature labour (<35 weeks)