1. Obstetrical Conditions Reference BLS Section 5

2. 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

3. 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.

4. 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.

5. 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 seconds

6. 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

7. 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

8. 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

9. 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

10. Stages of Pregnancy Divided into 3 trimester
Pregnancy is considered full term at 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

11. 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

12. 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.

13. 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

14. 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)

15. 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

16. 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

17. 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

18. 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)