| Flap 1 | Flap 2 |
| fetus | the baby as he develops in the womb |
| uterus | the nuscular abdominal organ where the fetus develops; womb |
| cervix | neck of the uterus at entrance to birth canal |
| vagina | birth canal |
| placenta | the organ of pregnancy where exchange of oxygen, foods, and wastes occurs between mom and fetus |
| umbilical cord | fetal structrue containing the blood vessels that carry blood to and from the placenta |
| amniotic sac | bag of waters that surrounds the developing fetus |
| How much does cervix dilate for baby's head to pass into vagina | 4 inches or 10 cm |
| How much amniotic fluid is expelled at birth? | about 2 quarts |
| first trimester | fetus being formed |
| second trimester | fetus grows rapidly |
| crowning | presenting part of baby first buldges from vaginal opening, usually head |
| cephalic presentation | presenting part is head |
| breach presentation | buttocks or both feet deliver first |
| labor | entire process of deliver |
| first stage of labor | regular contractions, thinning and gradual diation of cervix until cervix fully dilated |
| second stage of labor | full dilation of cervix, baby enters birth canal until born, EMT-B decides to transport or prepare to assist with delivery |
| third stage of labor | after baby is born until the afterbirth is delivered |
| dilation period of labor | first stage of labor |
| afterbirth | placenta, membrains of the amniotic sac, part of umbilical cord, some tissues from lining of uterus, delivered after birth |
| effacement | long neck of cervix must be shortened and thinned |
| contractions | start at every 30 minutes and then down to 3 minutes or less |
| meconium staining | amniotic fluid is greenish or brownish-yellow, may indicate maternal or fetal distress |
| bloody show | from mucus plug that was in cervix, mixed with blood |
| EMT-B and labor pain | time contraction time and interval, when contractions last 30 to 60 seconds and 2-3 minutes apart, delivery is imminent |
| EMT-B's primary role | determine if delivery will occur on scene and assist mother if so |
| sterile obsteric kit | sterile gloves, towels and sheets, 12 guaze pads, rubber bulb syringe, cord clamps, card tape, sucgical scissors, baby blanket, sanitary napkins, plasitc bag |
| decision for transport | series of questions, exam for crowning, vital signs |
| average time of labor for woman having first baby | 16-17 hours |
| supine hypotensive syndrome | also vena cava compression syndrome; mass compressing vena cava, major blood vessel, reducing return of blood to heart, reducing cardiac output - resulting in dizziness and drop of bp |
| vena cava compression syndrome | supine hypotensive syndrome |
| supine hypotensive syndrome treatment | tranport on left side with pillow or rolled blanket behind back to maintain proper position |
| 6 steps in preparing mother for delivery | 1. control the scene; 2. surgical gloves and apparel; 3. place mom on flat surface, elevate buttocks, knees drawn up; 4 remove clothing, cover with sheets; 5. position another person at mother's head for vomit and support; 6. OB kit near mom, easy access |
| Assisting with normal delivery | BSI; 1. support baby's head; 2. suction infant's mouth/nose; 3. aid in birth of upper shoulder; 4. support trunk; 5. support pelvis/lower ext.; 6. keep baby level with vagina until umb cord stops pulsating |
| fontanelles | soft spots on baby's skull |
| When do you assess the newly born? | with first observations while caring for mother and baby |
| general initial evaluation of baby | ease of breathing, heart rate, crying, movement, skin color |
| normal pulse for newborn | greater than 100 |
| crying with newborn | vigorous crying good sign |
| Apgar scale | evaluation protocol for newborns |
| APGAR | Appearance, Pulse, Grimace, Activity, Respiratory effort - 0, 1, 2 |
| APGAR Appearance | 0 - blue or pale all over, 1 - extremeties blue, trunk pink, 2 - pink all over |
| APGAR Pulse | 0 - no pulse, 1 - pulse between 1 and 100, 2 - pulse greater than 100 |
| APGAR Grimace (reaction to suctioning or flicking on the feet) | 0 - no reaction, 1 - facial grimace, 2 - sneeze, cough, cry |
| APGAR Activity | 0 - no movement, 1 - only slight activity (flex extremities), 2 - move around normal |
| APGAR Respiratory effort | 0 - none, 1 - slow, irregular breathing, weak cry, 2 - good breathing, strong cry |
| Caring for newborn | place baby on sterile sheet on padded surface, level with the vagina, |
| When do you begin resuscitation measures with a newborn | when the newborn doesn't breathe on his hown after suctioning, drying, and warming for 30 seconds |
| artificial ventilation rate during neonatal resuscitation | 40 to 60 per minute - rapid, small puffs - reassess in 30 seconds |
| What if heart rate is less than 60 minute | initiate chest compressions at rate of 120 per minute - 90 compressions and 30 ventilations each minute |
| What if baby exhibits cyanosis of face or torso | supplemental oxygen at 10-15 liters per minute with tubing placed close to infant's mouth |
| Clamping and cutting cord | keep infant warm, use sterile clamps from OB kit, slowly tie square knot, one clamp 10 inches from baby, other about 7 inches out, cut between clamps |
| When do you not cut the cord? | when it is pulsating - or if the baby is not breathing on his own |
| When do you cut the cord? | Cord not pulsating any longer, baby is breathing well, wrapped around neck during delivery, need to perform CPR |
| How long can you delay clamping the cord? | 30 minutes |
| After the baby is born and baby and mom are well, how long can you delay transportation to the hospital for delivery of the placenta? | 20 minutes |
| How much blood loss is normal after delivering the baby and placenta? | 500 cc |
| How can you control vaginal bleeding after delivery of the baby and placenta? | sanitary napkin, lower legs and raise feet, massage the uterus to help it contract (circular motion), mother nurse baby which leads to contraction of uterus (not recommended by all docs) |
| perineum | skin between vagina and anus |
| How do you treat a torn perineum? | Comfort mother, this will be quickly cared for at hospital. Apply sanitary napkin and apply some pressure |
| How can you care for the mother after birth? | Take vital signs frequently, wipe hands and forehead with damp cloth, freshen sheets, keep warm. |
| What does an EMT-B do for breech presentation, prolapsed umbilical cord, and limb presentation? | Provide high concentration oxygen and rapid transport. |
| How do you care for breech presentation? | rapid transport, high concentration oxygen, mother head down with pelvis elevated, if baby delivers, support and prevent explosive delivery of head |
| prolapsed unbilical cord | cord is pinched, most common in breech births, caused by being squeezed between vaginal wall and baby's head |
| How do you care for prolapsed umbilical cord? | elevate hips, oxygen, keep mother warm, keep baby's head away from cord, don't push cord back in, wrap cord in moist towel. Transport, continue pressure on baby's head. |
| What is often present with one or more limbs are presented? | prolapsed umbilical cord |
| How do you care for mother with limb presentation? | Treat as prolapsed cord, rapid tramsport, elevate hips, administer high oxygen |
| What do you need with multiple births? | additional personnel and identify birth order, care for babies like singles, keep babies warm |
| What is considered premature birth? | baby weighs less than 5.5 pounds or is born before 37th week of pregnancy |
| What are signs of a possible premature birth? | mother may inform you of length of pregnancy, head appears much larger in proportion than the small, thin, red body |
| How do you care for the premature baby? | Extra efforts to keep baby warm, keep airway clear with suction, provide ventilations or compressions if needed, watch cord for bleeding, flow oxygen by baby's face, avoid contamination, warm ambulance, transport to ER |
| Why is meconium such a risk to the baby? | baby has increased risk of respiratory problems, expecially if aspiration of the meconium occurs at birth |
| How do you care for the baby if you see meconium staining? | suction the oropharynx before stimulating, suction mouth, then nose. Maintain airway, provide ventilations or compressions if needed, transport |
| What is placenta previa? | placenta is formed in an abnormal location like low in uterus and close to or over the cervical opening, not allowing normal delivery, causes excessive prebirth bleeding - cervix dilates, the placenta tears |
| What is abruptio placentae? | placenta separates from the uterine wall, causing prebirth bleeding, occurs in 3rd trimester |
| Who do you assess prebirth bleeding? | look for signs of profuse bleeding from vagina, mother may or may not experience pain, look for signs of shock, obtain vitals (rapid heartbeat may indicate significant blood loss. |
| How do you care for mother with excessive prebirth bleeding? | High concentration oxygen, rapid transport, use sanitary napkins (save all for evaluation), save all tissue that passes |
| What is the oviduct? | fallopian tube that carries eggs from ovary to uterus |
| What is an ectopic pregnancy? | implantation of the fertilized egg is in the ovidcut, cervix, or abdominopelvic cavity |
| What are signs of a ectopic pregnancy? | acute abdominal pain, often beginning on one side, vaginal bleeding, rapid or week pulse, low BP |
| How do you care for a patient with ectopic pregnancy? | immediate transport, position and care for shock, high concentration oxygen, nothing by mouth |
| What is eclampsia? | eclampia is complication late in pregnancy that produces seizures and coma. |
| What is preeclampsia? | complication during pregnancy where woman retains large amounts of fluid and has hypertension. She may also experience seizures or coma. very dangerous to baby. |
| What are signs of seizure from preeclampsia? | elevated BP (increased with risk of abruptio placentae), excessive weight gain, extreme swelling of face, hands, ankles, feet; headache |
| How do you care for patient with seizures during pregnancy? | airway, high concentration oxygen, transport with patient on left side, gentle, keep her warm, not overheated though; have suction and OB kit ready |
| What determines miscarraige or spontanious abortion? | fetus and placenta deliver before the 28th week of pregnancy |
| How do you care for a woman who had a miscarraige? | obtain vitals, oxygen, absorb bleeding and save all pads and tissues, transport, provide emotional support |
