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Center of Gravity Change30% Increased in Total Blood
Volume
Symbiont Relationship
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Complications and
Treatment Options
in the RemoteSetting.
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Definition- Developing Fetus implants inthe falopian tube instead of in the Uterus
Treatment- Confirm diagnosis by ultrasound and lab testing
If diagnosis is ruptured, orsuspected rupturedectopic pregnancy, be prepared to treat
HYPOVOLEMIC SHOCK.
Rapid transport to nearest O.R.
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Hypertensive Disorders
Bleeding Problems
Malpresentations
Dystocias
Amniotic Fluid Embolism
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Gestational Hypertension
Preeclampsia mild
severe
Eclampsia
HELLP Syndrome
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Control BP Hydralazine
Labetolol
Prevent Eclampsia Magnesium Sulfate
The Cure For Preeclampsia is
Deliver The Baby
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The only difference between Preeclampsiaand Eclampsia
SEIZUREThe Cure for Eclampsia is
Immediately
DELIVER THE BABYBUT, in the meantime
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H- hemolysis
E- elevated
L- liver enzymes
L- low
P- platelets2% of patients with PEC will develop H.E.L.L.P.
A few patients will develop H.E.L.L.P. without havingsigns or symptoms of PEC
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Support Vital Signs
Treat HTN
Seizure prophylaxis
The only CURE for HELLP is
DELIVER THE BABY
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Please check your company protocols for proper
medication administration
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Placenta Previa
Placenta AbruptionVasa Previa
Uterine Rupture
Normal?
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Partial Mild
Moderate
Full Completely covers cervical OS
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Placenta is completely covering cervicalOS
May have antepartum bleeding and/oracute hemorrhage
Cannot deliver vaginally
O.R. Emergency Mom and baby can exsanguinize rapidly
Treat for
HYPOVOLEMIC SHOCK
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Different from Previa
Pain
Mild May happen at any time during pregnancy
Mild spotting
May be undiagnosed
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Very Painful
Hemorrhage externally
Hemorrhage internally Exsanguination of mother and baby
May not be compatible with life if OR not
readily available Treat for SHOCK
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O.R. EMERGENCY Pt needs emergent surgery
Support VS and treat for Shock
May not be compatible with
life in prolonged transportsetting
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Complete
Footling
Frank
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Feet Tucked down by buttocks
May deliver vaginallyHigh risk for cord prolapse
Tocolytics and transport
Cephalic Dystocia
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Most Common in Preterm
OR Urgently
Tocolytics and Transport
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May Deliver Vaginally
High Risk Cord Prolapse
Tocolytics and Transport Cephalic Dystocia
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Head has delivered but the baby is stuck McRoberts Maneuver: Sharp flexion of the
maternal hips
Suprapubic pressure: attempt to dislodge the
shoulder from behind the pubic bone Rubin Maneuver: Place pressure on the
presenting shoulder to push it inward anddecrease the diamter of the presentation
Woods Corkscrew maneuver: Apply pressurebehind the posterior shoulder to rotate the babyand dislodge the anterior shoulder
Fracturing the fetal clavical
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Manifested by Late Signs and
Symptoms of fetal and maternal
shockMost patients do not live past CPR
Treat For ShockTreat Respiratory Distress
Treat Cardiac arrest
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Toco- picks up ctxs, place on the apexof the fundus An external Toco can only measure
frequency and duration NOT strength An IUCP is required to measure strength, we
dont have the adapter for this
US- place wherever you can pick up thebabys heart rate the best.
A reassuring 20 minute strip will include twoaccelerations and normal variability
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Accelerations- twopink boxes or morefor at least two
boxes in length as aguideline
Accelerations =happy baby
i.e. baby is taking alittle jog around theblock and heartrate increases
Decels
Early- starts beforethe peak of the ctx
Late- starts after thepeak of the ctx
Variable is acombination of
both
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Early decels usuallyrequire notreatment. They can
be caused by headcompression at theend stages of labor.If they are deep or
prolonged, considerrepositioning andoxygen
Late decels indicatefetal hypoxia. As thetracing loses its
variability, the fetus isbecome morehypoxic andacidotic. Late
decels alwaysrequire intervention.Oxygen, reposition,fluid bolus?
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120-160
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How bumpy is the tracing?
Moderate variability is normal
Is is marked? Decreased?
Beat to beat variability only accessible
through FSE
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Tachycardia
Maternal fever
CNS immaturity
Maternalmedications, druguse
Bradycardia
Fetal hypoxia
Maternal drug use
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What we do to
momwe also do tobaby
Move mommovebaby
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Jake Feb 1,2011 6lbs 12oz 19.5 inches
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Blueprints Fifth edition Ostetrics & Gynecology.Tamara L. Callahan/ Aaron B Caughey: WoltersKluwer/ Lippincott Willaims & Wilkins 2009
Williams Manual of Obstetrics PregnancyComplications twenty-second edition KennethJleveno, F. Gary Cunninggham, James M.alexander, Steven L. Bloom, Brian M. Casey, Jodi S.
Dashe, Jeanne S. Sheffield, Scott W. Robers:McGraw Hill Medical 2007
American Congress of Obstetricians andGynecologists: http://www.acog.org