Obstetric emergency 2

1. Obstetric emergency 2 Dr. Miada Mahmoud Rady

2. Lecture 2 1- physiological changes during pregnancy.2- obstetric patient assessment

3. Physiological Changes of Pregnancy • Out lines : 1- Etiology . 2- Significance . 3- examples .

4. Physiological Changes of Pregnancy • Caused by : • Altered hormone levels. • Mechanical effects of enlarging uterus. • Increased uterine blood supply. • Increasing metabolic demands on the maternal system .

5. Significance • Physiologic changes occurring throughout pregnancy can: • Alter normal response to trauma. • Exacerbate or create medical conditions.

6. Physiological Changes to the Systems • Reproductive system • Uterus becomes larger : • Before pregnancy, the uterus: Weighs about 2 g. Has a fluid capacity of about 10 mL . • At the end of the pregnancy, the uterus: Weighs as muchas (1 kg). Has the capacity to hold about 5,000 mL.

7. Physiological Changes to the Systems • Respiratory system • Increase in oxygen demands. • 20% increase in oxygen consumption. • 40% increase in tidal volume. • Slight increase in respiratory rate. • Diaphragm pushed upward .

8. Physiological Changes to the Systems • Cardiovascular system • Cardiac output increases. • Maternal blood volume increases by 50% : • To meet fetus demand . • To adequately perfuse maternal organs . • To compensate for expected blood loss during labor. • Maternal heart rate increases by 10-15 beats.

9. Blood pressure : decreases slightly 1st & 2nd trimesters . Supine hypotensive syndrome when mother lies down ,especially by 5 months of pregnancy. • Number of red blood cells increases. • Clotting factors increase while fibrinolytic factors are depressed.

10. Physiological Changes to the Systems • Gastrointestinal system • Nausea & vomiting are common in 1sttrimester. • Delayed gastric emptying (due to slowed peristalsis). • Bloating and constipation common.

11. Physiological Changes to the Systems • Musculoskeletal system : • Pelvic joints loosened causing waddling gait • Postural changes taken to accommodate for increased anterior growth . → Increased complaints of low back pain.

12. Physiologic Maternal Changes During Pregnancy • Maternal metabolism • Weight gain averages 12.3 kg. • Increased blood volume , intracellular and extracellular fluid • Uterine growth. • Placental and fetal growth. • Increased breast tissue . • Increased proteins and fat deposits.

13. Physiological Changes to the Systems • Kidneys increase in size and volume. • Ureters increase in diameter. • Hormones cause changes to the skin, hair, and eyes Too many trips to bath rooms

14. patient assessment Ready or not , here I come

15. Important terminology • parity • Number of deliveries of living babies (twins counts as one) • Gravidity Number of time a women got pregnant.

16. Important terminology • Primigravida : woman pregnant for first time . • Primipara: woman with only one delivery . • Multigravida: two or more pregnancies . • Multipara: two or more deliveries • Grand multipara : more than five deliveries • Nullipara : never delivered primi First time Only one Multi More than one Nulli None

17. Important terminology • LMP: Last menstrual period. Pregnancies are dated from the first day of the LMP. • EDD: estimated date of delivery For a rough estimate: Add 7 days to 1st day of LMP, then add 9 months. (Nagele rule).

18. Evaluation of a pregnant patient • ABC’s. • always remember that you have TWO patients. • Primary survey is the same.

19. Obstetrical Assessment • Need to determine if delivery is imminent or if there is time to transport • Remain calm . • Ask a few questions. • Perform a visual examination . • Evaluate vital signs .

20. patient assessment step 1 step 2 Primary assessment History taking Scene size up Secondary assessment reassessment Step 3 step 4 step 5

21. Scene size up Take standard precautions. Expect a lot of blood and body fluid . Never judge patient by its look.

22. Standard Precautions

23. Primary assessment

24. Primary Assessment • Form a general impression. Determine if there is time for further evaluation. • Perform a rapid scan for ABC problems. • Evaluate trauma or other medical problems first. • Use the AVPU scale to determine level of consciousness. • Assess circulation early for signs of shock , internal or external bleeding .

25. Primary Assessment • Transport decision : • Imminent labor : prepare to deliver at the scene. • Not imminent, transport the woman lying on the left side when possible. • Provide rapid transport for patients: • With significant bleeding and pain • hypertensive. • having a convulsions. • have an altered mental status.

26. Gravity and Parity. LMP / EDC Bleeding Leaking fluid Contracting Baby moving Medical Comorbidities Any prenatal care and last US. Headache Blurry vision pain Seizures Trauma or Fall Any problems with placenta Obstetric History taking

27. Obstetric History • Any C-sections. • Any surgery on uterus. • Any problems with past pregnancies.

28. Secondary assessment • Include palpation of uterine fundus. • Listen for fetal heartbeat . • Vaginal bleeding or leaking of fluid. • Anything protruding from vagina. • Tender abdomen. Look for signs of imminent labor

29. Fundal height Fetal HR 120-150

31. Reassessment . Fetal heart rate and heart tones. • Time contractions, and perform exam. If delivery is imminent: • Notify staff at hospital. • Provide an update on the status after delivery. If delivery does not occur with 30 minutes or complication occurs: • Notify staff. • Provide rapid transport

32. Imminent Delivery • Crowning is present • Contractions last 30 – 60 seconds and are 2 - 3 minutes apart • Mother has the urge to move her bowels or she says “I HAVE TO PUSH!!!” • Bag of waters has ruptured

33. Summary • Several physiological changes occur during pregnancy which prepare the body to fetus but also make more exposed to complication. • While assessing pregnant female take in consideration that you have two patient.

34. Any questions ?