Essentials of Prehospital Maternity Care

Table of Contents

List of Tables. xxxviii

Acknowledgments. xxxix

Preface. xlii

1. The Woman and the Fetus. 1

Learning Objectives. 1

Key Terms. 1

Case Study. 2

Introduction. 4

Female Internal Reproductive Anatomy and physiology. 5

Ovaries. 5

Fallopian Tubes. 7

Uterus. 8

Vagina. 11

Bony Pelvis. 13

External Reproductive Anatomy. 15

Uterine Abnormalities. 20

Puberty. 23

The Menstrual Cycle. 25

Menopause. 29

Surgical Menopause. 33

Conception and Fetal Development 33

Developmental Highlights from Date of Conception. 41

The Placenta. 48

Fetal Circulation. 49

Congenital Abnormalities. 52

Physical and Behavioral Changes of Pregnancy. 53

Metabolism.. 53

Reproductive System.. 53

Breasts. 55

Nutritional Needs. 55

Cardiovascular System.. 56

Respiratory System.. 57

Urinary System.. 58

Gastrointestinal System.. 58

Musculoskeletal System.. 58

Psychological Changes. 59

Case Study Wrap-Up. 60

Answers. 61

Summary. 62

Review Questions. 63

2. Evaluating the Pregnant Woman. 64

Learning Objectives. 64

Key Terms. 64

Case Study. 65

Introduction. 67

Signs of Pregnancy. 68

Presumptive Signs of Pregnancy. 69

Probable Signs of Pregnancy. 72

Positive Signs of Pregnancy. 73

Taking a Relevant History. 73

Obstetrical History. 75

Evaluating the Present Complaint 79

Universal Precautions. 81

Vital signs. 81

Evaluating the Pregnant Abdomen. 84

Where to transport 94

Incorporating a Patient-Centered Approach. 96

Cultural and Religious Considerations. 97

Antenatal testing. 100

Case Study Wrap-Up. 102

Answers. 102

Summary. 105

Review Questions. 105

3. Pregnancy Complications. 106

Learning Objectives. 106

Key terms. 106

Case Study. 107

Questions. 108

Introduction. 108

Antepartal Bleeding—First half of pregnancy. 109

Spontaneous Abortion. 110

Threatened Abortion. 111

Inevitable Abortion. 113

Complete Abortion. 114

Incomplete Abortion. 114

Missed Abortion. 114

Septic Abortion. 114

Elective Abortion. 115

Therapeutic Abortion. 118

Hydatidiform Mole. 119

Ectopic Pregnancy. 121

Antepartal Bleeding—Second Half of Pregnancy. 125

Placental Abruption. 125

Disseminated Intravascular Coagulation (DIC) 128

Placenta Previa. 129

Pelvic and Abdominal Pain. 131

Ligament Pain. 132

Appendicitis. 133

Urinary Tract Infection. 133

Chorioamnionitis and Pelvic Inflammatory Disease. 136

Cholecystitis/Cholelithiasis. 137

Other Pain. 138

Low Back Pain. 138

Syncope. 139

Hyperemesis Gravidarum.. 140

Hypertensive Disorders. 142

Pregnancy-Induced Hypertension (Preeclampsia) 142

Eclampsia. 145

HELLP Syndrome. 149

Case Study Wrap-Up. 150

Answers. 150

Summary. 152

Review Questions. 153

4. Threats to Mother and Fetus. 154

Learning Objectives. 154

Key terms. 154

Case Study. 155

Questions. 156

Introduction. 156

Trauma in Pregnancy. 157

Vulnerability to Trauma. 158

Consequences of Trauma in Pregnancy. 160

Managing the Trauma Victim.. 161

Cardiac Arrest in Pregnancy. 165

Pregnancy and Chronic Diseases. 168

Asthma. 168

Diabetes. 169

Cardiac Disease. 172

Seizure Disorders. 174

Thromboembolism.. 177

HIV Infection. 178

RH Incompatibilities and Hemolytic Disease. 179

Preterm Labor 180

Carbon Monoxide Poisoning. 185

Substance Abuse. 188

Cocaine and Crack. 188

Opiates. 188

Alcohol 189

Amphetamines. 190

Tobacco. 190

Case Study Wrap-up. 191

Answers. 191

Summary. 192

REVIEW QUESTIONS. 192

5. The Woman in Labor. 194

Learning Objectives. 194

Key terms. 194

Case Study. 195

Questions. 197

Introduction. 197

Mechanism and Stages of Labor 198

Signs of Impending Labor 199

Stages of Labor 202

First-Stage Labor 203

Second-Stage Labor 207

Third-Stage Labor 207

Factors Affecting Length of Labor 208

The “Four P’s”. 208

Maternal Response to Labor 210

Vital Signs. 211

Bladder Function. 212

Gastrointestinal Changes. 212

Fluids and Electrolytes. 213

Induction of Labor 213

Impediments to Labor 214

Comfort Measures. 215

Evaluation of Labor 219

Taking a History and Assessing a Patient in Labor 219

Differentiate between False Labor and True Labor 221

Stay and Deliver or Transport?. 221

Precipitous Delivery. 224

Case Study Wrap-Up. 227

Answers. 227

Summary. 228

REVIEW QUESTIONS. 228

6. Normal Delivery Management 230

Learning Objectives. 230

Key terms. 230

Case Study. 231

QUESTIONS. 231

Introduction. 232

Equipment and Setting. 232

Maternal Positioning. 235

Squatting. 235

Supine (Dorsal, Lithotomy) 235

Semi-Fowler’s Position. 236

Left Lateral Recumbent 237

Hands-and-Knees. 237

Mechanism of Second-Stage Labor (Cardinal Movements) 239

Pushing Techniques. 242

Closed-Glottis Coached Pushing (Valsalva Pushing) 242

Open-Glottis (“Natural”) Pushing. 243

Normal Delivery. 244

Nuchal Cord. 247

Delivering the Body. 249

Immediate Care of the Normal Newborn. 251

Newborn Management Priorities. 252

Cutting the Umbilical Cord. 254

Apgar Scores. 256

Placenta Delivery. 257

Examining Placenta and Membranes. 261

Torn Umbilical Cord. 262

Perineal Tears. 263

Documentation. 267

Case Study Wrap-Up. 268

Answers. 268

SUMMARY.. 269

Review Questions. 270

7. Maternal and Fetal Complications of Labor and Delivery. 271

Learning Objectives. 271

Key Terms. 271

Case Study. 272

Questions. 273

Introduction. 273

Maternal Complications. 273

Third-Stage Hemorrhage. 273

Postpartum Hemorrhage. 275

Retained Placenta. 278

Uterine Rupture. 280

Uterine Prolapse (Uterine Inversion) 282

Amniotic Fluid Embolism.. 283

Chorioamnionitis. 284

Uterine Dysfunction. 285

Fetal Complications. 286

Fetal Heart-Rate Abnormalities. 286

Malpresentations and Cephalopelvic Disproportion. 288

Umbilical Cord Prolapse. 302

Multiple Gestation. 304

Fetal Demise and Stillbirth. 308

Case Study Wrap-Up. 311

Answers. 311

Summary. 312

Review Questions. 313

8. Postpartum Adaptation. 314

Learning Objectives. 314

Key terms. 314

Case Study. 315

Questions. 316

Introduction. 316

Physical Changes. 317

The Uterus after Delivery. 317

The Fundus and Hemostasis. 318

Afterpains. 319

Lochia. 319

Subinvolution. 321

Uterus Displaced by Full Bladder 321

The Vagina and Vulva. 322

Hematoma. 323

Hemorrhoids. 323

Postpartum Infections. 324

Thrombophlebitis. 328

Pulmonary Embolism.. 329

Postpartum Thyroiditis. 330

Emotional Changes. 331

Postpartum Depression. 331

Postpartum Blues. 332

Postpartum Major and Minor Depression. 333

Postpartum Psychosis. 333

Initiating Breastfeeding. 334

SUMMARY.. 337

Case Study Wrap-Up. 338

Answers. 338

Review Questions. 339

9. The Neonate. 340

Learning Objectives. 340

Key Terms. 340

Case Study. 341

Introduction. 342

Care of the Newborn at Delivery. 343

Apgar Scoring. 344

Vital Signs. 345

Physical Assessment of the Newborn. 346

The Skin. 347

The Head. 350

Neck , Trunk, and Genitals. 352

Extremities. 353

Reflexes. 353

Behavior 354

Gestational Age Assessment 354

Postmaturity. 358

Common Illnesses of the Neonate. 360

Hypoglycemia. 360

Hypovolemia. 361

Sepsis. 361

Neonatal Seizures. 363

Jitteriness. 364

Apnea. 364

Hypothermia. 367

Vomiting. 369

Diarrhea. 370

Sudden Infant Death Syndrome. 371

Case Study Wrap-Up. 373

Summary. 374

Review Questions. 374

10. The High-risk Neonate. 376

Learning Objectives. 376

Key Terms. 376

Case Study. 377

Introduction. 378

Care of High-Risk Newborns. 379

The Transition from Fetus to Neonate. 382

Neonatal Resuscitation. 384

Meconium.. 395

Respiratory Distress in the Neonate. 398

Meconium Aspiration Syndrome (MAS) 398

Transient Tachypnea of the Newborn. 399

Persistent Pulmonary Hypertension of the Newborn (Persistent Fetal Circulation) 399

Hypoxic-Ischemic Encephalopathy. 400

Birth Trauma. 401

The Infant with Low Birth Weight 404

Intrauterine Growth Restriction (IUGR) 404

Managing the Premature Infant 405

Conditions Associated with Prematurity. 407

Respiratory Distress Syndrome (RDS or Hyaline Membrane Disease) 407

Bronchopulmonary Dysplasia. 410

Bradycardia. 411

Intraventricular Hemorrhage (IVH) 412

Necrotizing Enterocolitis (NEC) 412

Retinopathy of Prematurity (ROP) 413

Congenital Anomalies. 413

Nervous System.. 414

Cardiovascular 418

Alimentary Tract 423

Genitourinary. 423

Hypospadias and Epispadias. 425

Ambiguous Genitalia. 425

Musculoskeletal/Limbs/Body structure. 428

Abdominal Wall 430

Chromosomal Abnormality. 432

Respiratory. 433

Case Study Wrap-Up. 436

Answers. 436

Summary. 437

Review Questions. 437

11. Gynecology. 439

Learning Objectives. 439

Key terms. 439

Case Study. 440

Questions. 441

Introduction. 441

Abnormal Vaginal Bleeding. 442

Postmenopausal Bleeding. 445

Prehospital Management of Vaginal Bleeding. 445

Acute Pelvic Pain. 447

Ectopic Pregnancy. 448

Pelvic Inflammatory Disease. 449

Other Causes of Noncyclic Pelvic Pain. 450

Cyclic Pain. 453

Nongynecological Pelvic Pain. 456

Prehospital Management of the Woman with Pelvic Pain. 456

Toxic Shock Syndrome. 457

Amenorrhea. 459

Vulvar Itching. 460

Nontraumatic Vulvar pain. 461

Bartholin Abscess. 461

Trauma. 461

Violence against Women. 463

Physical Abuse. 464

The Abuser 464

The Abuser’s Tactics. 465

The Victim.. 466

Seeking Help. 466

Abuse in Pregnancy. 467

The EMS Provider and the Abused Woman. 468

Sexual Abuse. 470

Rape. 471

Transporting the Sexual Assault Victim.. 473

The Evidence. 475

Female Genital Mutilation. 476

Case Study wrap-up. 483

Answers. 483

Summary. 485

Review questions. 485

12. Professional Issues. 487

Learning Objectives. 487

Key terms. 487

Case Study. 488

Questions. 489

Introduction. 489

Documentation. 490

The Pregnant Provider 495

Teratogen Exposure. 495

Disease Exposure. 499

Stress. 503

Physical Activity. 505

Other Concerns. 506

Working with Obstetrical Care Providers. 507

Patient-Centered practice. 515

Earning Trust 515

Excellence in Practice. 518

Holism and Patient-Centered Practice. 520

Case Study Wrap-up. 522

Answers. 522

Summary. 523

Review Questions. 524

Introduction to Appendices. 525

Appendix 1. 526

U.S. FDA Pregnancy-Risk Categories for Drugs. 526

Appendix 2. 528

Drugs Commonly Seen or Administered in Obstetrical and Gynecological Emergencies  528

Appendix 3. 566

Overview of Contraceptive Methods. 566

Glossary. 575

 

References. 646

About the Author. 659