Summary of "Chp 34 Obstetrics and Neonatal Care"

Summary of Chapter 34: Obstetrics and Neonatal Care

This chapter provides a comprehensive overview of Obstetrics and Neonatal Care, focusing on the recognition and management of normal and complicated deliveries, pregnancy-related complications, trauma in pregnant patients, and newborn assessment and resuscitation.

Main Ideas and Concepts

Obstetrics Overview

Normal Delivery Management: Recognition and steps for assisting normal childbirth, including positioning, hygiene, and delivery support.
Complications of Pregnancy: Identification and management of common complications such as vaginal bleeding, pre-Eclampsia, Eclampsia, Placenta Previa, abruptio placenta, ectopic pregnancy, miscarriage, and multiple gestations.
Anatomy & Physiology: Review of female reproductive anatomy (ovaries, fallopian tubes, uterus, cervix, vagina, placenta, umbilical cord, amniotic sac) and physiological changes during pregnancy affecting respiratory, cardiovascular, musculoskeletal, and gastrointestinal systems.
Pregnancy-Related Changes: Hormonal increases, uterine displacement, increased blood volume and heart rate, respiratory changes, joint laxity, and increased fall risk.

Pregnancy Complications

Hypertensive Disorders: Gestational hypertension, pre-Eclampsia (hypertension with edema, headaches, visual changes), and Eclampsia (seizures).
Bleeding Disorders: Placenta Previa (placenta covers cervix), abruptio placenta (placenta detaches prematurely), spontaneous abortion/miscarriage, and ectopic pregnancy (implantation outside uterus).
Domestic Abuse & Substance Abuse: Increased risk of abuse during pregnancy, effects of substance abuse on fetus (prematurity, low birth weight, fetal alcohol syndrome).
Trauma in Pregnancy: Dual-patient management (mother and fetus), increased blood volume masking shock signs, risk of placental abruption, importance of positioning to prevent supine hypotensive syndrome (left lateral positioning).

Neonatal Care

Newborn Assessment: Initial evaluation includes airway, breathing, circulation, skin color, muscle tone, and reflexes.
Neonatal Resuscitation: Different from adult CPR; involves a 3:1 compression-to-ventilation ratio, suctioning mouth before nose, warming and drying the newborn, and stimulation.
Apgar Score: Assessment at 1 and 5 minutes post-delivery based on Appearance, Pulse, Grimace, Activity, and Respiration (score 0-10).
Meconium Aspiration: If meconium-stained fluid is present and baby is not breathing, suction mouth and nose before ventilation.
Premature and Post-term Newborns: Premature defined as <37 weeks, often smaller and requiring special care; post-term >42 weeks with increased risks.

Labor and Delivery Management

Stages of Labor:
- Stage 1: Cervical dilation to full dilation.
- Stage 2: Delivery of fetus.
- Stage 3: Delivery of placenta.
Delivery Preparation: Positioning mother, maintaining sterile field, timing contractions, supporting head and perineum during delivery.
Complications During Delivery:
- Nuchal cord (cord around neck): Attempt to slip over head; if not possible, clamp and cut.
- Breech delivery: Buttocks first; support delivery, create “V” to prevent airway compression.
- Prolapsed cord: Insert hand to relieve pressure on cord, position mother to slow delivery.
- Limb presentation: Do not attempt delivery; rapid transport for cesarean section.
Post-Delivery Care: Skin-to-skin contact, drying and warming newborn, clamp and cut umbilical cord after ~60 seconds, monitor for excessive bleeding, massage uterus to control hemorrhage.

Transport and Communication

Transport decisions based on delivery imminence and complications.
Notify hospital of delivery status and pregnancy-related issues.
Provide thorough obstetric history (due date, prenatal care, contractions, previous pregnancies, drug use).
Maintain cultural sensitivity and privacy during assessment and care.

Detailed Methodology / Instructions for Normal Delivery and Neonatal Care

Scene and Patient Preparation:
- Scene size-up, standard precautions (gloves, eye protection).
- Position mother on firm surface with hips elevated 2-4 inches.
- Legs flexed, feet flat, knees apart.
- Create sterile field using OB kit supplies.
- Partner or assistant at patient’s head for reassurance.
- Monitor contractions and breathing.
Delivery Steps:
- Observe for crowning (baby’s head visible).
- Support head as it emerges; apply gentle pressure on perineum to reduce tearing.
- If amniotic sac intact, puncture it carefully.
- Suction baby’s mouth first, then nose.
- Check for nuchal cord; attempt to slip over head once.
- Deliver shoulders and body gently; do not pull on baby.