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Understanding Obstetrics and Neonatal Care

Sep 4, 2024

Chapter 35: Obstetrics and Neonatal Care

Overview

  • Focus on female reproductive anatomy and physiology as related to pregnancy.
  • Key areas: childbirth assessment, emergency treatment, stages of labor, pregnancy complications, neonatal evaluation, and resuscitation.

Anatomy and Physiology

  • Ovaries: Produce eggs; ovulation occurs 2 weeks before menstruation.
  • Fallopian Tubes: Site of fertilization; egg travels to uterus.
  • Uterus: Muscular organ, protects fetus, contracts during labor.
  • Vagina/Birth Canal: Passageway for childbirth.
  • Placenta: Nourishes fetus, separates maternal and fetal blood.
  • Umbilical Cord: Lifeline between woman and fetus.
  • Amniotic Sac: Fluid-filled, protects fetus.

Pregnancy Changes

  • Body Systems: Respiratory, cardiovascular, musculoskeletal changes.
  • Risks: Increased trauma risk, blood volume increase, heart rate changes.
  • Common Conditions: Gastroesophageal reflux, weight gain, hormonal changes.

Pregnancy Complications

  • Diabetes: Gestational diabetes arises in the second half.
  • Hypertension: Pre-eclampsia and eclampsia; characterized by severe headaches, visual disturbances, and more.
  • Bleeding: Ectopic pregnancy, placenta previa, abruptio placenta.
  • Abuse & Substance Use: Can lead to fetal alcohol syndrome, low birth weight.
  • Trauma: Increased risk of falls and complications.

Assessment and Management

  • Scene Size-Up: Follow standard precautions.
  • Primary Assessment: Check ABCs, determine labor status.
  • History Taking: Obstetric history, complications, prenatal care.
  • Transport Decision: Based on stage of labor and complications.

Labor Stages

  • First Stage: Cervix dilation; longest stage.
  • Second Stage: Delivery of the fetus; crowning occurs.
  • Third Stage: Delivery of the placenta.

Normal Delivery Management

  • Preparation: Delivery location, equipment setup.
  • Procedure: Support head, check umbilical cord, manage placenta delivery.

Neonatal Care

  • Golden Minute: Initial care immediately after birth.
  • Resuscitation: Based on heart rate, breathing, and color.
  • APGAR Score: Assessed at 1 and 5 minutes.

Delivery Complications

  • Breech Presentation: Buttocks-first; manage delivery carefully.
  • Limb Presentation: Immediate transport, do not deliver in field.
  • Prolapsed Cord: Manage head position to protect cord.
  • Spina Bifida: Cover exposed area with moist dressing.

Special Considerations

  • Multiple Gestations: Deliver similarly to a single fetus.
  • Premature Births: Special care needed; high survival rates with care.
  • Post-Term Pregnancy: Higher risks for complications.
  • Fetal Demise: Normal labor progression; do not resuscitate stillborns.
  • Postpartum Complications: Excessive bleeding, embolism risk.

Cultural and Special Situations

  • Cultural Sensitivity: Respect preferences in childbirth care.
  • Teenage Pregnancy: High occurrence; require special considerations.

Review Questions

  • First stage of labor ends with visible baby presentation.
  • Symptoms like edema, headache, high blood pressure indicate preeclampsia.
  • Transport pregnant women on left side to prevent supine hypotensive syndrome.
  • After delivery, check for umbilical cord around the neck.
  • Newborn resuscitation is guided by respiratory effort, heart rate, and color.

This chapter emphasizes the importance of understanding both normal and emergency obstetric and neonatal care, with a focus on practical assessment and management strategies.

Full transcript