Obstetrics pathology in pregnancy and labour

Pathologie obstétricale en grossesse anomalie et forme de présentation clinique des mains chez diagnostic signe symptômes et prise en charge

1. By: Darryl Jamison
Macon County EMS Training
Coordinator

2. •Describe fetal-maternal blood flow and the role
of the placenta.
•Identify the details of the history that should be
obtained from an obstetrical patient.
•Discuss the effects of pregnancy on pre-existing
conditions such as diabetes, HTN, and cardiac
problems.
•Define the following terms:
–Spontaneous abortion; criminal abortion;
therapeutic abortion

3. •Describe the pathophysiology and
management of the following conditions:
–Ectopic pregnancy
–Abruptio placenta
–Placenta previa

4. Objectives cont.
•Distinguish between pregnancy-induced
hypertension, preeclampsia, eclampsia.
•Describe management of prolapsed cord.
•Describe management of breech presentation
•Describe management of multiple-birth
presentation
•Describe the pathophysiology and management
of the following conditions:
–Postpartum hemorrhage
–Uterine inversion
–Uterine rupture

5. Fetal-Maternal Blood flow
•Blood flows from the placenta in through
the umbilical vein which connects to the
inferior vena cava then to the heart
•Routed around the lungs through the
ductus arteriosus, into the aorta and then
throughout the baby.
•Deoxygenated blood is filtered by the
liver and then transported to the mother

6. Role of the placenta
•Provides for exchange of respiratory
gases.
•Transport of the nutrients
•Excretion of wastes
•Transfer of heat
•The placenta becomes an active
endocrine gland, producing several
important hormones

7. History
•Should include:
–Gravidity—number of
pregnancies
–Para—number of viable
fetus delivered
–Length of gestation
–Estimated date of
confinement
–Previous complications
with pregnancies
–When did pain start
–Sudden or slow in onset
–Duration, location,
radiation
–Is it regular
–Spotting
–Proper prenatal care
–If active labor, question
push or bowel movement

8. Diabetes
–Patients have to be placed on insulin—
medication will pass to the fetus
–Effects on baby—tend to be larger in size
–Tend to have trouble maintaining body
temp. And subject to hypoglycemia

9. Hypertension
•Generally speaking bp is lower in
pregnancy than non-pregnancy
•Preexisting hypertension is exacerbated
•Persistent HTN adversely affects
placental size
•Leading to compromise of fetus and
placing mother at risk for CVA or renal
failure

10. Cardiac
•During pregnancy, cardiac output
increases up to 30%
•Can lead to CHF from preexisting

11. Spontaneous Abortion
•Commonly called a miscarriage
•Occurs of its own accord
•Occur before the 12
th
week of pregnancy
•Many occur within 2 weeks after
conception, being mistaken for menstrual
cycle

12. Criminal Abortion
•Attempt to destroy fetus by one whom is
not licensed to do so
•Amateurs
•Without aseptic techniques
•Leads to other complications

13. Therapeutic Abortion
•The pregnancy posed a threat to
maternal well-being
•Judged to medically indicated

14. Ectopic Pregnancy
•Pathophysiology
–Implantation of fertilized
ovum outside of the
uterus.
–Approximately 1:200
–Most common site—
fallopian tube
–Truly a medical
emergency
–Causes extensive bleeding
into the abdominal cavity
and pelvis
–Predisposing
factors—
•Previous pelvic
infections
•Pelvic adhesions—
previous abdominal
surgery
•Tubal ligations
•IUD

15. Assessment of ectopic
pregnancy
–At risk for rapid development of shock
–Take VS frequently
–Abdominal—significant lower quadrant
tenderness
–Avoid as much as possiblerupture of
ectopic
–Bleeding can range from spotting profuse

16. Management
–Difficult to diagnose
–If suspected should care for as any shocky
patient
–Emergent transport

17. Abruptio Placenta
•Third trimester bleeding
•Premature separation of
the placenta from the
uterine wall.
•Partial or complete
•Complete often results in
death of fetus
•Predisposing factors
–Preeclampsia
–Maternal HTN
–Multiparity
–Abdominal trauma
–Extremely short umbilical
cord
–Vaginal blood loss is
minimal due to blood
collecting behind placenta

18. Assessment
–Have constant, severe abdominal pain
–Feels like something is “tearing”
–Abdomen is very tender
–Bleeding will be dark in color
–PMH—abruptio placenta

19. Management
•COMI
•Large bore IV’s
•Rapid transport

20. Placenta Previa
–Attachment of the placenta that partially or
completely covers the internal cervix
–Begins to bleed as the cervix thins out,
spreading the placenta until it tears
–Precipitated by sexual intercourse or digital
vaginal examination

21. Assessment
–Usually multigravida
–Third trimester
–Most common—
painless, bright red
bleeding
–Uterus is soft
–Management—
•COMI
•High flow O2
•Large bore IV’s
•Rapid transport

24. PIH
•Bp of 140/90
•Early stage of disease process
•Bp is normally low so 130/80 maybe high

25. Preeclampsia
•Characterized by:
–HTN
–Abnormal weight gain
–Edema
–Headache
–Protein in urine
–Epigastric pain
–Visual disturbances

26. Eclampsia
•Characterized by the same as pre but
includes seizures

27. Supine Hypotensive Syndrome
•Occurs in the third
trimester
•Marked decrease in
blood flow to the heart
due to increase mass in
abdominal cavity
•Compresses on the
inferior vena cava thus
decreasing the blood
flow back to the heart
•Assessment—be
aware of signs of
shock and verify
previous problems
with same
•Management—place
in LLR, treat for
shock if other signs
of shock are present.