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The ovaries are the beginning point for reproduction. During the menstrual cycle,
one follicle releases an ovum. If the ovum becomes fertilized, it develops into an
embryo, and then into a fetus.
The fallopian tubes are the structures that transport the ovum from the ovary to
the uterus (a muscular, inverted pear-shaped organ). Once an egg is fertilized, it
implants in the endometrium (the inner lining of the uterus).
The fetus is enclosed in the amniotic sac, which contains amniotic fluid, allowing
the fetus to develop in a weightless environment.
The gestational period (the time that it takes for the infant to develop in utero)
normally lasts 38 weeks.
In the first trimester of pregnancy, the placenta, umbilical cord, specialized body
systems, and limbs form. In the second trimester of pregnancy, the fetus gains
weight and body systems become more specialized. In the last trimester of
pregnancy, the fetus primarily puts on weight.
Pregnancy is considered at term by week 37. Babies born before 37 weeks of
gestation are considered premature, and babies born after 42 weeks of gestation
are considered postmature.
Physiologic changes during pregnancy can alter a woman’s normal response to
trauma or exacerbate or create medical conditions that can threaten the health of
woman and fetus.
Conditions that can be exacerbated by pregnancy include heart disease,
hypertension, diabetes, respiratory disorders, renal disorders, hemoglobin
disorders, epilepsy, and thyroid disorders.
Preeclampsia is the most serious hypertensive disorder, manifesting after the 20th
week of pregnancy. Symptoms include edema, gradual onset of hypertension,
protein in the urine, severe headache, nausea and vomiting, agitation, rapid weight
gain, and visual disturbances.
Cholestasis is a liver disease that occurs only during pregnancy. In this condition,
the flow of bile is altered, causing acid buildup. The acid eventually spills into the
bloodstream, causing profuse and painful itching.
Abortion is expulsion of the fetus, from any cause, before the 20th week of
gestation.
An incomplete abortion occurs when only some of the products of conception are
expelled. In such cases, be alert for signs and symptoms of shock.
The three major causes of significant antepartum hemorrhage are abruptio
placenta, placenta previa, and uterine rupture.
Assessment of third-trimester bleeding is much the same as the assessment of
other vaginal bleeding. Keep the woman lying on her left side, administer
supplemental oxygen, provide rapid transport, provide IV fluids and ECG
monitoring, and place sanitary pads over the vagina.
Pregnancy occurs when a fertilized ovum has implanted somewhere other than the
uterus, usually in one of the fallopian tubes. The patient will be in severe pain and
possibly hypovolemic shock.
In assessing a patient with an obstetric emergency, identify the length of
gestation, estimated due date, any complications with this pregnancy or others,
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and the presence of The major causes of injury to pregnant women are motor
vehicle collisions, falls, domestic abuse, and penetrating injuries such as gunshot
wounds. Treatment of trauma in a pregnant woman is the same as treatment of a
nonpregnant woman, except that the pregnant patient should be transported on her
left side unless spinal injury is suspected.
Labor may begin with a bloody show, or release of mucus (sometimes with blood)
from the vagina.
The first stage of labor begins with the onset of contractions—crampy abdominal
pains that may radiate into the lower back. The amniotic sac may also rupture.
The second stage of labor begins when the baby’s head enters the birth canal. The
woman’s contractions become more intense and more frequent. When the baby’s
head becomes visible at the vaginal opening (crowning), delivery is imminent.
The third stage of labor occurs when the placenta is expelled.
In assessing a pregnant patient, determine whether there is time to transport.
If delivery is imminent, quickly prepare a private clean area. Behave in a calm
and reassuring way. Control the delivery. Clear the baby’s airway.
Never pull on the umbilical cord to deliver the placenta. Gently massage the
abdomen to aid in delivery of the placenta. Once the placenta is delivered,
examine it for completeness.
A baby born before 37 weeks’ gestation or weighing less than
5.5 lb is premature. Keep a premie warm, maintain the airway, prevent umbilical
cord bleeding, administer supplemental oxygen, and prevent contamination.
Complications of labor include postpartum hemorrhage. In such cases, massage
the abdomen, infuse normal saline or lactated Ringer’s solution, and transport
urgently.
Meconium is the baby’s first stool. A yellow or greenish black tint to the amniotic
fluid indicates the presence of meconium. Vigilantly suction the baby if
meconium staining is present.
Pulmonary embolism can cause maternal death during childbirth or postpartum.
Suspect this complication if the patient experiences sudden dyspnea, tachycardia,
atrial fibrillation, or postpartum hypotension.
Pharmacology during pregnancy may include magnesium sulfate for eclampsia;
calcium chloride to reverse respiratory depression following magnesium sulfate
administration; terbutaline for asthma and as a uterine relaxant and occasionally
for cord prolapse, Valium for treating anxiety, diphenhydramine for treating
hyperemesis gravidum, and oxytocin for treatment of postpartum hemorrhage.