TRANSITION SERIESTRANSITION SERIES

Topics for the Advanced EMTTopics for the Advanced EMT

CHAPTERCHAPTER

Obstetrics (Antepartum Obstetrics (Antepartum Complications)Complications)

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ObjectivesObjectives

• Review rates for complications seen during pregnancy.

• Discuss specific pathology related to certain antepartum complications.

• Review assessment parameters and current treatment standards for a patient with antepartum complications.

IntroductionIntroduction

• Antepartum refers to the period of pregnancy prior to the onset of labor.

• Emergencies that occur during this time may be benign or even life-threatening.

• The goal of the Advanced EMT is to differentiate between these and provide safe, and occasionally lifesaving, treatment to these patients.

EpidemiologyEpidemiology

• 4% of all pregnancies develop 3rd trimester complications.– 22% are placenta previa cases.– 31% are abruptio placentae cases.

PathophysiologyPathophysiology

• Placenta Previa– Placenta implants over the internal

cervical os (the opening of the cervix).– Types include complete, marginal, and

partial.

Placenta previa

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Abruptio Placentae– Placental lining separates from the

uterus.– The expanding collection of blood

continues to force the placenta away, which increases bleeding.

– Complete and partial abruption occurs.

Abruptio placentae

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Ectopic Pregnancy– Pregnancy in which the ovum implants

outside the uterine cavity.– Still the leading cause of pregnancy-

related deaths in the first trimester.– Almost 100% result in fetal death.

Ectopic pregnancy

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Preeclampsia and Eclampsia– Preeclampsia has hypertension, edema,

protein in the urine, visual disturbances, and headaches. Hypertension >140/90.

– Eclampsia is all the above, but in addition the patient has now developed seizures.

Pathophysiology (cont’d)Pathophysiology (cont’d)

• Spontaneous Abortion– Loss of pregnancy before the age of

viability.– Spontaneous means abortion was

unintentional, involuntary, and due to some natural cause.

– Patient will commonly have abdominal cramping, discharge, and expulsion of tissues of conception.

Types of Abortion

AssessmentAssessment

• Physical exam should follow the standard primary and secondary assessments.

Assessment (cont’d)Assessment (cont’d)

• Patient interview should include a focus on:– When was last menstrual period?– Have you been pregnant before?– Are you experiencing any pain or

discomfort?– Are you having any vaginal discharge?– Any prenatal care? – When is your due date?

Antepartum Complications and Associated Signs and Symptoms

Emergency Medical CareEmergency Medical Care

• Assess and maintain the airway.• Determine breathing adequacy.

– High-flow via NRB with adequate breathing.

– High-flow via PPV @ 10-12/min if inadequate.

• Assess circulatory components.– Check pulse, skin characteristics.– Control major bleeds.

Emergency Medical Care (cont’d)Emergency Medical Care (cont’d)

• Position patient left lateral recumbent tilted to the left side.

• Provide supportive care for seizures.• Expedite transport.• Initiate intravenous access en route.• Reassess and reassure while en route.

SummarySummary

• Antepartum emergencies can be the reason for the EMS call, or a consequence of some other trauma or medical problem.

• In many instances, there are two lives at stake—the mother and the unborn child.

Summary (cont’d)Summary (cont’d)

• Treatment is largely supportive, and rapid transport to the hospital is often warranted.