Obstetrics (Antepartum Complications)

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Obstetrics (Antepartum Complications)
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Objectives

• 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.

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Introduction

• 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.

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Epidemiology

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

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Pathophysiology

• Placenta Previa
• Placenta implants over the internal cervical os
  (the opening of the cervix).
• Types include complete, marginal, and partial.

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Placenta previa
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Pathophysiology (contd)

• 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.

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Abruptio placentae
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Pathophysiology (contd)

• 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.

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Ectopic pregnancy
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Pathophysiology (contd)

• Preeclampsia and Eclampsia
• Preeclampsia has hypertension, edema, protein in
  the urine, visual disturbances, and headaches.
• Hypertension gt140/90.
• Eclampsia is all the above, but in addition the
  patient has now developed seizures.

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Pathophysiology (contd)

• 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.

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Types of Abortion
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Assessment

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

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Assessment (contd)

• 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?

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Antepartum Complications and Associated Signs and
Symptoms
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Emergency Medical Care

• Assess and maintain the airway.
• Determine breathing adequacy.
• High-flow via NRB with adequate breathing.
• High-flow via PPV _at_ 10-12/min if inadequate.
• Assess circulatory components.
• Check pulse, skin characteristics.
• Control major bleeds.

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Emergency Medical Care (contd)

• 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.

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Summary

• 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
  stakethe mother and the unborn child.

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Summary (contd)

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