Obstetrics (Antepartum Complications)

1. 44 Obstetrics (Antepartum Complications)

2. 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.

3. 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.

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

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

6. Placenta previa

7. 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.

8. Abruptio placentae

9. 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.

10. Ectopic pregnancy

11. 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.

12. 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.

13. Types of Abortion

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

15. 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?

16. Antepartum Complications and Associated Signs and Symptoms

17. Emergency 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.

18. 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.

19. 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 stake—the mother and the unborn child.

20. Summary (cont’d) • Treatment is largely supportive, and rapid transport to the hospital is often warranted.