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Questions and Answers
What physiological change occurs in blood volume during pregnancy?
What is a key factor to consider in history taking for maternity and newborn patients?
What impact does the growing uterus have on maternal physiology?
What is the primary concern for non-English speaking patients in maternity emergencies?
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Which of the following is NOT typically included in history taking for a maternity patient?
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What is the recommended action for a patient in maternity with less than 20 weeks of gestation who is unstable?
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Which of the following is NOT a common cause for maternal cardiac arrest?
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In maternity patients, what does the presence of one red flag or two amber flags signify?
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What should be performed to manage a pregnant woman over 20 weeks gestation in the event of maternal cardiac arrest?
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Which presentation should lead to consideration of ectopic pregnancy, miscarriage, or placental issues in a maternity patient?
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What is one of the first actions to take in the first minute of a newborn's life?
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What condition related to vitamin K in newborns can be a concern?
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What action should be avoided until the appropriate time during newborn resuscitation?
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What is a physiological characteristic of newborns at the time of birth?
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Which of the following assessments is essential in the first minute of a newborn's life?
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Study Notes
Maternity and Newborn Patients
- Includes pregnant women, women who have recently given birth, and babies from birth to 4 weeks of age.
History Taking
- Should include: present complaint (PC), history of present complaint (HxPC), past medical history (PMHx), drug history (DHx), family history (FHx), social history (SHx), review of systems (ROS), immunizations (IMP), and history (Hx).
- Also include: current pregnancy (admissions, risk factors), past obstetric history
- Use a language line for non-English speakers.
- Review any hand-held notes if available.
- Many maternity units have moved to paperless documentation, so access to notes can be challenging.
Maternal Physiology
- Blood volume and cardiac output increase by 50%.
- Blood pressure decreases by 10mmHg.
- Growing uterus compresses the aorta and inferior vena cava.
- Vessels retain fluid, which can result in laryngeal oedema and a difficult airway.
NEWS2 and Maternity Patients
- NEWS2 is not validated for use in pregnancy.
- Maternity patients compensate well, meaning abnormal observations are a late sign of deterioration.
- There is a lower threshold for conveyance in maternity than in the general population.
Maternal Critical Presentations
- Two amber flags or one red flag = TIME (transfer immediately).
- If 20 weeks gestation or more, and woman is stable - convey to the nearest obstetric unit.
- If less than 20 weeks gestation or woman is unstable (e.g., ongoing life-threatening hemorrhage, recent seizure, reduced Glasgow Coma Scale (GCS), convey to the nearest emergency department with obstetric services)
- DO NOT call a midwife.
Acute Presentations in Maternity
- Abdominal pain, shoulder tip pain or hemorrhage: consider ectopic pregnancy, miscarriage, placental abruption, or previa.
- Hypertension, seizures, or new onset confusion: consider preeclampsia/eclampsia, stroke, or pregnancy-induced hypertension.
- Hypotension, tachypnea, or tachycardia: consider sepsis or hemorrhage (concealed?).
- Chest pain or shortness of breath: consider cardiac issues or pulmonary embolism (PE).
Maternal Cardiac Arrest
- Causes: heart failure, hypovolemia, anaphylaxis, embolism, sepsis.
Maternal Cardiac Arrest Management
- Over 20 weeks (in absence of known gestation, visibly pregnant or fundus palpable at umbilicus), perform manual displacement, ALS, and early call to critical care and HEMS.
- Aim is to increase probability of return of spontaneous circulation (ROSC) by reducing aortocaval compression to save the mother.
Newborn Physiology
- Babies' lungs are filled with fluid at birth.
- They undergo a transition from fetal circulation to newborn circulation.
- They have no mechanism for producing and conserving heat.
- They have low levels of Vitamin K, which can affect clotting factors.
- They have high levels of hemoglobin (Hb).
Newborn Resuscitation
- Start timer/note time of birth.
- Dry, stimulate, apply a hat, optimize thermoregulation.
- Assess color, tone, breathing, and heart rate.
- Leave the cord intact as long as thermoregulation is not compromised.
- Call for help if baby is not crying spontaneously, color is poor, or tone is floppy.
- If the baby is not crying spontaneously or has a suboptimal assessment, clamp/cut cord, and take the baby to the resuscitation area.
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Description
This quiz covers essential topics related to maternity and newborn care, including history taking, maternal physiology, and the NEWS2 score for maternity patients. It is designed for healthcare professionals working with pregnant women and newborns. Test your understanding and application of these critical concepts in maternity care.
