2d • Paramedic Talk
OB Emergencies Quick Study Guide
Primipara
Meaning: First-time delivery.
NREMT clue: A patient giving birth for the first time may have a longer labor, but EMS should still prepare for delivery if birth is imminent.
Ask:
- How many weeks pregnant?
- First pregnancy or first delivery?
- Contractions how far apart?
- Water broken?
- Need to push?
- Vaginal bleeding?
- Crowning?
Increased Blood Volume in Pregnancy
Pregnant patients have an increased blood volume, often around 45% higher than normal.
Why it matters:Pregnant patients may lose a significant amount of blood before showing obvious signs of shock.
NREMT clue: Do not underestimate blood loss in a pregnant trauma or bleeding patient.
Ectopic Pregnancy
Meaning: Fertilized egg implants outside the uterus, usually in the fallopian tube.
Usually occurs: First trimester, often up to 12 weeks.
Signs/Symptoms:
- Lower abdominal or pelvic pain
- Vaginal bleeding
- Missed period
- Shoulder pain
- Dizziness or syncope
- Signs of shock if ruptured
NREMT clue: Female of childbearing age + abdominal pain + vaginal bleeding = suspect ectopic pregnancy.
EMS care: Treat for shock and rapidly transport.
Supine Hypotensive Syndrome
Important: It is supine hypotensive syndrome, not hypertensive.
Meaning: The gravid uterus compresses the inferior vena cava when the patient lies flat.
Result: Decreased venous return, decreased cardiac output, and low blood pressure.
Signs/Symptoms:
- Hypotension while lying supine
- Dizziness
- Weakness
- Nausea
- Pale, cool, clammy skin
- Near-syncope or syncope
EMS care: Place the patient in the left lateral recumbent position or manually displace the uterus to the left.
NREMT clue: Pregnant patient feels faint while lying flat = move her onto her left side.
Hyperemesis Gravidarum
Meaning: Severe nausea and vomiting during pregnancy.
Signs/Symptoms:
- Persistent vomiting
- Dehydration
- Weight loss
- Weakness
- Dizziness
- Dry mucous membranes
- Tachycardia
EMS care: Assess perfusion, check glucose if available, give fluids/antiemetic per protocol, and transport if severe.
NREMT clue: Pregnancy + severe vomiting + dehydration/weight loss = hyperemesis gravidarum.
Preeclampsia
Meaning: Pregnancy complication usually after 20 weeks with hypertension and signs of organ involvement.
Signs/Symptoms:
- High blood pressure
- Protein in urine, if known
- Swelling of hands, face, or feet
- Severe headache
- Blurred vision
- Right upper quadrant or epigastric pain
- Nausea/vomiting
- Hyperreflexia
- Possible shortness of breath
EMS care: Reduce stimulation, place left lateral, monitor BP, establish IV if ALS, prepare for seizures, and transport.
NREMT clue: Pregnant patient after 20 weeks + hypertension + headache/blurred vision = preeclampsia.
Eclampsia
Meaning: Preeclampsia with seizures.
Signs/Symptoms:
- Seizure activity
- Hypertension
- Headache or visual changes before seizure
- Possible altered mental status after seizure
EMS care:Protect airway, prevent injury, reduce stimulation, consider magnesium sulfate if ALS protocol allows, and rapidly transport.
NREMT clue: Pregnant patient with hypertension and seizure = eclampsia.
Uterine Rupture
Meaning: The wall of the uterus tears open during pregnancy or labor.
Risk Factors:
- Previous C-section
- Previous uterine surgery
- Trauma
- Difficult/prolonged labor
Signs/Symptoms:
- Sudden severe abdominal pain
- Vaginal bleeding
- Signs of shock
- Pain between contractions
- Loss of contractions
- Possible abnormal fetal status
EMS care: Treat for shock, oxygen as needed, IV access if ALS, left lateral position, and rapid transport to an OB-capable facility.
NREMT clue: Pregnant patient + sudden severe abdominal pain + shock = uterine rupture.
Uterine Inversion
Meaning: The uterus turns partially or completely inside out, usually after delivery.
Signs/Symptoms:
- Severe postpartum bleeding
- Shock
- Severe pelvic/lower abdominal pain
- Mass protruding from the vagina
- Recent delivery
EMS care:Treat for shock, oxygen as needed, IV access if ALS, rapid transport, do not pull on the cord, and do not remove an attached placenta.
NREMT clue:Postpartum bleeding + shock + mass protruding from vagina = uterine inversion.
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OB Emergencies Quick Study Guide
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