High Risk OB assessment and treatment in the pre-hospital setting - Research Paper Example

Each paramedic personnel should be aware that appropriate care for a mother provides appropriate care for a fetus. Ideally, pre-hospital assessment of a pregnant woman should be conducted in a clean, quiet and private area. Explaining the steps of assessment to the patient and respect for her privacy should be done to relieve any anxiety. In asking questions from a patient who still does not know if she is pregnant, claims of regular menstrual periods and/or lack of sexual activity still do not rule out the possibility of pregnancy as denial is highly possible.

Any abdominal pain and its characteristics, last normal menstrual period or expected date of delivery, likelihood of pregnancy, such as presence of sexual activity, gravidity, presence and amount of vaginal bleeding or discharge and prenatal care should be elicited in the history. For those in labor, the following should be asked: previous caesarean delivery, presence of watery discharge with any discoloration, characteristic of contractions and any known complications. Immediate life-threatening symptoms should be identified by checking the vital signs of the patient.

Hypotension diverts the blood from the fetus to the maternal organs. Blood pressure should be measured when a mother is lying on her left side so as to allow blood to flow through the inferior vena cava which is impeded by the uterus when the patient is supine. Ample support should be provided as the patient may suffer from syncope. Physical examination in pre-hospital setting is limited to determining blood loss and/or presence of crowning. A visual inspection of the vagina instead of internal vaginal exam should be conducted for patients complaining of vaginal discharge or labor.

For treatment, oxygen administration has benefits for both mother and child. In cases of hypotension, venous access and fluid resuscitation via a 250 ml bolus of normal saline should be provided as needed to maintain the maternal blood pressure above 90 mmHg. Vasopressors, such as dopamine and norepinephrine, should only be provided after this procedure to prevent decreased blood flow to the uterus. The patient should also be placed on a cardiac monitor. In transporting, the patient must be lying on her left side, immobilized if necessary.

If birth is imminent, delivery should be prepared in the pre-hospital setting. In such cases, the role of paramedic is to control birthing process and prevent an injurious explosive delivery. Pillows or blankets to support the buttocks can allow greater access to the baby. The mother should not be prevented nor delayed from delivering the baby. The EMS personnel should neither hold the mother’s legs together nor should she be allowed to go to the bathroom. Vaginal intervention is indicated when there is imminent delivery of a baby in breech position or there is prolapsed umbilical cord.

After delivery, the baby’s mouth should be suctioned, and the APGAR score should be calculated. However, when the patient has not delivered yet within 10 minutes or when the fetus is in breech or limb presentations, she should be taken to the nearest hospital. She should be transported lying down with her knees widely apart and her feet flat on the bed.In cases of trauma, airway, breathing and circulation should be the top priority. The cervical spine and backbone should be protected by a backboard tilted 20°.

In abortion, hemodynamic stability by fluid resuscitation and oxygen are necessary to prevent hemorrhagic shock. A patient with pre-eclampsia should not be transported with lights or sirens as this may trigger seizures. In such cases administer benzodiazepine. Work CitedNavarro, K. Pre-hospital Management of Obstetric Complications. Texas EMS Magazine January/February, 32-39, 2009. Print.