Paramedics Assessment with Problems in Pregnancy and Complicated Childbirth – Case Study Example

The paper "Paramedics Assessment with Problems in Pregnancy and Complicated Childbirth" is a great example of a case study on medical science. This is a case of a 26-year-old woman who presents with uterine contractions with two previous cesarean sections due to obstructed labor which may be secondary to the large fetus, fetal malpresentation, or cephalopelvic disproportion. Taking into consideration her obstetrical history, this patient must be transported to the hospital for cesarean delivery if she is in true labor. Meanwhile, it is important that maternal and fetal vital signs are closely monitored. The patient must be inquired about her prenatal check-ups, acquired illnesses especially genitourinary infections, or painful experiences. By estimating her EDC or EDD through ultrasonography or manual calculations by measuring the fundic height or getting the LMP, a rough correlation with her uterine contractions can be deduced to know if the patient is undergoing false or true labor. Rupture of membranes or excretion of a mucus plug may indicate an active labor process. General health must also be assessed if the mother has had allergies, is smoker or alcoholic or takes any drugs or medications (Complicated childbirth). In ancient times, the mode of delivery for subsequent pregnancies after a history of cesarean section (CS) will always be CS. Currently, there are now options to undergo a trial of labor after a cesarean birth but patients must be aided in their decision making with sufficient understanding about the risks and benefits of a vaginal delivery. With TOLAC, there is a risk of uterine rupture. The following characteristics increase the success of vaginal delivery: previous vaginal delivery, history of VBAC, spontaneous labor, competent cervix, nonrecurring indications i.e. breech, Previa, herpes, preterm delivery, an interpregnancy interval of more than 18 months. Similarly, the risks associated and factors that may contribute to the failure of the process are morbid obesity, Hispanic and African American race, increasing birth weight, previous history of cephalopelvic disproportion, diabetes mellitus, failure to progress labor, no history of vaginal deliveries, or a previous cesarean section. In the clinical case given, her risks of undergoing a trial of labor may be high; therefore a cesarean delivery may be recommended (Caughey, n.d.).  Multiple pregnancies present with larger uterine size than the expected age of gestation, multiple fetal heartbeats and increased levels of maternal serum alpha-fetoprotein. Physiologic maternal perinatal manifestations include anemia, elevated cardiac stress, aspiration, supine hypotension, dyspnea, increased lumbar lordosis back edema, uterine atony and polyhydramnios (Capogna & Celleno, 1997). Multiple gestations predispose the mother to preterm delivery. Delivery of more than one baby poses a threat to both the mother and child. Fetal complications include intrauterine growth restriction which occurs after 29 weeks in twins or 27 weeks in triplets, congenital anomalies, or cord entanglement, malpresentation, or birth asphyxia. Also, there is a risk of twin-twin transfusion syndrome (TTTS) which is due to vascular anastomoses between circulations usually of monozygotic twins. Clinical manifestations of the donor are anemia, growth retardation, and oligohydramnios while the recipient presents with hypervolemia, polycythemia, increased growth, polyhydramnios, and cardiac hypertrophy. Hydrops fetalis may also develop. The demise of one fetus puts the survivor in danger for exsanguination, acute hypotension, embolization, limb amputation, intestinal atresia or gastroschisis (Multiple Births, 2004). Maternal complications include pregnancy-induced hypertension, preterm labor, and birth, anemia, or antepartum hemorrhage (Multiple pregnancies, 2011). The following antenatal and postpartum maternal complications are noted in patients with triplets: PROM, gestational diabetes mellitus, pre-eclampsia/eclampsia, or postpartum hemorrhage (Al-Suleiman et al., 2006). Management through bed rest and hydration, home monitoring of uterine contractions or cardiotocography, cervical cerclage or tocolytic agents were used but there are no well-established documents that would support their effectiveness. Mode of delivery usually depends on the presentation of the first fetus. Vaginal delivery is indicated if the first baby is a vertex in position, no factors leading to fetal distress or there is the minimum duration of the second stage for the second twin (Capogna & Celleno, 1997). If the first baby breech gently lifts the body and move downward to deliver the anterior shoulder then pull simultaneously with the next contraction. In the case of cord prolapse, the cord is covered with warm saline-soaked packs. Administer oxygen to the mother and put her in exaggerated Sim’s position to elevate the cord. It may be pushed back with during contraction. With complications of postpartal hemorrhage, efficient management is to leave the cord uncut and allow spontaneous placental delivery. Allow baby to breastfed to induce the release of oxytocin or massage uterus to aid uterine contraction. With excessive bleeding, the cord is clamped and cut and applied with cord traction. Otherwise, referral to specialized hospital is necessary for monochorionic monoamniotic twin or triplet pregnancies, monochorionic/ dichorionic diamniotic triplet pregnancies, fetal anomaly or death, or TTTS (Multiple pregnancies, 2011).