EMT: Late Pregnancy Complications
This lesson focuses on complications that can arise during late pregnancy, which are critical for EMTs to recognize and manage in the prehospital setting. While pregnancy is a natural process, the later stages can present significant risks to both mother and fetus. Understanding these potential complications and appropriate interventions can improve outcomes.
TORCH Syndrome
TORCH is an acronym for a group of infections that can pass from a pregnant woman to her fetus, often leading to congenital abnormalities or severe illness in the newborn. While the term "TORCH syndrome" is a bit of a misnomer as it's a collection of individual infections, recognizing the potential for fetal impact is important.
T - Toxoplasmosis: Caused by a parasite, often contracted from contaminated food or cat feces. Risk to fetus increases as pregnancy progresses.
O - Other agents: Includes infections like syphilis, varicella-zoster (chickenpox), and parvovirus B19.
R - Rubella (German Measles): Can cause severe birth defects if contracted early in pregnancy.
C - Cytomegalovirus (CMV): A herpes-family virus that can remain dormant for years. Active infection during pregnancy poses risk to the fetus.
H - Herpes Simplex Virus (HSV): Can be transmitted during childbirth.
Fetal Symptoms (if infection occurs): Fever, lethargy, cataracts, jaundice, hearing loss, low birth weight, microcephaly, and various other complications. Prehospital care is largely supportive and focused on maternal stability and rapid transport.
Bleeding During Pregnancy
Vaginal bleeding in late pregnancy is always a serious concern and can indicate life-threatening conditions.
Abortion: Expulsion of the fetus before 20 weeks gestation.
Spontaneous Abortion (Miscarriage): Natural loss of pregnancy.
Threatened Abortion: Vaginal bleeding with an intact cervix; pregnancy may or may not continue.
Incomplete Abortion: Some fetal or placental tissue remains in the uterus.
Placenta Previa: The placenta partially or completely covers the cervix.
Symptoms: Painless, bright red vaginal bleeding, typically in the second or third trimester.
Management: Rapid transport, position on left side, administer oxygen, treat for shock if present. DO NOT perform vaginal examination.
Abruptio Placentae: Premature separation of the placenta from the uterine wall.
Symptoms: Severe abdominal pain, vaginal bleeding (may be external or concealed), uterine tenderness, signs of shock.
Management: Rapid transport, position on left side, administer oxygen, treat aggressively for shock. DO NOT perform vaginal examination.
General Management for Vaginal Bleeding: Position patient supine with legs elevated (unless near term, then left lateral recumbent). High-flow oxygen. Treat for shock. Save any passed tissue/pads for hospital evaluation. Rapid transport. DO NOT pack the vagina.
Other Late Pregnancy Complications
Premature Rupture of Membranes (PROM): Amniotic sac ruptures before labor begins, potentially leading to infection.
Preterm Labor: Labor that begins after 20 weeks but before 37 weeks of pregnancy.
Fetal Distress: Can be indicated by decreased or absent fetal movement. Requires rapid transport.
Uterine Rupture: A rare but catastrophic event where the uterine wall tears.
Symptoms: Severe abdominal pain, sudden cessation of contractions, signs of shock (weakness, dizziness, thirst).
Management: Treat aggressively for hypovolemic shock, rapid transport.
Precipitous Labor and Birth: Labor and birth that occur within 3 hours. Can lead to increased risk of trauma and hemorrhage.
Critical Thinking Questions
A pregnant patient in her third trimester presents with sudden onset of severe, tearing abdominal pain and minimal vaginal bleeding, along with signs of shock. What condition do you suspect, and what is your immediate priority?
Why is it crucial for EMTs to avoid performing a vaginal examination on a pregnant patient experiencing vaginal bleeding?
Describe the primary difference in presentation between placenta previa and abruptio placentae.
A pregnant patient is in suspected preterm labor. What is your role as an EMT in managing this patient?
Discuss the significance of the "O" in the TORCH acronym for prehospital providers and the potential impact on the neonate.