what to ask a pregnent pt

[sportygirl]

On my ride-out we got a call for a 24 year old femal with LLQ and LLR pain and it turned out that she was 16 weeks pregnent and this was her 7th pregnancy 2live births, 2 abortions, and 2 misscarriges she decribed the pain as contractions she said that last week her doctor said she was high risk.

I am an EMT student and we have not gone over childbirth/pregnancy yet and had no idea what to ask? Dose my assessment change? What qustions should be asked? Will it make vitle signs different?

[spenac]

Is the pain you have similar to the previous births or the miscarriages?

Any vaginal discharge? What color?

Any STD's?

I suggest a visual vaginal exam to see if anything peeking back at you and so you can describe any discharge appropriately. This is just a few things to start. Do vitals as always. Treat accordingly.

[sportygirl]

No ther was no discharge and we did not take a look and pt said that it flt like it did with her son how is 4 and she had UTI last week

[Scaramedic]

"what to ask a pregnent pt"

You lied to me, you said you were on birth control!! Are you sure I'm the father?

[Ridryder 911]

My standard questions on O.B. patients are if time permits:

How did you confirm your pregnancy ( physician, health clinic, EPT?, just a hunch?)

Are you under prenatal care at this time?

How many times have you been pregnant (Gravida)

How many live births, did you have? (Para)

How many miscarriages (spontaneous abortions) did you have?

How many therapeutic/ planned abortions? How long ago?

When was the last menstrual period? (LMP)

Estimated date of confinement (due date) and how was that determined?

Difficulties in past deliveries? Vag delivery vs. C-sections. why?

Have you been exposed to viral or childhood diseases, fever,

Any medications, OTC, home remedies (which is common), herbs?

Any vaginal discharge (d/c) or foul odor or leakage of fluid? When?

Any past medical conditions? (HTN, diabetes, seizures)

Recent weight gain, fluid retention, ShOB, etc.?

I would focus upon risk factors ?

Drugs, smoker, diabetic, did they mention at prenatal possibility of protein in the urine (when they dipsticked your urine) as possibility of toxic or high risk.

Have they performed an ultrasound? If so, when and did they discuss the pelvic girth?

Multi births (twins)

Any foreseen problems?

Of course the usual:

Contractions/duration/interval

Location of contraction( back versus lower uterus)

Water break? When?

Baby movement? (quickening)

Pressure on the bowels?

If the patient describes < 20 weeks, ask if there was any tissue or clots noted. If she has felt any type of displacement?

>24 weeks I do a quick external examination, after I asses the Fetal Heart Rate (yes we carry dopplers) and assess the fundal height, and check per Leopold's maneuvers to check fetal position. Many times, the baby has not engaged towards the uterus, and may have false labor pains

Many other things, this is off the top of my head.. there is much information out there.

R/r 911

[Doczilla]

Any problems with previous pregnancies? (Hypertension, prematurity, seizures...) Any heart problems after your last pregnancy? (I have now seen 3 cases of peripartum cardiomyopathy, and it scares the crap out of me)

Did you have to have antibiotics with any of your previous deliveries, or were you told that you need antibiotics near this delivery? (Indicates colonization with group B strep, a risk factor for neonatal sepsis).

If there was a previous c-section, was it transverse or vertical? Vertical incisions are much more likely to lead to uterine rupture with subsequent deliveries, and usually dictate that all deliveries after that will be by c-section. Most c-sections are a low transverse incision, which may be okay with a trial of vaginal birth. Vertical incisions are done for emergent c-sections when mother or baby is really in trouble.

Is the pain constant or intermittent? Uterine tetany is seen with abruption or infection.

Any recent illnesses, fevers, chills, etc.? This may indicate chorioamnioitis, a serious infection of the amniotic fluid.

When was the last time you felt the baby move?

Any urinary symptoms? UTI in pregnant women frequently leads to pyelonephritis. Even bacteria in the urine without symptoms will lead to treatment.

The typical Gravida/Para/Aborta question is broken down further by OB/Gyns. They'll still understand you just fine, but you'll sound like you know what you're talking about if you use their system.

Instead of G5P3A1, it's broken down like this:

G (# of pregnancies, including the current one)

P (# of term deliveries) (# of preterm deliveries) (# of abortions/miscarriages) (# of living children)

Therefore, a woman who is pregnant for the 5th time, delivered 1 full term infant, 2 preterm infants (before 36 weeks), had one miscarriage, and has 2 living children after one died in a car accident, would be noted like this: G5P1212

And Scara, you're a sick dude.

'zilla

[Scaramedic]

Thanks 'Zilla, your so sweet.

Seriously though, we should note if a live birth is killed/died after the birth? I always thought it was times pregnant-gravida and live births, miscarriages, abortions-uni or multipara. But I didn't know we should include living children AND children that died after birth in that number.

Cool, I learn something new everyday.

[Dustdevil]

And you won't want to be asking these questions in the presence of the patient's mother/husband/boyfriend/baby daddy if you want to get honest answers. Many of them won't admit to previous pregnancies or abortions in front of others. If you can't get rid of the audience on scene, wait until you are in the privacy of the ambulance before proceeding with that line of questioning.

[Scaramedic]

Yeah, learned that the hard way. I asked a 14 yo if there was any chance she was pregnant on a syncope call in front of her dad. He went ballistic on scene and in the ER when they asked the same thing.

Turns out Dad was the Dad. :shock:

[Doczilla]

Seriously though, we should note if a live birth is killed/died after the birth? I always thought it was times pregnant-gravida and live births, miscarriages, abortions-uni or multipara. But I didn't know we should include living children AND children that died after birth in that number.

You wouldn't include it in the traditional G#P#A#, but if using G#P####, you do. I don't know why. It doesn't seem to be all that relevant for birth hx unless the baby died of neonatal sepsis or congenital anomaly.

'zilla