30- L&D

Question 1

normal fetal heart rate

Answer 1

110-160

Question 2

normal variability of FHR

Answer 2

6-25

Question 3

what does it mean to have a reactive strip?

Answer 3

A neurologically intact and healthy fetus should have two heart rate accelerations of at least 15 beats per minute over at least 15 seconds in a 20-minute period

Question 4

Absolute Contraindications to Digital Cervical Exam

Answer 4

patient reports of vaginal bleeding with an undocumented placental location (or known previa)

AND leaking vaginal fluid with prematurity (or known PPROM)

Question 5

how many minutes should you delay umbilical cord clamping and why?

Answer 5

2 min

decreases risk of anemia in infants

Question 6

stages of labor

Answer 6

First stage: latent and active phase

Second stage: begins at full dilation; ends when the baby is delivered

Third stage: begins with birth of the baby; ends with delivery of the placenta

Question 7

latent vs active labor

Answer 7

latent phase: regular contractions have started, but the cervix is less than 6 cm dilated

active phase: begins when 6 cm dilated; ends when fully dilated

Question 8

criteria for preeclampsia

Answer 8

2 readings of >140/90 and proteinuria

over 20 weeks gestation

Question 9

definition of proteinuria

Answer 9

at least 300 mg on a 24 hour urine collection or at least 1+ or 30 mg/dL on dipstick (again, on two occasions ideally six hours apart)

Question 10

Criteria for Preeclampsia with Severe Features (any ONE of the following):

Answer 10

severe hypertension of at least 160 mmHg systolic or 110 mmHg diastolic

right-upper-quadrant pain or a doubling of serum transaminases

platelet count < 100 > 1.1 mg/dL

pulmonary edema

Question 11

Late decelerations

Answer 11

are decelerations in the fetal heart rate that begin after a contraction begins, with the nadir after the peak of the contraction.

utero-placental insufficiency

Question 12

category 1 FHR tracing

Answer 12

Normal FHR (baseline 110-160)
Moderate variability (between 6 and 25 beats per minute changes that are not accels or decels)
Plus or minus accelerations (at least 15 beats per minute above the baseline for at least 15 seconds from start to finish)
Plus or minus early decelerations (mirror contractions, nadir of deceleration with peak of contraction and resolves when contraction resolves - usually indicates fetal head compression when the fetus is low in the pelvis, often occurs with pushing)
No late or variable decelerations

Question 13

category 3 fetal heart rate tracing

Answer 13

No fetal heart rate variability (absent) PLUS at least one of the following:
FHR baseline less than 110 (bradycardia)
Recurrent late decelerations (occur with more than 50 % of contractions in a 20 minute period)
Recurrent variable decelerations
OR
Sinusoidal fetal heart rate pattern (smooth undulations of fetal heart rate in a sine wave like pattern). This pattern is rare and is considered an agonal pattern in a fetus near death.

Question 14

avg speed of dilation for multi and primiparous women and avg length of active phase

Answer 14

The average speed of dilation is about 2 cm/hour for multiparous women and about 1 cm/hour for primiparous women,

so the average length of the active phase of the first stage of labor is 2.4 hours for multiparous women and 4.6 hours for primiparous women.

Question 15

Left occiput anterior indicates that

Answer 15

the back (occiput) of the fetal head is anterior in the mother’s pelvis and to the mother’s left.

Question 16

Direct occiput anterior indicates that

Answer 16

the occiput is directly posterior to the pubic symphysis (with the baby’s face towards the rectum.)

Question 17

What are alternative forms of pain management for women who wish to avoid epidural use in labor?

Answer 17

A. Intradermal sterile water injections in the back
B. Self-hypnosis
C. Acupuncture
D. IV opioids (but not close to delivery)
E. Water immersion

Question 18

Causes of Postpartum Hemorrhage

Answer 18

Tone (uterine atony leading to continued bleeding)

Trauma (perineal or cervical lacerations, uterine inversion)

Tissue (retained or invasive placental tissue in the uterus)

Thrombin (a bleeding disorder-much less common that the other three causes)

Question 19

evidence-based approaches to encourage breastfeeding and increase breastfeeding rates.

Answer 19

pacifiers and supplements should be avoided in the first few weeks of life,

mothers and newborns should ideally stay in the same room in the hospital, and infants should only be fed on demand.

immediate skin-to-skin contact

education, office visits, lactation counseling

Question 20

The most important benefit of group prenatal care for an African-American patient is

Answer 20

the decreased risk of preterm delivery as it is the number one cause of neonatal deaths in African-Americans.

Question 21

early decelerations indicate

Answer 21

head compression

Question 22

variable decels indicate

Answer 22

cord compression

Question 23

the best treatment for severe pre-eclampsia

Answer 23

expedited delivery of the fetus