CNM Varney's Review Book Part D Flashcards
false and early labor; normal first stage of labor; normal 2nd stage; complications in first and second stage of labor;
What describes the cervix of the average primigravida on the verge of true labor?
50-100% effacement with fingertip to 1cm dilation
how do uterine contractions differentiate the uterus into two segments?
upper zone of uterus shortens and thickens, while lower zone legnthens and thins
What is the definition of fetal engagement?
when the widest diameter of fetal presenting part has passed through pelvic inlet
Which landmark of the fetal head would you use to determine station in a well-flexed, cephalic presentation?
occipital bone
What are some characteristics of true labor contractions?
regular; increase in freuquency, duration, intenstiy; radiate from fundus to back
Which of the following findings would be LEAST likely to give a false positive result when confirming ROM?
+nitrazine test
+ferning
being unable to visualize or feel membranes bulging over presenting part
visualizing amniotic fluid escaping from cervical os
visualizing aminiotic fluid escaping from cervical os
G1P0 at 39 wks. Calls at 10 pm; has been having ctxn since 11 am, is exhuasted and unable to sleep. No signs of ROM, neg bleeding. Ctxn q 10-30 min, lasting 20-30 sec. Have not changed in character, but most comfortable ambulating, least comfortable sitting/laying. Normal fetal movement. You suspect she is experiencing what?
false labor
What is your management of this person in false labor?
Take a warm bath and have a hot drink with sugar and call you back if unable to sleep.
At 2 am, woman comes in who had false labor since 11am previous morning. 2/90/-1 contractions moderate intensity q 7-10 min, lasing 20-40 sec. FHR 130, neg decels. She has had no sleep, is tired and frustrated. What is she experiencing, and what should you do?
Latent phase of labor
send her home with sedatives and encourage her to rest
during what stage of labor does majority of progressive descent of fetal presenting part occur?
During deceleration phase and second stage
what are some traditional s/s of transitional phase/impending second stage?
uncontrollable desire to bear down
expulsive grunt upon exhalation
ROM
What is the most common position, lie, presentation and variety of the fetus at onset of labor?
LOT
Waht is the term used to describe changes in fetal heart rate associated with uterine contractions?
periodic changes
what is considered teh cut-off lower limit for marked tachycardia?
180 bpm
What method of FH evaluation provides the most reliable, comprehensive data?
internal continuous monitoring with FSE
What is considered the critical level of fetal scalp pH at which immediate deliver becomes necessary?
a second reading of a pH <7.20
normal arterial and venous cord blood pH levels
arterial: 7.11-7.36
venous: 7.25-7.45
fetal scalp capillary: 7.25-7.35
What represents a normal rise of BP during contractions for a woman in labor?
systolic rise of 10-20 mm Hg
diastolic rise of 5-10 mm Hg
Which position will be helpful in facilitating the long arc rotation of a fetus in ROP?
Right-lateral position
second stage is also known as what stage?
expulsion stage
according to friedman, what is the avg length of second stage for primigravidas?
60 minutes
G3P2 in active labor turns to you and cires, “the baby is coming!” You checked her 15 min ago and she was 8cm, 0 station. Waht do you do?
Ask her to start panting respirations and while you keep an eye on her perineum, put on your gloves.
what mechanism of labor occurs thorughout labor?
descent
birth of the head occurs throgh which mechanism for an OA delivery?
extension
External rotation accomplishes what in a birth with cephalic presentation?
brings the bisacromial diameter of the fetus into alignment with the AP diameter of the pelvic outlet
what is the bisacromial diameter?
the distance between the outermost parts of the fetal shoulders
internal rotation accomplishes what in a birth with cephalic presentation?
brings A-P diameter of fetal head into alignment with A-P diameter of maternal pelvis
If engagement took place in ROP, how many degrees does the fetal head rotate during internal rotation for OA delivery?
135 degrees
???
shouldn’t it be 180?
If engagement was in ROT, how many degrees for birth in OA?
90
birth in OA from RO, head will restitute to what position?
ROA
head restitutes to ROA, where will it be after external rotation?
ROT
If on abdominal exam you feel the fetal back on the maternal left side and on vag exam you feel sagittal suture in right oblique diameter, what is osition of fetus?
LOA
What physiologic change is abnormal in second stage?
persistent, constant vomiting
what are some NORMAL physiologic maternal changes in second stage?
increase in BP of 20 mm Hg during ctxn
tachycardia at time of delivery
maternal temp elevation of 2 degrees F
Generally accepted frequency of BP checks in second stage is how often?
q 15 min
When is the lithotomy position contraindicated?
severe varicosities (of course, in general it's not what we want to do, but there are exceptions..shoulder dystocia, etc)
what is the usual concentration of lidocaine used for a pudendal block?
1%
what is the best gauge to use for local infiltration of the perineal body?
22 gauge
VBAC most likely contraindicated for which one of the following:
previous c/s for CPD
2 PLTCS for failure to progress
previous c/s with vertical incision of lower uterine segment
previous emergency c/s at 26 wks before onset of labor
book says D, but I say C
I guess because it’s in the lower uterine segment, it remains a slim option. I don’t understand why an emergent section before labor in a second trimester would mean risking out of VBAC, unless it implies a high vertical incision.
How does management of a woman laboring for VBAC (good candidate) differ from women without previous c/s?
Manage the same as any woman in labor
In someone with a classical uterine incision, what is the best option for the next delivery?
scheduled RLTCS without labor
For which of the following women would a dx of preterm labor be accurate? 18 wks, contractions, ROM 24 wks, ctxn q 6 min 20 wks, ctxn q 8 min, ROM 34 wks, ctxn q 10, 1 cm dilation
20 wks, ctxn q 8, ROM
Antenatal corticosteroid therapy has been shown to be most effective at improving neonatal oucome when administered at what GA to women at risk for preterm birth?
24-34 wks
What are some sequelae of PTB?
RDS
intraventricular hemorrhage
LBW
reserach has demonstrated that what is associated with prevention of PTL among women with multiple gestation or a hx of PTL/PTB?
daily contact with a nurse
Waht percentage of women with PROM will go into spontaneous labor within 24 hours?
80-85%
What s/s are associated with intrauterine infection?
fetal tachycardia
BPP 6 or less
white blood cell count with a shift to the left
In a client with PROM at 32 weeks with no curren tsigns of infection, what is the most appropriate mgmt plan?
watchful waiting and allowing pregnancy to continue for as long as possible because the risks of prematurity outweight reisks of sepsis (or thats what the 2002 book said)
s/s: 38 wk GA, temp 102, leaking some liqid that “smells really bad”. uterus tender, HR 100 bpm, FHR 180. What is your dx?
chorioamnionitis
What is the most appropriate first step to take if you suspect chorio in antepartum?
admit to hospital for induced vaginal birth or c/s within 24 hours
Calculate Montevideo units for a woman who iin the last twenty minutes has had four contractions, each 5 minutes apart, lasting 45 seconds, and with a baseline of 10 mm Hg, amplitude of 55 mm Hg.
90,110,135, 165
90
Why should oxyocin only be administered with a physiologic electrolyte solution such as LR and not with an aqueous fluid such as dextrose in water?
to avoid water intoxication
dduring which decel pattern is the FHR most likely to dip befow 100 bpm?
variable decels
Can late decels occur within normal HR range and be as shalow as 10 bpm?
yes
in the absence of administration of any medications, a sinusoidal pattern of the FHR is associated with what?
severe fetal hypoxia
what is teh definition of hypoxia?
decreased oxygen in the tissue
what is the definition of asphyxia?
decreased oxygen in the tissue and metabolic acidosis
deep transverse arrest is associated with what?
android pelvis
upon vag exam of woman in second stage labor with hypotonic uterine dysfunction, you determine that the saggital suture is in the transverse diameter of the mother’s pelvis and that there is considerable molding and formation of caput succadeneum. What is most likely dx?
deep transverse arrest
What might you do to remedy deep transverse arrest?
change maternal position
pitocin
instument or cesarean delivery if condition is not overcome
what is the usual mangement for hypertonic uterine dysfunction in early labor?
administration of morphine and/or barbiturate
Multip in 1st stage has had no change in dilation in 3 hours. You have ensured maternal hydration, encouraged ambulation, performed an amniotomy which reealed clear amnitic fluid. What next?
Pitocin stimulation
woman with uterine rupture. In addition to alerting the physician STAT, what is the most important action for the midwife to take next in this situation?
order blood for a transfusion and ensure that there is appropriate venous access
the fetal shoulders normally enter the true pelvis with the bisaccromial diameter in which diameter?
oblique
what is Varney’s predictive factor for shoulder dystocia?
an estimated fetal weight 1 pound or more greater than the woman’s largest previous baby
it is believed that the exaggerated lithotomy position (McRobert’s maneuber) facilitates delivery of the fetal shoulders through what mechanism?
rotating the symphysis pubis to free the impacted shoulder
during a breech delicery, a hands-off approach is recommended until the baby is born spontaneously up to which body part?
the umbilicus
during breech deliery, suprapubic pressure is applied for what reason?
to maintain flexion of the fetal head
waht is the reasoning behind clamping and cutting the cord of the first-born twin?
to avoid having the second twin exsanguinate through the cord
what finding on its own does not signal fetal hypoxemia?
meconium-stained amniotic fluid
