CNM Varney's Review Book Part E Flashcards
normal third and fourth stages of labor; complications of 3rd/4th stage labor; transition of the fetus to extrauterine life; healthy newborn; neonatal resuscitation
desultory labor
uterine inertia
what is the average duration of the third stage of labor?
5-10 minutes
once you are sure that the placenta has separated, waht is the next step you sould take in managing the deliver of the placenta?
assess whether the uterus is contracted
after the placenta separates and moves into the lower uterine segment or the upper vaginal vault, what change in the uterus would hou expect?
it would be displaced upward and thus rise in the abdomen
http://library.med.utah.edu/nmw/mod2/Tutorial2/fig13-williams.html
what is the modified Brandt-andrews maneuver?
bringing the fingertips of your abdominal hand straight down above the symphysis into the lower abdomen while holding the umbilical cord taut to check for placental separation (but it is not the same as counterpressure on uterus while pulling on cord/placenta to remove it)
what is the fourth stage of labor?
the period beginning with the birth of the lacenta and ending one hour later
a woman’s blood pressure, pulse and respirations should be monitored how often during normal fourth stage of labor?
q 15 min until stable at prelabor levels
woman just delivered 4200 gm infant following prolonged first stage of labor for which you initiated pitocin. Second stage unremarkable except for fact that you preformed an episitomy to expedite birth of infant’s head. This woman is most at risk for what?
uterine relaxation/atony
what would be indications for postpartum inspection of cervix?
Well-contracted uterus accompanied by steady trickle of blood from the vagina
Presence of anterior lip that had to be pushed back manually
Forceps or vacuum extraction delivery
As you try to tease out trailing membranes during third stage, you feel that there is some tearing of the membranes. You inspect the placenta and the membranes and it appears that parts of the memebranes are indeed missing and therefore, probably retained within the uterus. What is appropriate mgmt of this situation?
Order a methergine series for teh woman to achiever rapid expulsion of the retained membrane fragments.
What is the most common cause of third stage hemorrhage?
mismanagement of third stage
as you examine a placenta during the postpartum period you notice approximately four small, hard, nodular whitish areas on both the maternal and fetal side of the placenta. Wha tis the term used to describe these nodules?
infarcts
what is teh most appropriate mgmt of finding infarcts?
note it as a normal degenerative change of the placenta
Approximately what percentage of infants born with only one umbilical artery will have multiple, severe malformations?
30%
Third stage hemorrhage due to partial placetal separation. You immediately put a STAT call in to the consulting physician, and as you come into the room, you notice that there is an IV line running with LR. What is the best action to take to manage the hemorrhage?
masage uterus to attempt to cmplete placental separation adn then apply controlled cord traction to facilitate delivery of the pacenta.
partial placental separation leading to 3rd stage hemorrhage is most likely caused by
uterine massage prior to placental separation
when should manual repositioning of the uterus be performed following uterine inversion?
should be performed with the placeta still attached to the uterine wall
what is the last step in manual removal of the placenta?
administration of oxytocin
what is the most common cause of immediate postpartum hemorrhage?
uterine atony
What is the proper dosage and freuqency for a methylergonovine (Methergine) series?
0.2mg every 4 hours for 6 doses
As you examine a placenta, you note that there appear to be several cotyledons missing. What is most appropriate management of this situation?
perform a manual uterine examinationa dn removal of the retained placental fragments to ensure that a hemorrhage does not ensue.
What is the drug of choice for a normotensive woman who is experiencing excessive postpartum bleeding due to uterine atony?
Methergine
which pelvic muscle comprises the largest portion of the pelvic floor?
levator ani
What muscle would NOT be cut in a midline episiotomy? bulbocavernosus pubococcygeus superficial transverse perineal deep transverse perineal
pubococcygeus muscle
When are mediolateral episiotomies indicated?
they are indicated if there is an increased risk of a sevre laceration or cut that will extend into the rectal sphincter and rectum
what gauge suture should you use to repair a tear/incision of the vaginal mucosa?
3-0
what gauge suture should you use to repair a clitoral tear?
4-0
a sulcus tear is what degree of laceration?
second degree
Which of the following has the potential to inhibit respirations in the newborn? rubbing on newborn's back flicking sole of newborn's foot exposure of newborn to cold exposure of newborn to light and noise
exposure of newborn to cold
what neonatal heat-crating mechanism is most efficient?
non-shivering thermogenesis
You are trying to rewarm a newborn who has been stressed by hypothermia by placing her under a radiant warmer. What would be most helpful in the rewarming process?
uncover the newborn’s head prior to placing her under the warmer
what is the mean glucose level for newborns from 4-72 hours after birth?
60-70 mg/dL
in our hospital as long as its above 40, we’re ok with it
what is the approximate maximum capacity of the stomach of the term newborn?
30 cc
What characteristic of the newborn GI system predisposes the newborn to water loss complications?
immaturity of the lining of the colon
What is “gut closure”?
process by which the epithelial surfaces of the intestine become impermeable to antigens
What findings would suggest that the fetus of a mother exposed to CMV in pregnancy has actively responded to a CMV infxn in utero?
Positive IgM antibodies to CMV
metabolic acidosis caused by cold stress has what effect on the pulmonary vasculature?
vasoconstriction
fetal lungs require waht for the production of surfactant?
oxygen
glucose
lung perfusion
How is brown adipose used for thermoregulation?
its utilization is under the control of the hypothalamus and is triggered by cold sstimulus
At 1 minute following birth: HR 88 bpm slow, irregular breathing with grunting limp extremities grimace in response to stimulus pale color
3 1 for HR 1 for breathing 0 for extremities 1 for grimace 0 for color
what is the maximum amount of time after birth that a newborn can go without voiding before referral to a pediatric provider is warranted?
24 hrs
but I thought we learned 36 or 48 was when to call peds
when is the best time to apply eye prophylaxis against opthalmic infection by GC/Ct?
at approximately 1-2 hours after birth
of the follwoing situations leading to the need for resuscitation, which is the most common? birth trauma fetal asphyxia maternal medication fetal malformations
fetal asphyxia
what step in newborn resuscitation whould always be undertaken first?
clear the airway
ABC) (provide warmth, clear airway, dry, stimulate
a newborn has no respiratory effort. Stim and clearing airway does not initiate spontaneous respirations. Now what?
Positive-pressure ventilation
Waht is the pressure needed for the first newborn breath?
40-50 cm H2O
When shoudl you do ET intubation of newborn?
when diaphragmatic hernia is suspected
when newborn needs prolonged ventilation
when adequate exygenation cannot be achieved with bag/mask
