EM OB 1: Emergency Delivery, part 1

Question 1

Most common reasons for transport to obstetric centers

Answer 1

1) preterm labor

2. premature rupture of membranes
3. hypertensive disease
4. antepartum hemorrhage

Question 2

remarks on rupture of membranes

Answer 2

50% of women will deliver within 5 hours
95% will deliver within 28 hours

Question 3

Explain nitrazine paper test

Answer 3

Amniotic fluid has a pH of 7.0 to 7.4
it will turn the nitrazine paper to dark blue

Vaginal fluid has a pH of 4.5-5.5
it will turn allow the nitrazine paper to remain yellow

Question 4

false positive results in nitrazine paper test occurs when?

Answer 4

presence of
blood
lubricant
Trichomonas vaginalis
semen
even cervical mucus

Question 5

these serve as reference point in determining station

Answer 5

maternal ischial spines
located at 4 and 8 o’clock of the vaginal canal

Question 6

a +3 station corresponds to

Answer 6

visible scalp at the introitus, indicating a fetal position consistent with impending delivery

Question 7

Describe a false labor

Answer 7

aka Braxton Hicks contractions
irregular, brief contractions
usually confined in the lower abdomen
do not produce cervical changes

Question 8

Describe a true labor

Answer 8

painful , repetitive uterine contractions that increase steadily in both intensity and duration
results in cervical effacement and diltation

pains typically commence in the fundal region and upper abdomen and radiate into the pelvis and lower back

Question 9

rate of cervical dilatation in the active phase

Answer 9

nulliparous: 1.2 cm/hour
multiparous: 1.5 cm/hour

Question 10

typical duration of second state of labor

Answer 10

nulliparous: 54 mins
multiparous: 20 mins

Question 11

typical duration of third stage of labor

Answer 11

10 mins
active intervention is usually not required until after 30 minutes, unless hemorrhage occurs

Question 12

indicators of fetal distress

Answer 12

fetal bradycardia or tachycardia
late decelerations
(persistent drops in fetal heart rate both during and more than 30 seconds after a contraction)

Question 13

What to do if decelerations are suspected?

Answer 13

Obtain emergency obstetrics consultation
Try to increase maternal blood flow by
- positioning the patient in the left lateral decubitus position
- providing IV hydration
Administer oxygen

Question 14

normal fetal heart rate

Answer 14

120-160 bpm
bradycardia: <110 bpm
tachycardia: >160 bpm

Question 15

Used to estimate gestational age

Answer 15

Nägele’s rule
-3 to months
+7 to days

Question 16

remarks on using fundal height to estimate gestational age

Answer 16

cm = weeks of gestation +/- 2 weeks

Question 17

remarks on using bedside US to estaimate gestational age

Answer 17

if used in the third trimester, can very by +/- 3 weeks

Question 18

What to ask in history in a patient in labor

Answer 18

onset and frequency of uterine contractions
+/- gush of water
+/- vaginal bleeding
+/- fetal movement

Question 19

Patient with vaginal bleeding should be evaluated with:

Answer 19

bedside ultrasound prior to speculum or bimanual examination in order to rule out placenta previa

Question 20

simplest method to verify presentation

Answer 20

bedside US

Question 21

remarks on meconium

Answer 21

if meconium is present on the examining finger, be prepared for neonatal resuscitation

Question 22

what to do if rupture of membranes is suspected?

Answer 22

Perform a sterile speculum examination.
Do not use lubricant because it may produce a false positive nitrazine test.
Do not perform a digital examination because even one digital examination increases the risk of infection
Also avoid digital examinations in the preterm patient in whom the prolongation of gestation is desired.

Question 23

How to administer Oxytocin?

Answer 23

20 units in 1000 mL normal saline
or
10 units IM

Question 24

How to administer hydralazine?

Answer 24

5 mg IV,
followed by 5- to 10-mg boluses every 20 mins

Question 25

How to administer Labetalol

Answer 25

20 mg IV,
followed by doubled doses up to 80 mg every 10 mins
(20-40-80-80)
max total dose, 220 mg

C/I: sinus bradycardia

Question 26

How to administer magnesium sulfate

Answer 26

LD 4-6 g IV over 15 mins,
MD 2g/hr infusion

or
5 g IM in each buttok

max serum Mg = 8 mg/dL
C/I: myasthenia gravis

Question 27

How to administer Naloxone?

Answer 27

0.4 - 2.0 mg IV every 2-3 mins as needed up to 10 mg cumulative dose