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Labor and Delivery > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q
  1. What are the 5 P’s that affect labor?
A
  1. Passenger (fetus and placenta)
  2. Passageway (birth canal)
  3. Powers (primary and secondary)
  4. Position (of the mother)
  5. Psychologic Response (psyche)
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2
Q
  1. Name some of the premonitory signs that precede labor:
A 
1. Lightening
Contractions (Braxton Hicks)
Increased vaginal discharge/bloody show
Energy burst (nesting)
GI (nausea, vomiting etc)
Cervical changes
Rupture of membranes
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3
Q
  1. name 5 factors about the fetus that determine fetal descent and delivery:
  2. What is the fetal lie?
  3. what is a longitudinal (aka parallel) lie as opposed to a transverse lie? What is oblique?
A 
1. Size of the fetal head
Fetal lie
Fetal presentation
Fetal attitude
Fetal position
  1. The relationship of the maternal longitudinal axis (spine) to the fetal axis (spine):
  2. longitudinal (aka parallel) is vertical. Think of the mother and infant’s spines being parallel to each other.

Transverse is sideways. Mother’s and baby’s spine form a cross.

oblique is on an angle, somewhere between parallel and transverse.

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4
Q
  1. What is meant by fetal presentation?
  2. What are the 2 types of fetal presentations?
  3. What is meant by the following fetal attitudes in cephalic and breech presentations?

Cephalic: Occiput, sinciput, brow, shoulder, face.
Breech: Frank, Footling, Complete, and Shoulder

A
  1. The part of the fetus that is entering the pelvic inlet first.
  2. Cephalic (head down) and Breech (feet down)
  3. Fetal attitudes in Cephalic Presentations:
    Occiput (chin tucked), Sinciput (looking straight forward)
    Brow (chin up)
    Face (chin totally up and back).
Breech Presentations: 
Frank (butt first, pike)
Footling (one or both feet hanging out)
Complete (legs crossed indian style upright)
Shoulder (shoulder first)
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5
Q
  1. What is meant by fetal position?
  2. how do we label fetal position?
  3. Which is the optimal position for delivery?
  4. which positioning causes “back labor”?
A
  1. The relationship of the presenting part of the fetus to the four quadrants of the maternal pelvis.
  2. Labeled with 3 letters;
    R(right) or L(left) – the side of mom’s pelvis

O(occiput),S(sacrum),M(mentum), Sc(scapula) – fetal presenting part

A(anterior),P(posterior),T(transverse) – the part of the mom’s pelvis

  1. LOA - left occiput anterior
  2. OP occiput posterior
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6
Q
  1. what is meant by station in labor and delivery?
  2. what is zero station?
  3. where are the minus stations?
  4. the true pelvis is the pelvic ………… .
A
  1. Relationship of presenting part to ischial spines. It is the measurement of fetal descent in centimeters.
  2. fully engaged with presenting part at level of ischial spines.
  3. Minus stations are superior to the spines.
  4. inlet
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7
Q
  1. Name the different shapes of pelvises
  2. What should be included in a sterile vaginal exam?
  3. Give an example of how this would read:
A
  1. Gynecoid (ideal)
    Platypelloid (large from side-side, but not front to back)
    Android (heart or triangular shaped inlet), and Anthropoid (large from anterior to posterior, bnut not from side-side).
2. Dilation
Effacement
Station
Presentation
Fetal lie
Attitude
Position
Membrane status
  1. 5/80%/0; cephalic, longitudinal(vertical), flexed(occiput), ROA; SROM @ 10am, clear, straw colored, large amount, odorless
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8
Q
  1. What are primary powers and secondary powers?
  2. What is lithotomy position?
  3. How long is the first stage of labor typically? Second stage? Third stage? fourth stage? What happens at each stage?
A
  1. Primary: uterine contractions (frequency, duration, intensity, resting tone). Secondary powers are the mother bearing down.
  2. on your back, legs open in stirrups
  3. 1st (latent, active, and transition): 12.5 hrs (contractions progress as body is getting ready).
    2nd: 30min - 2 hrs (full dilation, intense contractions until birth of neonate).
    3rd: 5 to 30 minutes (delivery of placenta).
    4th: 1 -4 hours (begins after delivery of placenta and maternal stabilization of vital signs).
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9
Q
  1. Gravidity:
  2. Parity:
  3. Gestational age:
  4. What does each letter of the GTPAL acronym stand for?
A
  1. number of pregnancies
  2. number of pregnancies that reached 20 weeks
  3. calculated from 1st day of last menstrual period
  4. Gravidity, Term births (37+ weeks), Preterm births (up to 37 weeks), Abortions or miscarriages, Living children
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10
Q
  1. What factors determine whether or not a vaginal birth is possible?
  2. Position is determined by what or whom?
  3. What 5 items comprise the psyche of the mother?
  4. The cardinal movements of the mechanism of labor are:
A
  1. The diameter of the pelvic inlet, the midpelvis, the outlet, and the axis of the birth canal.
  2. the maternal/provider preference and condition of the mother and the fetus
  3. environment, anxiety level, previous experiences, cultural beliefs, uniqueness of the woman
  4. engagement, descent, flexion, internal rotation, extension, restitution and external rotation, and expulsion of the infant.
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11
Q
  1. Lochia rubra:
  2. Lochia serrosa
  3. Lochia alba

4, persistently red lochia is associated with what?

  1. malodorous lochia and a tender uterus is associated with what?
  2. what is the threat is uterus stays boggy?
  3. After 1 hour of pad, what are the amounts of lochia corresponding to?
A
  1. bright red bloody lochia that lasts for first 3 days.
  2. pinkish brown lochia from day 4 - 10.
  3. creamy whitish lochia from day 11 to 8 weeks
  4. retained piece of placenta
  5. infection
  6. hypovolemic shock from bleeding
7. 1" or less is scant
>1" but <4" is light
>4" but <6" is moderate
If pad is saturated in 1 hour = heavy
If pad is saturated in 15 or less = hemorrhage
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12
Q
  1. How much blood loss is normal in vaginal delivery? C-section?
  2. What is normal hemoglobin for a non-pregnant and pregnant woman?
  3. When is a transfusion ordered?
  4. why are wbc’s not a good indicator of infection in pregnancy?
A
  1. 500 cc’s and 1000 cc’s
  2. non pregnant: 12 - 16. pregnant 11.5 - 14
  3. if hemoglobin drops below 7.
  4. because they are naturally higher in pregnancy anyways. Around delivery can be 20,000 - 25,000 per cubic millimeter
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13
Q
  1. what is uterine involution? which hormone causes it?
  2. How much does the uterus weigh in pregnancy and not?
  3. how much does fundal height decrease daily? When is it no longer palpable?
  4. What stimulates milk productions?
  5. by how much does blood volume increase in pregnancy?
  6. T or F, cardiac output increases after delivery and stays elevated for 1 day?
  7. Do temp and BP also rise just after birth?
A
  1. shrinking of uterus back to size? oxytocin released when breast feeding
  2. 1000g and 60g
  3. 1cm daily after 10 days it’s not palpable.
  4. prolactin
  5. 1 to 1.5 L
  6. T
  7. yes, transiently
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14
Q
  1. Why are women susceptible to DVT postpartum?
  2. what is fetal deceleration?
  3. Describe early, late, and variable decelerations
A
  1. Because platelets and clotting factors increase to mitigate blood loss in delivery
  2. temporary decreases in the fetal heart rate (FHR) during labor (early, variable, and late).
  3. Early: begin before the peak of the contraction, can happen when the baby’s head is compressed. Often happens during later stages of labor as the baby is descending through the birth canal. generally not harmful.

Late: don’t begin until the peak of, or after the contraction is finished. They’re smooth, shallow dips in heart rate that mirror the shape of the contraction that’s causing them. Can mean baby isn’t getting enough O2.

Variable: irregular, often jagged dips in the fetal heart rate that look more dramatic than late decelerations. Happen when the baby’s umbilical cord is temporarily compressed.

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15
Q
      1. What are the expected outcomes in the newborns transition to extrauterine life, and which is most critical?
      1. Describe the periods of reactivity and decreased responsiveness after birth:
A
  1. Normal respiratory pattern established. Most critical. RR should be btw 30 - 60
  2. Transition from fetal to neonatal cardiovascular circulation (regulates after cord clamping)
  3. Thermoregulation maintained.
  4. Normal serum glucose level maintained
  5. For 30 min after birth there is a period of reactivity. Baby is alert and HR is 160-180 bpm (breast feed now)
  6. after the initial period of reactivity, newborn settles into decreased responsiveness for 2 hours. Newborn sleeps. Decreased motor activity.
  7. second period of reactivity (2-8 hours after birth) happens after. Lasts from 10min - several hours. Increased responsiveness to stimuli
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16
Q
  1. What the cord is clamped, which structure is occluded, sending blood to the liver?
  2. What does ductus venosus become?
  3. during transition, the pressure in the left atrium is greater than in the right, so the …….. …….. flap closes.
  4. Finally, ……….. ……… closes within 12hrs to 4 days.
  5. What predisposes newborns to heat loss (5)?
  6. what can happen as a result of heat loss?
  7. what are the 4 external factors to newborn heat loss?
A
  1. ductus venosus
  2. ligamentum vinosus
  3. foramen ovale flap
  4. ductus arteriosis
  5. vessels close to skin surface, large surface area compared to weight, limited fat, lack of shivering reflex, inability to communicate
  6. Cold Stress. Increased O2 consumption leading to metabolic acidosis, increases in glucose metabolism leading to hypoglycemia, and decreased surfactant leading to resp. distress
  7. Evaporation - loss from moisture on skin evaporation

Convection - loss to surrounding air

Conduction - loss to cool surfaces

Radiation - loss to surrounding structures like a cold wall nearby

17
Q
  1. How do newborns respond to heat loss?
  2. How does the WHO classify hypothermia?
  3. What are the signs and symptoms of newborn hypothermia?
  4. What do congenital reflexes indicate?
  5. Name the newborn reflexes:
A
  1. vasoconstriction, metabolism of brown fat, and voluntary movement
  2. axillary temperature less than 97.7°F (36.5°C) for term Infants. We need to keep temp between 97.7 and 99.5
  3. cyanosis, tachypnea, less active, lethargic, hypotonicity, and weakness
  4. maturity of neurological system
  5. Babinski, moro grasp, rooting, sucking, stepping
18
Q
  1. Why do newborns often get jaundiced?
  2. Why are newborns susceptible to fluid imbalances?
  3. newborn specific gravity is …..? Newborn should pee withing first ….. hours of life.
  4. Why do newborns frequently regurgitate? What is their stomach capacity?
  5. How much weight do babies lose in the first week?
  6. meconium happens within
A
  1. liver is too immature to break down too many rbcs
  2. Their kidneys are immature and can’t concentrate urine
  3. low, 24
  4. because stomach wall doesn’t stretch and cardiac sphincter is immature. 30-90ml
  5. 5-10% of body weight
  6. 12-24 hours of birth
19
Q
  1. Which antibody passes from placenta to fetus?
  2. Which antibodies pass in breast milk?
  3. Which antibody does the fetus produce in utero?
  4. Which vaccine is given shortly after birth?
A
  1. IgG.
  2. IgA, IgE, IgM, IgG
  3. IgM
  4. Hep B
20
Q
  1. When does liver become fully active?
  2. In the liver, ………… and …………… conjugation are crucial to newborn survival
  3. What is considered hypoglycemia in newborns?
  4. What is normal range of blood glucose in newborns?
  5. Signs and symptoms of hypoglycemia
  6. Which babies have a greater chance of developing hypoglycemia?
A
  1. 3 months
  2. carb and billirubin
  3. less than 40mg/dL
  4. 60-80 mg/dl
  5. Jitteriness, tremors, seizures, hypotonicity, Change in level of consciousness (irritability,
    lethargy, or stupor), Apnea, bradycardia, cyanosis, Tachypnea, Poor suck or poor feeding, Hypothermia, Seizures
  6. those with diabetic mothers
21
Q
  1. What is the danger when high levels of bilirubin accumulates in the skin and mucous membranes?
  2. The name for brain damage by bilirubin overload is ………… .
  3. What percentage of infants have jaudice after 24 hours of life?
  4. How long does it take bilirubin to peak and when does it start coming down?
  5. What are some common reasons for hyperbilirubinemia?
  6. Jaundice is considered pathologic if it appears within the first …….. hours of life
A
  1. cross the blood-brain barrier and cause neurotoxicity and brain damage
  2. kernicterus.
  3. 60% in full term, and 80% in preterm
  4. peak is 72-96 hours. Decreases around 5th day
  5. blood type incompatibility w/mother, increased hemoglobin, altered hepatic function, delay of meconium, delayed feeding, trauma, cold stress.
  6. 24
22
Q
  1. what is newborn orientation sensory behaviors?
  2. What is habituation?
  3. T or F, sleep-wake states influence the newborn’s behavior?
  4. What are the behavioral states of the newborn?
A
  1. newborns response to vision and hearing stimuli.
  2. The newborn’s predisposed capacity and response to environmental stimuli: consolability, cuddliness, irritability, crying. Basically, the more a newborn is exposed to a stimulus, the more it gets used to it.
  3. T
4. Quiet sleep state
Active sleep state
Drowsy state
Quiet alert state
Active alert state
Crying state
23
Q
  1. What is the apgar score?
  2. What are the 5 indicators on the apgar?
  3. How does scoring work?
A
  1. Tool to evaluate newborn’s response to the extrauterine environment and need of
    resuscitation efforts.
  2. HR, RR, Muscle tone, Reflex Irritability, and skin color.
  3. Each indicator is scored 0 (absent or very bad) thru 2 (good) at 1 min and 5 min after birth. If the 5 min score is less than 7, continue at 5 min intervals up to 20 min.
24
Q
  1. After first newborn assessment, how often are vitals taken?
  2. What are the norms for newborn vitals?
  3. Is apnea normal in newborns?
  4. What is typical newborn weight?
  5. Typical length?
  6. Head circumference
  7. Chest Circumference
A
  1. every 30 min for 2 hours after birth, then by facility protocol.
  2. HR 110-160, RR 30-60, T 36.5 - 37.5 (97.7 - 99.5). BP not taken on a healthy newborn, but if taken, 60-80/40-50.
  3. yes, but not longer than 15sec.
  4. 2,500 - 4000 g. (5lb 8oz - 8lb, 14 oz)
  5. 45 - 55cm (18 - 22 in)
  6. 32 - 36.8cm (12.6 - 14.5)
  7. 30 - 33 cm (12 - 13 in)
25
Q
  1. Which tool is used to verify gestational age?
  2. On dark skinned babies, where is the best place to observe color?
  3. What is normal color?
  4. describe the following abnormal findings: central cyanosis, pallor, plethora, mottling.
  5. what is vernix?
  6. what is lanugo?
A
  1. Ballard scoring system
  2. mucuos membranes
  3. pink with cyanosis on the hands and feet due to cardiovascular instability (acrocyanosis)
  4. Central cyanosis: blue on trunk.

Pallor: not pink. can be from poor perfusion.

Plethora: redness caused by elevated hematocrit.

Mottling: lacy look caused by pain, infection, cold stress and hypokalemia

  1. a fetal protective skin film that acts as a barrier in utero and facilitates postnatal adaptation to a dry extrauterine environment.
  2. Lanugo is fine, soft hair that grows on a fetus and may be present on a newborn
26
Q
  1. what is petechia?
  2. what is Erythema toxicum?
  3. What is Milia?
  4. What are Mongolian spots?
  5. Name the 3 types of nevi:
A
  1. are pinpoint hemorrhages less than 2 mm in diameter.
  2. innocuous papular rash of unknown origin which occurs in up to 70% of term newborns.
  3. aka baby acne. White spots found on 50% of babies
  4. bluish gray or dark pigmented spots from melanocyte concentrated under the dermis. Disappear by 7 - 10 y.o.
  5. simple (stork bites until 2 y.o), Nevus Vasculosus (strawberry hemangiomas), and Nevus Flameus (port wine stain permanent capillary angiomas)
27
Q
  1. What is caput?
  2. Cephalohematoma:
  3. Even if newborn’s eyes are swollen, they should be ……… . If Too far apart or together it could indicate …………… .
  4. Why do newborns not produce tears?
  5. T or F, cross eyes, strabismus, and nystagmus are normal at birth?
  6. Eyes should be at same level as ……. . Low set ears could mean ………… .
  7. Skin tags on ears might indicate disorders of the ………… . Why?
  8. What is important to note about nose?
  9. T or F newborns sneeze a lot in order to clear mucous.
A
  1. swelling of the soft tissue of the skull, caused
    by the pressure on the head in labor, crosses the suturelines
  2. a collection of blood between the membrane and the bone. Results from trauma. Doesn’t cross suture line. Takes longer to resolve than caput.
  3. Symmetrical. Congenital anomaly.
  4. lacrimal glands are not mature.
  5. T resolves around 4 months
  6. ears. downs syndrome.
  7. kidneys. Ears and kidneys form at the same time.
  8. patency of nares and nose is midline on face. Check patency by closing one nostril at a time.
  9. T
28
Q
  1. What to watch for in newborn’s mouth?
  2. What other things are important to check in nose and mouth?
  3. Neck should be ………. ……… and ………..: There should be no ………….. It should have full …… Head should … as infant is raised.
  4. Clavicles should be checked why?
A
  1. look for color and white patches (could be thrush) on tongue, palate, and mouth.
  2. check for cleft palate, gag and sucking reflex, and presence of nasal teeth
  3. short & thick, surrounded by skin folds. Webbing. ROM. Lag.
  4. They could get broken in delivery.
29
Q
  1. Chest is round symmetric and ………., should be 2 or 3
    centimeter smaller, than the ……. circumference. Nipples are ……….. .
  2. We shouldn’t see chest …(action)….. . Newborns are .(body part)………. breathers. Irregular respirations are not ………….. upon birth, but heart rate should be ……….. .
  3. Abdomen should be ………, dome-shaped, and non-………., and it should feel ……….. .
  4. Umbilical cord should have …. arteries and 1 …..
A
  1. barrel-shaped. head. formed.
  2. retractions. abdominal. irregular
  3. round, non-distended. Soft.
  4. 2 arteries, 1 vein. If there’s only 1 artery, it could be associated with GI probs
30
Q
  1. When assessing extremities check for the proper number of …….. and ……
  2. Assess extremities for what 3 things?
  3. The spine should be ………, ………, and easy to ………
A
  1. fingers and toes.
  2. full range, symmetry of motion, and spontaneous movements.
  3. straight, flat, easy to flex
31
Q
  1. The penis should be how long? The scrotum should have ………….. .
  2. If scrotum is edematous and large it could be a ………….
  3. the labia majora will …….. the labia minora
A
  1. 2.5 3.5cm. ruga
  2. hydrocele
  3. cover
32
Q 
1. Give the timelines for when the following reflexes should go away: 
stepping:
Sucking/rooting: 
moro reflex: 
palmar grasp: 
plantar grasp: 
babinski's reflex:
A
  1. Stepping: birth to 4 weeks.

sucking/rooting: birth - 4mo.

Moro reflex: birth to 4 mo.

Palmar grasp: birth - 8mo.

Plantar grasp: birth - 8mo.

Babinski’s reflex: 1y

33
Q
  1. Name 4 non-pharmacological pain interventions to aid in management/comfort of newborn:
  2. Name 3 different prophylactic treatments for the newborn that happen before discharge:
A
  1. Skin-to-skin contact
    Containment (swaddling)
    Breastfeeding
    Nonnutritive sucking
  2. Vitamin K: IM for coagulation

Erythromycin opthalmic ointment (fights against gonorrheal or chlamydial infection. 0.5 – 1 cm ribbon)

Hep B vaccine

34
Q
  1. What are Universal Newborn Screening Tests?

2. What other tests are performed before discharge?

A
  1. Determined by state law, blood samples that detect anomalies like hypothyroidism, sickle cell, galactosemia, phenylketonuria etc.
  2. Hearing screening, and CCHD (Critical Congenital Heart Disease)
35
Q
  1. Name some education points that we discuss with new parents before discharge:
A 
1. Temperature
Respirations
Use of bulb syringe
Feeding patterns
Elimination
Positioning and holding
Safe sleep positions/Sudden infant death syndrome (SIDS)
Infant follow-up care
Immunizations
Cardiopulmonary resuscitation
Practical suggestions for first week at home
Interpretation of crying and use of quieting techniques 
Recognizing signs of illness
36
Q
  1. What are the main things we do after birth?
A
  1. maintaining an open airway, preventing heat loss, and promoting parent-infant interaction

Labor and Delivery (3 decks)

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