Exam 3: At-Risk Labor and Birth

Question 1

Labor Dystocia

Answer 1

Long, difficult or abnormal labor occurs in approx. 10% of births
Powers: Dysfunctional labor patterns
Passage: Pelvic dystocia or soft tissue dystocia
Passenger: Macrosomia, malposition, malpresentation, multifetal pregnancies

Question 2

Indications of labor induction

Answer 2

Preeclampsia
Diabetes
Infection
Post term pregnancy
PROM
Fetal death

Question 3

Contraindications of labor induction

Answer 3

Complete placenta previa
Transverse fetal lie
Umbilical cord prolapse
Previous trans-fundal surgery
Active vaginal herpes infection

Question 4

Bishop Score

Answer 4

Tool used to identify those most likely to have a successful induction (ideal score: 8 or above)

Question 5

Cervical ripening

Answer 5

Process of softening and thinning the cervix through the use of medication or by mechanical means

Question 6

Cervical ripening medications

Answer 6

Cytotec
Prepidil/Cervidil

Question 7

Mechanical cervical ripening

Answer 7

Foley catheter
Laminaria

Question 8

Labor induction

Answer 8

Artificial labor initiation by mechanical (stripping membranes, amniotomy) or medication (Pitocin)

Question 9

Dinoprostone

Answer 9

Cervadil, Prepidil
Softens and dilates the cervix, FDA approved for cervical ripening

Side effects: n/v/d, headache

Adverse effects: tachysystole (a lot of contractions)

Question 10

Cesarean birth indications

Answer 10

Previous classical cesarean
Placental abnormality
Gestational hypertension
Diabetes
Active herpes
Positive HIV status
Prolapsed cord
Dystocia
Fetal distress
Some congenital anomalies

Question 11

What incision has a higher chance of uterine rupture?

Answer 11

Classical

Question 12

Maternal risks of cesarean birth

Answer 12

Infection
Hemorrhage
Aspiration
Pulmonary embolism
Urinary tract trauma
Thrombophlebitis
Paralytic ileus
Atelectasis

Question 13

Fetal risks of cesarean birth

Answer 13

Fetal injury
Transient tachypnea

Question 14

VBAC candidates

Answer 14

One or two previous low transverse uterine incision cesarean births
Absence of other uterine scars

Question 15

VBAC management during labor

Answer 15

Availability to perform emergency cesarean
Continuous fetal monitoring
Cervical ripening medications are contraindicated
Tachysystole

Question 16

What type of twins are more prone to complications?

Answer 16

Monozygotic

Question 17

Prolapsed umbilical cord

Answer 17

Umbilical cord slips between presenting part and cervix
May or may not be visible

Question 18

Treatment of prolapsed umbilical cord

Answer 18

Priority: Relieve pressure on cord

Reposition laboring person
Knee-chest position
Manually lift presenting part off of cord
Delivery by cesarean section unless it’s quicker to deliver vaginally

Question 19

Shoulder dystocia interventions

Answer 19

McRobert’s maneuver: Put head of bed down so PT is flat, hyperflex knees back toward abdomen

Suprapubic pressure: Steady, firm pressure right on suprapubic bone to dislodge anterior shoulder

Question 20

Uterine inversion

Answer 20

Ensure you are supporting the lower uterine segment when doing fundal checks

Uterus pushed out of vagina

Sometimes happens with short cord when trying to deliver placenta

Emergency - Hemorrhage

Question 21

Anaphylactoid Syndrome of Pregnancy (amniotic fluid embolism)

Answer 21

Allergic reaction/inflammatory response to circulatory products which find an entry route to maternal circulatory system
Very high mortality rate

Profound hypotension, unable to get pulse, multisystem collapse

Question 22

Uterine rupture

Answer 22

Classical cesarean section
Loss of fetal station
Fetal bradycardia
Extreme abdominal pain in PT