Fetal heart rate and labor

Question 1

what can cause late deceleration assoc with presercation of beat-to-beat variability

Answer 1

mediated by arterial chemo R in mild hypoxia

Question 2

etiologies of late decelerations

Answer 2

excessive uterine contractions, maternal hypotension or maternal hypoxemia
reduced placental exchange as in HTN disorders, DM, IUGR, abruption

Question 3

what do we do for management of late decelerations

Answer 3

patient on side
discontinue oxytocin
correct any hypotension
IV hydration
administer O2 by tight face mask
if late decelerations persist for more than 30 min, fetal scalp pH is indicated

Question 4

obsercation of recurrent late decelerations with no variability

Answer 4

expeditious delivery is needed unless believed to be from maternal condition such as DM keoacidosis or pneumonia with hypoxemia

Question 5

how do you mange variables

Answer 5

change position to where FHR pattern is most improved
discontinue oxytocin
check for cord prolapse or imminent delivery by vaginal exam
administer 100% O2 by tight face mask

Question 6

how are uterine contractions quantified

Answer 6

number of contractions present in a 10 minute window averaged over 30 minutes

Question 7

what is tachysystole

Answer 7

more than 5 contractions in 10 minutes, averaged over a 30 minute window

Question 8

what is category I in the FHR interpretation system

Answer 8

normal: moderate variability, +/- accelerations, no late or variable decelerations

Question 9

What is category II in FHR interpretation system

Answer 9

indeterminate
FHR tracing shows: tachy, brady without absent variability, minimal variability, absent variability without recurrent decelerations, etc
requires continued surveillance and re-evaluation

Question 10

What is cateogry III in FHR interpretation system

Answer 10

abnormal
FHR shows
-sinusoidal pattern
-absent variability with recurrent late decelerations, recurrent variable decelarations or bradycardia

Question 11

what does abnormal fetal heart tracing preduct

Answer 11

abnormal fetal-acid base status at time of observation

depending on clinical situation

Question 12

1st degree vaginal tear

Answer 12

least severe
involve only skin around vaginal opening
patient might have some burning or stinging with urination
heal on own within few weeks

Question 13

2nd degree vaginal tear

Answer 13

involved vaginal tissue and perineal muscles that help support uterus, bladder and rectum
typically require closure and heal within a few weeks

Question 14

3rd degree vaginal tear

Answer 14

involve posterior vaginal tissues, perineal muscles and the capsule of the anal sphincter

Question 15

4th degree vaginal tear

Answer 15

perineal muscles and anal sphincter as well as tissue lining rectum
require repair, sometimes in operative setting

Question 16

complications of 4th degree vaginal tears

Answer 16

fetal incontinence and painful intercourse

Question 17

postpartum care with lacerations includes what

Answer 17

vaginal soreness, discharge, contractions, urination problems, hemorrhoids and bowel movements, sore breast and leaking milk, hair loss and skin changes, mood changes, weight loss

Question 18

antenatal risk factors for problems with labor

Answer 18

• young and older nulliparas
• short stature
• previous difficult birth or c-section
• previous stillbirth or neonatal death
• multiple pregnancy
• nutritional deficiency, severe anemia
• large for dates
• obvious pelvic deformity
• malpresentation
• high parity

Question 19

when do you induce labor

Answer 19

• when risks outweigh risks of induction
• at 41+ weeks
• within 96 hr of ruptured membranes at term
• for pre-eclampsia at term
• for maternal DM at term
• absent doppler end diastolic function

Question 20

how do we induce labor for prlonged pregnancy

Answer 20

-sweep/stripe membranes

Question 21

how do we induce labor for ruptured membranes

Answer 21

oxytocin by IV infusion

Question 22

induce labor in majority patients

Answer 22

vaginal PGs

amniotomy with oxytocin infusions

Question 23

what should you not do to induce labor in women who previously had c section

Answer 23

PG

Question 24

discontinue oxytocin at what amount if patient has not gone into labor

Answer 24

5 units

Question 25

what is failure to progress in the second stage of labor

Answer 25

arrest after 60 minutes of active pushing

Question 26

what sequelae are more likely in vaginal birth than CS

Answer 26

perineal pain
urinary incontinence
uterovaginal prolapse

Question 27

what sequelae occur, no difference between CS or vaginal birth

Answer 27

postpartum hemorrhage
endometritis
genital tract injury
fecal incontinence
post natal depression
back pain
dyspareunia

Question 28

what sequelae more likely with C section

Answer 28

hospital stay, ICU, death, bladder or ureter damage, hysterectomy, thromboembolism, placenta previa, stillbirth in next pregnancy, placenta acreta

Question 29

what is passive second stage labor

Answer 29

time of full filatation to commencement of involuntary expulsive effort by woman

Question 30

what is active second stage labor

Answer 30

from commencement of expuslive effots by woman and if any Sx signs full dilatation or baby is visible

Question 31

If second stage of labor is lasting over 4 hours, there is now increased risk of

Answer 31

CS
assisted birth
chorioamnionitis
3rd and 4th degree trauma
5 min Apgar <7 min

Question 32

how long is second stage labor averaged in a nullipara woman

Answer 32

2.5 hrs w/o epidural

3 hrs w/ epidural

Question 33

how long is second stage labor averaged in parous patient

Answer 33

60 min w/o epidural

120 min w/ epidrual

Question 34

if pushing is eneffectual what can you change

Answer 34

position

empty bladder

Question 35

when to do episiotomy, what kind

Answer 35

when clinically indicated

mediolateral