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Antepartum > Intrapartum > Flashcards

Intrapartum Flashcards

0
Q

Old meconium in labor

significance

A

It’s a yellow tinge

Evidence of a brief episode of hypoxia much earlier in labor or the days preceding it

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1
Q

Breech

predisposing factors

A 
Prematurity 
multiple pregnancy
 Polyhydramnios
 high parity:lax uterus
fetal anomalies: hydrocephaly, anencephaly 
 uterine anomalies: bicornate 
short cord/ baby tangled in cord
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2
Q

In labor
fresh meconium
significance

A

Particulate and green or brown like pea soup
Indicative of recent or current fetal distress
Immediately listen to fetal heart tones for several contractions and unless the sounds perfect consider transport

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3
Q

Which episiotomy cut is said to be the best in regards to healing the fastest

A

Midline

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4
Q

Contractions ____ minutes long, coming every ____minute signal the onset of active labor

A

1min long

Every 5 min

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5
Q

Hind leak

A

A gush of amniotic fluid caused by a high tear in the membranes, which releases enough fluid to allow the baby to settle snuggly down in the pelvis so that any further flow is prevented

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6
Q

During labor her pulse should stay within ____to____points of her normal range

A

10to 15

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7
Q

Face/brow presentation

management

A 
Prepare for a imminent birth 
determine position of chin 
prepare resuscitation equipment 
prepare treatment for newborn bruising/swelling 
administer Arnica 
position the mother in a squat 
prepare for for potential eye injury
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8
Q

Explain how a C-section done before 28 weeks without labor affects the safety of subsequent vaginal births

A

Sinu you the lower uterine segment is poorly developed in early gestation, a C-section done before 28 weeks involves the corpus muscles mass, even with a low transverse incision
Safety of subsequent vaginal birth is questionable especially without labor prior

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9
Q

Most common cause of third stage hemorrhage

reason

A

Partial separation of the placenta

Mismanagement third stage, usually involving uterine massage prior to placental separation

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10
Q

Conditions that predispose to third stage hemorrhage

A 
And infectious process with a high temp during pregnancy increases placental adherence
Intrauterine infection
 disease of the fetal membranes
 previous C-section 
partial placenta accreta
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11
Q

Causes/reasons for death with a breech birth

A

Head entrapment and hypoxia

premature placental separation

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12
Q

For what condition is the lithotomy position for delivery contraindicated

A

Severe varicosities

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13
Q

Factors in the decision to use an enema during labor

A

Station/location of presenting part should be engaged/below ischial spines
Membranes ruptured? Best when intact
Complications? Contraindications vaginal bleeding, placenta previa, PTL, breech, preeclampsia

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14
Q

Five times when vaginal exam is indicated in labor

A

On admission as baseline
before deciding on the kind, amount, root of medication
Verify complete dilation
After spontaneous rupture of membranes to rule out prolapsed cord if suspected
To check for prolapsed cord if fetal heart tone decelerations are not improving with the usual maneuvers

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15
Q

Four factors to consider when deciding to catheterize a woman in labor

A

The discomfort of the woman
whether the bladder needs emptying, is it distended, has she peed in the last two hours, fluid intake
Risk of bladder infection
Anticipating potential complication: postpartum hemorrhage, shoulder dystocia

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16
Q

Management of meconium stained fluids

A

Asses degree of Meconium
Prepare to resuscitate baby
instruct the mother to stop pushing after delivery of the head
clear the airway with section of mouth and nose

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17
Q

When is cord traction appropriate

A

You must first make sure it is fully separated by gently following the cord to the cervical os
Only if It is right behind the os or in the vagina, you may use controlled cord traction to remove it

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18
Q

What’s the cardinal rule for handling a postpartum hemorrhage

A

Determine the cause of bleeding before taking action

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19
Q

Bloody show is a sign of eminent labor, which usually takes place within

A

24 to 48 hours but it is not of value if a vaginal exam has been done in the last 48 hours

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20
Q

History that should be obtained from a woman with a previous C-section

A 
Weeksgestation at time of C-section
 type of C-section 
reason for c-section
 Length of labor
 cervical dilation at time of delivery 
physical exam 
describe abdominal scar
 pelvic exam
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21
Q

Molding
definition
diagnosis
management

A

Definition change in shape of the head. Shape of the head depends on the presentation
If cephalic:overriding of the parietal bones over the occipital bone’s involves the entire skull

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22
Q

Lightning occurs about ____ _____before labor for a primip
The baby’s head is usually____ afterwards.
definition

A

2 weeks
Engaged

Definition the descent of the presenting part of the baby into the true pelvis
result of increasing intensity of BH contractions and good abdominal muscle tone

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23
Q

Significance of ketones in labor

A

To screen the woman for maternal exhaustion and distress inclusive of dehydration, electrolyte imbalance, and nutritional deficiency
Ketonuria indicates the need for an IV

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24
Q

Describe the significance of the ferning pattern

A

Ferning, a.k.a. arborization, is caused by the presence of sodium chloride and protein in the amniotic fluid
more reliable than nitrazine

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25
Q

Amniotomy

midwife should observe these principles

A

Before between contractions so: a. Force behind rupture is reduced b. Membranes looser against fetal head
Use an instrument that can be effective quickly and easily
After rupture of membranes leave fingers in through a contractio to check the effect on cervix and fetus and for prolapsed cord
Fetal heart tones during and after to monitor the effects on the fetus

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26
Q

What is the most crucial reason for charting emesis amount

A

To watch for HELLP syndrome or other extreme medical conditions

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27
Q

During labor fetal heart tones should be evaluated

A

Every 30 minutes during active labor
Also with rupture of membranes
after expulsion of an enema
with any sudden change in contraction or labor pattern
after giving medication and again after its peak action
any indication of a developing complication

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28
Q

Superficial perineal muscles

names and functions

A

Superficial transverse perineus: helps stabilize central tendon of perineum
Bulbospongiosus: helps propel urine
constricts vaginal orifice
assists in erection of clitoris
Ishiocavernosus: maintains direction of clitoris

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29
Q

Friedman labor curve

A

In 1955, Friedman depicted the progress of labor as a sigmoid curve and subdivided the active phase into three sequential phases acceleration, maximum slope, and deceleration
Deviation from this curb is not abnormal
progress is most important

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30
Q

Acidemia

A

Increase concentration of hydrogen ions in the blood

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31
Q

Hypoxemia

A

Decreased O2 content in the blood

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32
Q

Hypoxia

A

Decreased level of o2 in tissue

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33
Q

Caput Succedaneum
Definition
diagnosis
management

A

Definition: formation of edematous swelling over the most depended portion of the presenting fetal head
Caput crosses suture lines as a generalized swellin
Indicates a prolonged labor with pressure on the fetal head

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34
Q

Percent of women that enter labor with a breech presentation

A

3.0-3.5%

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35
Q

A fetus in a breech presentation with both limbs flexed is a _______presentation

A

Complete

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36
Q

What percentage of babies are in breech presentation immediately before labor

A

3-4%

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37
Q

Situations that may require a consent or waiver during IP, third or fourth stages

A 
Vaginal exam 
artificial rupture of membranes
 GBS anabiotic's 
use of Doppler 
who should be in room
 IV use 
enema 
Pitocin 
Methergine 
O2
Catheter 
transport 
breast-feeding 
suturing 
lidocaine
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38
Q

Three planes of obstetrical significance in the true pelvis

A

Inlet
midplane
outlet

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39
Q

Purpose of superficial perineal muscles

A

Help stabilize central tendon of perineum
helps propel urine
constricts vaginal orifice

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40
Q

The five bones of the pelvis

A 
Coccyx 
sacrum 
ilium 
ischium 
pubic bone
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41
Q

What is the smallest pelvic diameter to which the fetus has to accommodate itself

A

That interspinous diameter

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42
Q

Define anesthesia and analgesia

A

Anastasia takes away all feeling

analgesia takes away pain

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43
Q

Differentiating between monozygotic and dizygotic twins

A

Two amnion, two chorion, two placenta
either mono or dizygotic
Two amnion, one chorion, one placenta
monozygotic
Dizygotic division occurred in first three days after fertilization
Mono division occurred between days 4 to 8 after fertilization

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44
Q

Trendelenburg position

A

Knee- chest

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45
Q

Explain the difference between amnionitis

and Chorioamnionitis

A

Amnionitis: inflammation of the amniotic sac and amnion
Chorio: inflammation of the chorion in addition
These conditions almost always coexist

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46
Q

During second stage, pressure of the lumbosacral nerve plexus can cause
is resolved by

A

Muscle cramps in the leg

resolved by extending the leg and dorsiflexing the foot

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47
Q

Internal versus external os

A

If there is a discrepancy between the dilation of the internal and external os the official dilation is of the inner os

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48
Q

In a client with premature rupture of membranes at 32 weeks with no current signs of infection, what is the most appropriate management plan

A

Watchful waiting and allowing pregnancy to continue for as long as possible because the risk of prematurity outweighs the risks of sepsis

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49
Q

The Sims position is when the mother

A

Is left side lying

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50
Q

Diaphoresis

definition

A

Excessive sweating

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51
Q

Eutocia is defined as

A

A normal labor

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52
Q

When the fetal side of the placenta delivers first this is called

A

Shiny Schultz

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53
Q

What is the optimal birth weight range as demonstrated by studies of perinatal morbidity and mortality?

A

3500-3999

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54
Q

What is the best management for asymptomatic scar dehiscence that occurred during VBAC and that you discovered during a postpartum manual exploration of the uterine cavity for retained placental fragments

A

Nothing the defect will heal on its own

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55
Q

Leukocytosis

A

Elevated white blood count to 15,000+

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56
Q

Urogenital triangle includes

A

The external genitals, which include the labia, vagina, clitoris, urethra

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57
Q

Curve of Carus

A

The curve formed by the sacrum, coccyx, and pubic bones

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58
Q

Rhombus of Michaulis
definition
position

A

Kite shaved area of the lower spine with the points at the waist, coccyx, and sacroiliac joints
Has the potential to open dramatically and second stage, increase the front to back dimensions of the pelvis by several centimeters
Can only happen if mother is leaning forward with knees lower than hips and legs extended

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59
Q

Deep perineal muscles

name and function

A

Deep transverse perineus helps to expel last drops of urine
External urethral sphincter helps expel last drops of urine
External anal sphincter keeps anal canal and anus closed

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60
Q

Function of Levator Ani

Pubococcygeus and iliococcygeous

A

Supports and maintains position of pelvic viscera
Resists increased intra-abdominal pressure during forced expiration, coughing, vomiting, defecation, urination
Constricts anus, urethra, and vagina
Supports fetal head during birth

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61
Q

Birth in a face presentation is only possible if internal rotation brings the mentum into what position

A

Anterior

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62
Q

The fetal shoulders normally enter the true pelvis with the bisacromial diameter and what diameter?
Transverse
Oblique
Anteroposterior

A

Oblique

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63
Q

Average duration of third stage?

A

5-10 min

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64
Q

List three factors associated with intrauterine infection

A

Fetal tachycardia
a BPP score of six or less
a WBC count with a shift to the left

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65
Q

Condition which predisposes to the worst shoulder dystocia

A

Estimated weight of 1 pound or more than the woman’s largest previous baby

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66
Q

What is the most appropriate first step with a G1 PO at 38 weeks with no signs of labor but with the diagnosis of chorioamnionitis

A

Admit to the hospital for induced vaginal birth or C-section within 24 hours

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67
Q

Cephalic prominence

A

Felt during Leopold’s maneuver forth

the part of the head that is felt above the pubic bone

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68
Q

Why is VBAC a safe option for women with a low transverse scar

A

Any incision that pulls into the muscle mass of the uterine corpus or fundus increases the risk of rupture
Risk of rupture with low transverse scar: .19-.8%
Which is less then morbidity rates for a repeat C-section

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69
Q

Asphyxia

A

Hypoxia with metabolic acidosis

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70
Q

Plateau phenomenon
explain
how long is okay

A

When labor slows for maternal integration can occur at four, seven, or 9 cm. Each is a turning point in terms of a new sensation
Four from control to surrender
7 transition
9 bearing down urges disrupt relaxation
Explain nature of change several hours is okay as long as health and morale is okay

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71
Q

Complete breech

A

Babies hips and knees are flexed so that the baby is sitting cross legged with the feet beside the bottom

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72
Q

Footling breech

A

One or both feet come first with the bottom at a higher position
this is rare at term but relatively common with premature babies or second twin

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73
Q

During the first stage, in the absence of complications, heart tones should be taken every

A

30 minutes

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74
Q

Woods maneuver

A

Corkscrew maneuver for shoulder dystocia

Anterior shoulder pushed towards baby’s chest

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75
Q

Management for hypotonic uterine dysfunction

A 
Decrease maternal stress in environment
 increase rest and fluid intake
 discuss fears and concerns
 ambulation 
hydrotherapy
 enema if appropriate 
rupture of membranes 
nipple stimulation 
Pitocin stimulation
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76
Q

Anemia at the onset of labor can lead to

A 
Fetal distress 
incoordinate prolonged labor 
postpartum hemorrhage from tired uterus 
infection 
shock from moderate blood loss
 poor postpartum recovery
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77
Q

What causes lactation during late pregnant

A

fetal demise all the hormones have shifted as if the birth has taken place

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78
Q

What is the most accurate definition of prolonged rupture of membranes

A

Rupture of membranes more than 24 hours before delivery

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79
Q

Constriction of bandi’s ring

how to diagnose a labor

A

Feel with vaginal exam
possible uterine rupture
Ascent of presenting part with contraction
usually long labor

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80
Q

When should sedatives be used during labor

A

When the woman is in false labor
when the woman is in early labor and is exhausted and needs rest
treatment for hypertonic uterine dysfunction to stop the present labor with it’s abnormal gradient pattern

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81
Q

Situations when IV is indicated intrapartally

A 
Gravida 5+ 
over distended uterus,for any reason
 history of postpartum hemorrhage 
maternal dehydration/exhaustion 
positive GBS 
maternal temp greater than 100.4
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82
Q

Fetal position

A

Position is the arbitrarily chosen point on the fetus for each presentation in relation to the left or right side of the mothers pelvis

Left or right side
Variety anterior, transverse, or posterior portion of the mothers pelvis
ROA, LOP, RMT, LAA

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83
Q

After starting an IV, a woman exhibit signs of cyanosis even in the presence of low flow oxygen most likely cause?

A

An air embolus

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84
Q

Prognosis for face presentation in the mentum posterior position

A

Arrest of descent
C-section baby cannot deliver vaginally
Must recognize immediately before impaction of the head occurs
Because length of the neck is half length of sacrum not possible for chin to escape from vaginal floor over perineum

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85
Q

Define shoulder dystocia

A

Cephalic presentation with the anterior shoulder is wedged above the symphysis pubis instead of entering the true pelvis

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86
Q

Kneeling breach

A

One or both legs extended at the hips but flexed at the knee
extremely rare

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87
Q

Breech presentation types

A

Frank
complete
Footling

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88
Q

Identifying face presentation

A

Abdominal palpation; occiput becomes the cephalic prominence and is located on the same side as the arched back of baby
Pelvic exam
may be able to feel both fontanelles clearly or only the anterior and head is hyperextended
landmarks of face will become evident

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89
Q

Fetal attitude

A

Characteristic posture determined by the relationship of the fetal parts to each other and effect this has on the fetal vertebral column. The attitude of the fetus varies according to its presentation
flexed
military
extended

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90
Q

Cephalic presentation types

4

A

Vertex (flexed)
sincipital (military)
Brow
face (extended)

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91
Q

Fetal lie

3

A

Lie is the relationship of the long axis of the fetus to the long axis of the mother there are three possible lies
longitudinal
transverse
oblique

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92
Q

Fetal presentation

3

A

Presentation is determined by the presenting part, which is the first portion of the fetus to enter the pelvic inlet. There are three possible
Cephalic
Breech
shoulder

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93
Q

Erythroblastosis fetalis

A

Isoimmunization, destruction to fetal erythrocytes ensues, followed by:
Severe fetal anemia
cardiac decompensation
eventual hydrops and possible fetal or early neonatal death(dependent upon the severity of the reaction)

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94
Q

A woman transported for FTP during pitocin augmentation, she suddenly complains of chest pains and has pink frothy sputum and diaphoresis this is an early sign of

A

Amniotic fluid embolism

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95
Q

With a VBAC what is the first indication of uterine rupture

A

Fetal bradycardia

96
Q

Woman comes to the BC in labor, reporting that her water may have broken on the drive. What procedure would best determine if she has SROM

A

A fern test

97
Q

Listening through contraction, the midwife notes that the fetal heart rate deceleration occurs during the increment of a contraction, reaches its lowest point at the Acme of the contraction, and returns to baseline during decrement of the contraction this type of decel indicates

A

Fetal vagal nerve stimulation
early decel
Head compression

98
Q

Cause
Early decels
Late decels
Variable decels

A

Early: head compression

late: uteroplacental insufficiency
variable: cord compression

99
Q

Fetal variety

A 
Variety is the same arbitrarily chosen point on the fetus used in defining position in relation to the
Anterior 
transverse 
 posterior 
portion of the pelvis
100
Q

Flexion

A

This is essential for further descent
Occurs when the fetal head meets with resistance, this resistance increases with descent and it’s first met from the cervix, then from the sidewalls of the pelvis, and finally from the pelvic floor

101
Q

Acidosis

A

Increase concentration of hydrogen ions in the tissue

102
Q

Quiet uterine rupture

S/s

A 
Vomiting 
tenderness all over abdomen
severe suprapubic pain 
hypertonic contraction 
no further progress and labor
 faintness 
eventually vaginal bleeding, signs of shock, loss of fetal heart tones
103
Q

Episiotomy

Four principles to be observed

A

Presenting part of fetus is protected
a single cut is better than repeated snipping
the cut should be large enough to accomplish the purpose of cutting it the cut should be time to avoid lacerations and excessive blood loss
Perineum should be bulging and distended by at least a centimeter diameter of fetal presenting part between contractions
Deliver of presenting part should occur in the next 2 to 4 contractions

104
Q

What is the best description of how uterine contractions differentiate the uterus in two segments

A

Upper zone of the uterus shortens and thickens the lower zone lengthens and thins

105
Q

Curve of Carus

A

The lower exiting end of the pelvic curve
the fetus and placenta must follow this curve in order to be born
a curved cylinder
first downward from the axis of the inlet to just above the tip of the sacrum and then forward, upward, and outward to the vulvovaginal orifice

106
Q

Respiratory alkalosis
definition
symptoms
cause

A

The amount of CO2 found in the blood drops to a level below normal. Causes a shift in the body’s pH balance and causes the body to become more alkaline
Brought on by hyperventilation

107
Q

Defined the two types of umbilical cord prolapse

A

Frank: cord slips through the cervix
Occult: cord slips alongside presenting part but does not protrude through the cervix
Danger: fetal hypoxia from court compression

108
Q

Deep transverse arrest

signs and symptoms

A

Sagittal suture is transverse in mothers pelvis
development of second stage hypertonic uterine dysfunction extensive molding of the fetal head
formation of considerable caput
lack of descent of the fetal head
these are all late indications

109
Q

Birth of the shoulders and body is by _____ _____ via the_____ _ ______

A

Lateral flexion via the curve of Carus
The anterior shoulder comes into view at the vulvovaginal orifice, where it in impinges under the symphysis pubis; the posterior shoulder than distend a the perineum in is born by lateral flexion

110
Q

Birth of the head by _____ for _____ deliveries

A

Extension for occiput anterior
Extension must occur when the occiput is anterior because of the resistance force of the pelvic floor where it forms the curve of Carus which directs the head upper to the vulval outlet

111
Q

Internal rotation

A

Twist the next 45° LOA to OA
Brings the anterior posterior diameter of the fetal head into alignment with the anteroposterior diameter of the maternal pelvis
is essential for vaginal birth to occur
When the occiput rotates, the shoulders also rotate with the head until the LOA or ROA has been reached. As a occiput rotates the final 45° into that away position, the shoulders enter the pelvis and the oblique diameter

112
Q

Extreme rotation

A

Occurs as the shoulders rotate 45° bringing the bisacromial diameter into alignment with the anterior posterior diameter of the pelvic outlet
Causes the head to rotate externally another 45° into the LOT or ROT position
LOA-LOT

113
Q

Ferguson reflex

A

UTP prior to second stage
the reflex mechanism is initiated too early and makes the women feel she’s in constant need of having a BM
occurs when the fetal head is very low in the pelvis

114
Q

Restitution

A

The rotation of the head 45° to either the L or R depending on the direction from which it rotated into the OA position
In effect, restitution untwists the neck and brings the head so it is again at a right angle with the shoulders
OA-LOA

115
Q

Engagement

definition

A

When the widest diameter of the presenting part (which in a cephallic occipital presentation, is the biparietal diameter) has passed through the pelvic inlet

116
Q

Descent

A

Occurs throughout labor
is the result of several forces, including contractions, and in second stage, the pushing the mother accomplishes by contraction of her abdominal muscles

117
Q

Describe the modified Brandt Andrews maneuver

A

Bringing the fingertips of your abdominal hand straight down above the symphysis pubis into the lower abdomen while holding the umbilical cord taught to check for placental separation

118
Q 
Normal vital signs in labor
Blood pressure
Pulse 
 temperature 
respirations
A

Increase with contractions by 5-15mmhg, between contractions return to prelabor or levels
Increase with contractions should return to normal levels in second stage, increase with pushing, reaching peak at time of birth
Slightly elevated in labor, highest during right during and right after delivery
A slight increase is normal and labor

119
Q

Shiny Schultz

Attachment

A

Fundal implantation

Separation beginning at the center

120
Q

Dirty Duncan

Attachment

A

Low implantation

Separation starting at the edges

121
Q

How far should the Delee to be inserted into the babies mouth

A

4 1/2 inches

122
Q

After the placenta separates and move into the lower uterine segment or the upper vaginal vault what change is expected in the uterus

A

It would be displaced upward and thus rise in the abdomen

123
Q

Occipitofrontal diameter

A

11.5 cm the distance from the occiput to the bridge of the nose sincipital

124
Q

Occipitomental diameter

A

12.5-13.5 cm

The distance from the posterior fontanelle to the mentum (chin): the largest diameter of the fetal head (brow)

125
Q

Suboccipitobregmatic diameter

A

9.5 cm

The distance from the junction of the neck and the occiput to the bregma (anterior fontanelle) vertex

126
Q

Trachelo diameter

A

(Submental) bregmatic 9.5 cm

the distance from the junction of the neck and lower jaw to the bregma (face)

127
Q

The midwife listens during and after a few contractions, and notes that a deceleration occurs about 30 seconds after the contraction begins, returning to baseline after the construction is over. This type of deceleration is caused by

A

Uteroplacental insufficiency

128
Q

If physician would prescribe heparin to a woman with femoral thrombophlebitis in order to

A

Prevent additional thrombus formation

129
Q

Biparietal diameter

A

9.5 cm
Distance between the two parietal eminences: the largest transverse diameter of the fetal head, used in definition of engagement

130
Q

Respiratory acidosis
definition
symptoms

A

Build up of CO2 in the blood produces a shift in the body’s pH balance and causes the body system to become more acidic
Slowed or difficulty breathing, rapid heart rate, changes in blood pressure, death, coma
Causes blockage of the airway

131
Q

Which is the smallest pelvic diameter to which the fetus has to accommodate itself

A

The interspinous diameter

132
Q

Metabolic acidosis
Definition
Symptoms

A

PH imbalance in which the body has accumulated too much acid and does not have enough bicarbonate to effectively neutralize effects of the acid
Signs and symptoms: headache, lack of energy, breathing fast and shallow, and N & V, diarrhea
Causes: lack of insulin, starvation diet, vomiting, diarrhea, problem with heart, liver, kidneys

133
Q

Pendulous belly inhibiting descent

ways to manage

A

Assisting the positioning of the uterus over the pelvis
positioning semi reclining on back
lithotomy position

134
Q

If engagement took place in ROP position, how many degrees does the fetal head rotate during internal rotation of an OA delivery?

A

135

135
Q

Shoulder dystocia

Management steps

A 
Apply gentle traction and encourage pushing 
reposition the mother to hands and knees, McRoberts, end of bed, 
Squat, 
Reposition shoulders to oblique diameter
Extract posterior arm
Flex newborn shoulders, then corkscrew
Suprapubic pressure 
sweep arm across newborn face
Fracture babies clavicle
136
Q

Frank breach

A

Babies bottom comes first, legs
flexed at the hip extended at the knees (feet by ears)
65-70% of breech babies
The best for NVSD

137
Q

Molding

A

The Change in shape of the head as a result of the soft skull bones overlapping each other because they are not yet firmly united and movement is possible at the sutures
The shape of the head becomes depends on the presentation
molding helps the fetal head pass through the pelvis

138
Q

The sequelae of preterm birth for the baby

A

Respiratory distress syndrome
intraventricular hemorrhage
Low Birthweight

139
Q

In a face presentation, which of the following will be the cephallic prominence that is palpable during the fourth Leopold’s maneuver?
In a flexed position?

A

The occiput

The sinciput

140
Q

Internal rotation accomplishes what in a birth with cephalic presentation

A

Brings the anterior posterior diameter of the fetal head into alignment with the anterior posterior diameter of the maternal pelvis

141
Q

In normal labor, the head usually enters the pelvic inlet with a moderate degree

A

Posterior asynclitism

142
Q

Percent of women that enter labor with the face presentation

A

0.5%

143
Q

External rotation accomplishes what in the birth with cephalic presentation

A

Brings the bisacromial diameter (shoulders) of the fetus into alignment with the to anteroposterior diameter of the pelvic outlet

144
Q

Bishop’s score

A

Each gives points 0,1,2,3

dilation 0, 1to2, 3-4,  greater than five
Effacement 0-30, 40-50, 60-70, >80
Station -3,-2,-1/0,+1/+2
Consistency firm, med, soft
Position posterior, mild, anterior 
Maximum score of 13
Evaluates cervical readiness for induction 
Unripe cervix=score less than 6
145
Q

Metabolic alkalosis
definition
symptoms

A

PH imbalance in which the body has accumulated too much of an alkaline substance (example bicarbonate) and does not have enough acid to neutralize the effects
S/s slowed breathing, apnea, cyanosis, and N and V, diarrhea, rapid heart rate, decreased blood pressure
Causes: vomiting, excessive urination, diuretic drugs, steroids, laxatives

146
Q

Cardinal rules to avoid entrapment of the head in a breech birth

A

Use scoring chart to predict outcome
progress should not stall for long periods in active labor
upright labor and delivery is best to prevent extension of arms or head
One hour of panting past full dilation
pushing with urge to umbilicus, then constant pushing until baby is born
Hands off breach until umbilicus appears
let body hang after full delivery of body
assist delivery of head after you see nape of the neck

147
Q

Breech

what do you do if the baby is not moving down after being born to the umbilicus

A

You may give gentle traction on the legs, or cover the baby in a towel and give gentle traction holding the hips, or swing the baby gently in a figure 8 but usually not necessary if the mother is in an upright position

148
Q

Technique for release of nuchal arm with breech

A

If arms do not come down, reach up and sweep them down one at a time
if you cannot reach, the arm may be behind the head;
gently rotate the baby around 90° until you can grasp the arm and sweep it over the babies chest do the same on the other side

149
Q

Breech what do you do if the baby is stuck at the shoulders

A

Hold the baby gently straddled on your arm and rotate 90° until shoulders deliver one side and then the other

150
Q

Cord prolapse

Steps

A

Change maternal position to knee chest
activate EMS
monitor fetal heart tones and cord for pulsation
keep presenting cord warm, moist, protected
give oxygen to mother
place cord back into vagina
facilitate immediate delivery if birth is imminent
Prepare to resuscitate the newborn

151
Q

If the cervix tight rimmed and the woman is in early labor, insert 6-8 capsules of EPO high around the cervix, which should soften it in about 12 hours

A

0

152
Q

Transition

A

The woman is ending first stage and nearing second stage
Signs-
contractions every one and a half to two minutes lasting 60 to 90 seconds painful
decreased modesty, frustrated, irritable, and N & V, restlessness, natural amnesia between contractions, increase bloody show, rectal pressure, rejection of those around her, hard time coping, thirst, perspiration, burping, anorexia

153
Q

Risks associated with increased parity

A

Increase the risk of abruptio placentae, placenta previa, uterine hemorrhage, maternal mortality, and perinatal mortality
Double ovum twinning increased in G5 and above

154
Q

Signs and symptoms of uterine rupture

A

abrupt change or cessation of uterine contractions
vaginal bleeding
loss of fetal station
abrupt changes in fetal heart tones

155
Q

Describe the three types of uterine inversion

A

Incomplete fundus protrudes through the cervical os
Complete descends to immediate within the vaginal and introitus
Prolapsed extends beyond the vulva

156
Q

Fetus ejection reflex

what does the mother do

A

The back of the babies head contacts the G spot which triggers the sacrum to open
Mother will grab forward for support, spread her knees apart and let belly sag, arch back and wiggle her lower body
This series of movements brings the baby down

157
Q

Seven signs and symptoms of chorioamnionitis

A

Maternal fever of 100.4, maternal tachycardia, fetal tachycardia, tender uterus, vaginal walls unusually hot to the touch, foul smelling amniotic fluid, elevated white blood count

158
Q

Chorioamnionitis
causes
concern

A

ROM over 24 hours, prolonged labor, repeated vaginal exams or intrauterine procedures
Mother and baby infected, uterus does not contract as well, labor dystocia, abnormal cervical dilation, uterus does not respond well to oxytocin, infant may develop pneumonia and acidosis

159
Q

Why should the weather be kept warm immediately after the birth of the baby

A

If she is not warm, adrenaline will remain high, which can disrupt placental separation by opposing oxytocin

160
Q

Management of Chorioamnionitis

A

Birth should take place within 24 hours of diagnosis, oxytocin induction, rupture of forewaters if present, hydration with IV fluids, monitor maternal vital signs hourly

161
Q

What percent of women with premature rupture of membranes will go into spontaneously labor within 24 hours

A

80-85%

162
Q

Meningocele

A

A bony defect of the spinal cord
must be differentiated from caput or cephalohematoma
The infant must be positioned prone and fecal contamination carefully avoided

163
Q

Contraindications for Methergine use

A

High blood pressure, normal involution occurring on its own, placenta still in uterus

164
Q

How is fetal station determined

A

Measuring the distance of the lower most part of the fetal presenting part above or below that ischial spines

165
Q

Contractions felt mainly in the front are sign of true labor
true or false

A

False

true contractions are felt all around

166
Q

What is the most common cause of you uterine rupture

A

Separation of a previous C-section scar

167
Q

What best describes the cervix of a multip on the verge of true labor

A

Little or no effacement with 1 to 2 cm or more dilation

168
Q

Ritgen maneuver

A

One hand on occiput to control babies head, other hand covered with towel to protect from contamination, the draped had exerts inward pressure posterior to the woman’s rectum him until the baby’s chin is located and in the grass of the fingers
Forward and outward pressure is then exerted on the underneath side of the chin and the head is controlled between this hand and the hand exerting pressure on the occiput

169
Q

Mechanisms of labor
EDFIEREB
Every dog fights if each run expects best

A

0

170
Q

Nine signs and symptoms that rule out tocolysis

A

Fetal maturity, cervix more than 5 cm, severe IUGR, acute fetal distress, fetal death or fetal anomaly incompatible with life, severe placental abruption, maternal hemodynamic instability, severe preeclampsia, Chorioamnionitis

171
Q

Predisposing factors to prematurity

A

Low socioeconomic, nonwhite race, poor nutrition, history of preterm labor, short interval between pregnancy, multiple gestation, substance-abuse, no prenatal care, uterine abnormality, incompetent cervix, DES exposure, UTIs, GBS positive, premature rupture of membranes, chorioamnionitis, severe physical violence with pregnancy, fetal death, polyhydramnios

172
Q

How can you differentiate between IUGR and SGA

A

SGA: genetically small but well grown infant
IUGR: fetal size significantly less than expected
The best way to tell is by doing serial ultrasound and monitoring growth. If the fetus is SGA, there is overall growth, just smaller than expected. With IUGR, there will be a small baby that is not thriving or not consistently getting bigger

173
Q

IV therapy

How many cc of air can a healthy adult tolerate

A

200 cc’s

174
Q

Oblique lie
definition
why

A

Presenting part is in the lower pole of the uterus but not centered over the pelvic cavity
something may be preventing direct engagement such as: small pelvic inlet, anomaly of uterine structure (septum), pelvic tumor, a fetal defect, placenta previa, a cord presentation, impacted rectum, or an extremely distended bladder

175
Q

Transfer lie
Definition
Outcome

A

One in 500 births
successful labor and birth with a viable fetus is impossible
Most Transverse lies established before labor begins
It is rare for the onset of contraction to result in the baby turning from head down to transverse

176
Q

Most dangerous consequence of uterine inversion

A

Shock

177
Q

Fetal vagal nerve stimulation causes what kind of fetal heart rate pattern

A

Decel during increment of contraction
lowest point at Acme of contraction
baseline during decrement of contraction
early decels

178
Q

A normal placenta weighs approximately how much in relation to the baby

A

1/5 weight of the baby

179
Q

Disseminated intravascular coagulation DIC
definition
causes

A

Disseminated intravascular coagulopathy
Can happen with a missed abortion or fetal death that does not resolve promptly
Abnormal clotting mechanisms
Labs: Prothrombin, partial thromboplastin time, fibrinogen, platelets

180
Q

What statement best describes the management plan for the labor of a woman that is determined to be a good VBAC candidate

A

She should be managing the same manner as any other woman in labor

181
Q

Research has shown that _____ is associated with prevention of PTL among women with multiple gestation or a history of PTL or birth

A

Daily contact with a nurse

182
Q

What is the most technically accurate definition of premature rupture of membranes

A

Rupture of membranes before the onset of labor

183
Q

Deep transverse the rest is associated with which type of pelvis

A

Android

184
Q

Vaginal exam in second stage
the sagittal suture is in the transverse diameter of the mothers pelvis and there is considerable molding and formation of caput
most likely diagnosis

A

Deep Transverse arrest

185
Q

DIC
Definition
Signs and symptoms

A

With an internal injury, all the clotting factors rush to that one part of the body and are completely depleted
Symptoms are bleeding from any body opening and zero clotting factors

186
Q

Nonallopathic remedies for preterm labor

A 
Good hydration 
magnesium supplements
 homeopathic mag phosphate 30c
 Bed rest 
 wine/alcohol
187
Q

Management of rupture of membranes when the pregnancy is less than 36 weeks

A

The risks of sepsis is outweighed by the risk of prematurity
Primary purpose is prolonging the pregnancy as long as the woman is not in labor, does not have Chorioamnionitis and there is no fetal distress

188
Q

Six precipitating causes of cord prolapse

A

Rupture of membranes and unusual presentation/small fetus or second born twin
Administration of enema if rupture of membranes and unengaged presenting
Amniotomy if unengaged presenting part
Exam causing rupture of membranes with unengaged presenting part
Spontaneous rupture of membranes with unengaged presenting part
Displacement of the vertex during fetal assessment

189
Q

Incidence of premature rupture of membranes is higher in women with

A

Incompetent cervix, polyhydramnios, fetal malpresentation, multiple gestation, vaginal/cervical infection (including GBS)

190
Q

Which women are candidates for tocolysis

A

Woman who meet the definition of preterm labor who are less than 4 cm dilated and less than 34 weeks gestation

191
Q

The increased number and activity of endocervical glands are responsible for

A

Mucous plug

192
Q

What percent of women at or near term will start labor spontaneously within 24 hours of premature rupture of membranes

A

80%

193
Q

What best describes the cervix of the average primip on the verge of true labor

A

50 to 100% effaced

a fingertip to 1 cm dilation

194
Q

Compound presentation
definition
risk factors

A

When two or more fetal parts present simultaneously at the inlet usually an extremity and the presenting pole of the body
Contracted pelvis, pendulous abdomen, multiple gestation, large head, not vertex presentation, polyhydramnios

195
Q

Partial placenta accreta versus complete placenta accreta

A

Partial: first seen as an acute third stage hemorrhage clinical diagnosis made when the placenta adherence is discovered with manual removal definitive diagnosis microscopic exam
Complete: no signs and symptoms, no hemorrhage, it is discovered during attempted manual removal of the retained placenta

196
Q

Three risks of rupture of membranes to the fetus

A

Formation of caput
head trauma lead to brain damage
cord prolapse

197
Q

Elevated temperature and ketonuria in labor indicates

A

A level Of exhaustion threatening to both the mother and baby transport is advisable

198
Q

Ketonuria in labor indicates

A

Mother is dipping into her fat reserves for energy

Trace reading okay, but higher levels indicate a disrupted electrolyte balance and the need for more fluid and calories

199
Q

Acute/dramatic uterine rupture

signs and symptoms

A

Sharpshooting pain in lower abdomen during height of strong contraction
vaginal bleeding
presenting part movable above inlet, dramatic repositioning of fetus, fetal movements violent then reduced to none, contracted uterus felt besides fetus, women showing signs of shock

200
Q

A woman complaining of tingling and numbness in her hands and feet as she uses her breathing technique these symptoms indicate

A

Respiratory alkalosis

hyperventilation

201
Q

How often should the laboring woman urinate and for what two purposes

A

Every two hours
Prevent obstruction of labor by full bladder that prevents descent of the presenting part
Prevent trauma to the bladder from prolonged pressure, which will cause hypotonia of the bladder and urinary retention during the immediate postpartum.

202
Q

Variable decels are thought to be caused by

A

Court compression

203
Q

Lightening

definition

A

Occurs two weeks before labor
Descent of presenting part of the baby into the true pelvis
baby’s head is usually fixed or engaged after
decrease of shortness of breath, increasing urinary frequency, pelvic pressure, leg cramps, dependent edema from venous stasis

204
Q

Rupture of low transverse uterine scar usually

A

Not catastrophic for either mom or baby

most of these ruptures are only dehiscence or puckering of the scar

205
Q

Diagnosis is definitive of rupture of membranes when

A

When you see amniotic fluid escaping from the cervical os and pooled in the vaginal vault during speculum exam
When you cannot feel the membranes over the presenting part of the cervical orifice

206
Q

Explain how the diagnosis of CPD in the previous birth affects the VBAC candidates ability to give birth normally this time

A

Many diagnosis of CPD do not reflect actual CPD, but rather an unknown reason for failure to progress in labor
About 60 to 70% of women with a previous C-section for CPD or failure to progress will deliver vaginally in a subsequent pregnancy and often deliver babies larger than the one for which CPD was diagnosed

207
Q

Describe fetal fibronectin testing

FFN

A

FF is a protein produced by the fetal membranes that serves as an adhesive binder of the membranes and placenta to the deciduas and is normally present and cervical secretions until 20 to 22 weeks
From 24 to 34 weeks, presence of FFN and is assessed with preterm labor
Negative test is 95% predictive for not delivering in the next 14 days
Positive test 61% sensitivity and 83% specificity for predicting PTL

208
Q

Define preterm labor

A

Labor commencing anytime after the start of the 20th week to the 37th week
Culminates in preterm birth and 12% of all births in the US
Second leading cause of neonatal mortality
Any woman who had one PT birth in a past pregnancy has 20 to 40% risk of reoccurrence

209
Q

Diagnosis of preterm labor

A

20 and 37 weeks when the woman’s having uterine contractions five to eight minutes apart
AND
Rupture membranes
Or
Intact membranes and
Progressive cervical change or 2 cm dilation or a positive FFN test

210
Q

Eight signs and symptoms which must be evaluated to rule out premature labor

A

Painful menstrual cramps could be round ligament
Dull low backache
Suprapubic pain/pressure could be UTI
Sensation of pelvic pressure or heaviness
Change in type or amount of vaginal discharge
diarrhea
Unpalpated uterine contractions with or without pain felt more often than 10 minutes for one hour or more and not relieved by laying down premature
rupture of membranes

211
Q

Causes of abnormal pain in labor

A

Uterine rupture

placental abruption

212
Q

Aspirin, when taken near-term, can cause

A

Maternal hemorrhage
Cephalohematoma
Intercranial hemorrhage

213
Q

What assessment finding is characteristic of abruptio placenta

A

A tender, increasingly rigid uterus

increase in maternal pulse

214
Q

During what deceleration pattern is the fetal heart rate most likely to dip below 100 bpm

A

Variable decels

215
Q

Which of the following periodic fetal heart changes does not reflect the shape of the uterine contraction
Early decels
Late decels
Variable decels

A

Variable

216
Q

What component of fetal heart rate assessment is the most significant indicator of fetal well-being

A

Fetal heart rate variability

217
Q

False/prodromal labor
versus
early/latent labor

A

Falsely labor: contractions every 10 or 20 minutes, of short duration, never form a pattern, can be painful, no measurable progressive effect on the cervix
Early/latent labor: contractions that gradually increase in intensity and get closer together
progressive increase in frequency, intensity and duration
Measurable effect on servant 0-3/4 cm

218
Q

Anterior transverse suture is called the

A

Coronal

219
Q

The anterior fontanelle is formed by the meeting of what sutures

A

Frontal, sagittal, coronal

220
Q

The posterior transverse suture is called the

A

Lambdoidal

221
Q

The anterior posterior suture is

A

Sagittal

222
Q

What contraction pattern defines hyperstimulation of the uterus

A

Contractions more frequent than every two minutes lasting more than 90 seconds

223
Q

If a baby is delivering in the face presentation he must rotate to a

A

Mentum anterior position

224
Q

Amniotic fluid embolism

signs and symptoms

A

Difficulty breathing, gasping for air, decreased cardiac function, hypoxia, seizures, 60 to 80% mortality

225
Q

Amniotic fluid embolism

management

A

Treatment for shock, warmth, elevate feet, 02, IV, transport

226
Q

Placental abruption

risk factor

A

Very high BP, five or more prior pregnancies, history of second trimester bleeding, a prior abruption, history of heavy smoking/cocaine use, severe abdominal trauma

227
Q

Define placenta accreta

A

An abnormal partial or total adherence of the placenta to the uterine wall
The placenta directly adheres to the myometrium with either a defective decidua or no decidua in between

228
Q

Three conditions that can create uterine inversion

A

Uterine atony
a patio us, dilated cervix
fundal pressure or traction caused by pulling on the umbilical cord or placenta

229
Q

Factors associated with higher success rates for VBAC

A

Not repetitive indications breech, malpresentation, fetal distress, preeclampsia
Spontaneous labor with normal progression
History of previous VBAC

230
Q

Factors associated with lower success rates for VBAC

A

Possible repetitive indications
CPD, failure to progress, labor dystocia, induction or augmentation, more than one C-section, no prior vaginal delivery, nonreassuring fetal heart tones when first seen in labor

231
Q

What fetal heart assessment finding is the most ominous

A

Repeated late decels with loss of short-term variability

232
Q

What to expect with a breech labor

A

Premature rupture of membranes
labor starts a few weeks early
thick meconium is normal
no rupture of membranes, gentle vaginal exam
prepare to resuscitate
dilation is difficult to determine make sure the cervix is really gone slower labor because smaller presenting part on the cervix takes longer to dilate

233
Q

Nitrazine paper color
urine
amniotic fluid

A

Urine: blue because it’s alkaline
amniotic fluid: blue
Dark yellow paper turns blue green when in contact with an alkaline substance
this includes urine, blood, cervical mucus, secretions from BV

234
Q

Vaginal bleeding during labor

spotting versus Frank

A

Bleeding is abnormal
vaginal exam is contraindicated in the presence of bleeding
Frank bleeding requires physician consultation and collaboration or referral
possible causes placenta abruption/previa

235
Q

What is a normal rise in blood pressure during contractions for a woman in labor

A

Systolic rise of 10 to 20 MM HG

Diastolic it rise of 5 to 10 MM HG

236
Q

Breech what do you do if you’re having difficulty delivering the head

A

Make an airway with your finger by pulling back the perineum, so the baby can breathe
Use suprapubic pressure, or use Ritgen maneuver, and with finger on lower jaw, flex head and bring baby out
Use strong steady traction

237
Q

Factors that make breech delivery higher risk

A

Danger prolapsed cord
Cord getting pinched by after coming head
possibility of fetal anomalies
head has less time to mold
intracranial pressure hemorrhage maybe result of too rapid decompression of head
possibility of head entrapment

238
Q

Breech scoring system

A 
0,1,2
Parity: primip, multip 
Fetal weight: 8+, 7-8, 5-7 
Gestational age 39+, 37-38, 36-37
1st dilation check: 2cm, 3cm, 4cm
Station: -3,-2,-1
Previous breech, none, one, 2 or more
Subtract 1 for footling breech
0-3 dangerous 4-5 review carefully 5+ reasonable success

Antepartum (3 decks)

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