L&D Postpartum - Hill

Question 1

What kinds of variability are there for FHR monitoring?

Answer 1

1) minimal: 0-5 bpm
2) moderate: 6-25 bpm
3) maximal: > 25 bpm

Question 2

What is the baseline HR for the fetus?

Answer 2

110-160 bpm

Question 3

What is NIH Category I or “normal”?

Answer 3

1) predictive of normal acid-base balance
2) follow in a routine manner
3) must include ALL of the following:
a) baseline FHR 110-160
b) moderate variability (6-25)
c) No late or variable decels
d) early decels present or absent
e) accels present or absent

Question 4

What is NIH category III “abnormal”?

Answer 4

1) predictive of abnormal acid-base status

2) requires prompt evaluation - prepare for delivery and intrauterine resuscitative measures

Question 5

What are the criteria for NIH category III?

Answer 5

Must meet (1) or (2)
   1) absent baseline FHR variability AND any
      of the following:
            a) recurrent late decels
            b) recurrent variable decels
            c) bradycardia
    2) sinusoidal pattern for > 20 min

Question 6

What are early decelerations?

Answer 6

1) gradual decrease in FHR
2) onset to nadir > 30 seconds
3) Nadir occurs with peak contraction

Question 7

What causes early decels?

Answer 7

head compression

Question 8

What causes variable decels?

Answer 8

cord compression

Question 9

What are variable decelerations?

Answer 9

1) abrupt decrease in FHR of > 15 bpm
2) onset to nadir < 30 sec
3) lasts > 15 sec and > 2 min

Question 10

What causes late decels?

Answer 10

Placental Insufficiency

Question 11

What are late decelerations?

Answer 11

1) gradual decrease in FHR
2) onset to nadir > 30 sec
3) onset after start of contractions
4) FHR returns to baseline after ctxn ended

Question 12

What are the different pelvic shapes and which are good for delivery?

Answer 12

1) Gynecoid - circle - good
2) platypelloid - flat oval - good
3) anthropoid - tall oval - bad
4) android - heart - bad

Question 13

What are the changes in position for the baby during delivery?

Answer 13

1) engagement
2) descent
3) flexion
4) internal rotation
5) extension
6) external rotation
7) restitution

Question 14

What makes up the first stage of the labor curve?

Answer 14

A) latent labor
B) acceleration
C) maximum slope
D) deceleration

Question 15

What makes up the second stage of the labor curve?

Answer 15

E) after fully dilated

Question 16

What is the third stage of the labor curve?

Answer 16

from delivery of fetus to delivery of placenta

Question 17

When do you treat for GBS?

Answer 17

1) GBS+ from vagina or rectum
2) positive history of birth of infant with early onset GBS disease
3) GBS bacteriuria in current pregnancy
4) GBS unknown AND
a) intrapartum fever OR
b) preterm labor OR
c) prolonged rupture of membranes
> 18 hours

Question 18

What would you use broad spectrum intrapartum antibiotics for?

Answer 18

The treatment (not prophylaxis) of the febrile woman in labor with clinical etiology of chorioamnionitis

Question 19

What is chorioamnionitis?

Answer 19

1) maternal temp > 38 C (+ ONE of…)
a) fetal tachycardia
b) maternal tachycardia
c) abdominal tenderness
d) foul smelling AF
e) +AF cx = fold standard