Maternal And Neonatal Resus Part 1

Question 1

What are maternal factors for malpresentation?

Answer 1

• lax abdominal/uterine muscles
• uterine anomalies (fibroids or bicornuate uterus)

Question 2

What are placental or pregnancy risk factors for malpresentation

Answer 2

• placenta previa
• preterm labour
• polyhydraminos
• multiple pregnancies

Question 3

What labour complications do malpresentation carry?

Answer 3

• limb prolapse
• uterine rupture due to obstructed labour
• obstructed delivery increasing maternal and fetal mortality

Question 4

What is normal fundal height and position?

Answer 4

Normal vertex: fungus reaches under the ribs as the babies head descends into the pelvis

Question 5

Fundal height and positioning in malpresentation

Answer 5

Fungus height might be lower due to the baby being sideways

Question 6

Twin births are most common in what age range of mothers?

Answer 6

37 years or older

Question 7

Hormonal factors of having twins

Answer 7

High levels of FSH increase the likelihood of having twins

Question 8

What are complications with multiple gestation (9)

Answer 8

• prematurity due to limited space
• discordant growth (one twin grows larger than the other)
• twin-twin transfusion syndrome
• congenital abnormalities
• polyhydraminos
• malpresentation of the second twin
• perinatal mortality
• gestational HTN
• PPH

Question 9

How should you manage and deliver twins?

Answer 9

1. Deliver first twin
2. Clamp and cut the cord (do not delay)
3. Visualize for PPH
4. Delivery of second twin

Question 10

What interventions can midwives perform?

Answer 10

• bimanual uterine compression
• fundal massage

Question 11

Can you leave a patient in the care of a midwife?

Answer 11

Yea, only if they are Ontario certified and capable

Question 12

What are signs that the second twin may deliver soon?

Answer 12

• increased contractions
• more bleeding
• visible presenting parts

Question 13

How much time is typically passed before the second twin is born?

Answer 13

20 - 30 mins

Question 14

What can be indicators of a second baby in undiagnosed twins?

Answer 14

• the first baby is smaller than expected
• fundus remains high after delivery of the first baby
• palpation s reveals another head or body part in abdomen

Question 15

Nearly half of twins are delivered preterm, with a significant proportion under ____ weeks

Answer 15

32 weeks

Question 16

Why do mothers of twins have a higher risk of PPH?

Answer 16

Due to uterine overdistension

Question 17

What is twin-twin transfusion syndrome

Answer 17

Donor twin: receives too little blood flow and causes growth restrictions
Recipient twin: receives too much blood flow which increases the risk of heart failure

Question 18

For preterm neonates, avoid traditional dry stimulation. Instead you should…

Answer 18

Place the neonate in a plastic bag to maintain warmth

Question 19

Placenta management with twins

Answer 19

1. Guard the uterus during delivery to prevent uterine inversion
2. Hold both cords together in one hand and use gentle traction

Question 20

What should you document with twins?

Answer 20

• time of ROM
• Time of baby 1 head delivery and time of entire baby delivery
• presentation of baby 2
• time of birth for baby 2s head and entire baby delivery
• time of placental delivery

Question 21

Why doe preterm neonates run the risk of hypothermia?

Answer 21

• thin skin
• reduced fat stores
• immature thermoregulatory systems

Question 22

what are key indicators of PPH

Answer 22

• excessive bleeding following the delivery of one or both babies
• retained placenta or uterine atony

Question 23

what is the consequencial sequence of heat loss?

Answer 23

heat loss causes cold stress

which causes peripheral vasoconstriction which reduces oxygen delivery.

this triggers pulmonary vasoconstriction which decreases oxygen supply

Question 24

at what gestation age is the plastic bag method used?

Answer 24

neonates <32 weeks gestation

Question 25

what is a denied pregnancy?

Answer 25

an individual is unconsciously denies their pregnancy due to dissociative psychopathology

Question 26

what is la belle indefference

Answer 26

mother expresses no emotional response to the experience of pregnancy

Question 27

what are hidden pregnancies?

Answer 27

the individual is consciously aware of their pregnancy but hides it intentionally

Question 28

what risks are associated with denied and hidden pregnancies?

Answer 28

lack of prenatal care causes no screening for gestational diabetes or preeclampsia or malpositioning of fetus or placenta