Maternity Flashcards

Question

What are the stages of labour?

Answer 1

1. Effacement and dilation of the cervix, the onset of contractions to full dilation of the cervix a) latent phase: cervix opens to 5 cm, contractions are mild and last about 30 to 45 seconds, 5 to 10 minutes apart; b) Active phase: cervix dilate 4 to 7 cm, contractions are 40 to 60 seconds, and 3 to 5 minutes apart; c)transition phase: cervix dilated to 10 cm, contractions are 60 to 90 seconds, with 30 seconds in between 2. Cervix is 10 cm dilated and 100% effaced: fetus descends into birth canal and mother voluntarily bears down 3. From birth to delivery of the placenta 4. Recovery: after delivery of placenta until bonding established with baby

Answer 2

With vaginal delivery blood loss is an estimated 500 ml and for C-section delivery blood loss is an estimated 1000 ml

Answer 3

Duration: timing of the onset and the end of a contraction, measured in seconds, ranges from 45 to 80 seconds and should not last longer than 90 seconds Frequency: ranges from 2 to 5 contractions per 10 minute period Intensity: strength of a contraction at its peak determined by palpation or intrauterine pressure catheter (IUPC) measured in mmHg Resting tone: tension in the uterine muscles between contractions, 10mmHg is the average resting tone during labour

Answer 4

Braxton Hicks are irregular, painless uterine contractions that are normal and may occur from the 4th month of pregnancy. These contractions facilitate uterine blood flow and promote oxygen delivery to the fetus. After the 28th week these contractions become more definite, but ease with walking or exercise. They can be mistaken for true labour but do not intensify and duration or cause cervical dilation

Answer 5

A woman who is pregnant

Answer 6

A woman who has had two or more pregnancies

Answer 7

A woman who has completed two or more pregnancies to 20 weeks of gestation

Answer 8

A woman who has never been pregnant and is not currently pregnant

Answer 9

A woman who has not completed a pregnancy with a fetus or fetuses is beyond 20 weeks of gestation

Answer 10

The number of pregnancies in which the fetus or fetuses have reached 20 weeks gestation, not the number of fetuses born

Answer 11

A woman who is pregnant for the first time

Answer 12

A woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks gestation

Answer 13

The capacity to live outside the uterus usually occurring about 22 to 25 weeks of gestation

Answer 14

A pregnancy from the beginning of week 37 of gestation

Answer 15

A pregnancy that has reached 20 weeks but prior to the completion of 36 weeks gestation

Answer 16

A pregnancy between 37 weeks and 38 weeks six days gestation

Answer 17

A pregnancy between 39 weeks and 40 weeks and six days

Answer 18

A pregnancy in the 41st week gestation

Answer 19

A pregnancy after 42 weeks gestation

Answer 20

1) Cephalic which occurs in 96% of births 2) Shoulder which occurs in less than 1% of births 3) Breach which occurs in 3% of births

Answer 21

1) Frank breech: legs point up with feet by babies head so the bottom would emerge first 2) Complete breech: legs folded with feet at the level of the baby’s bottom 3) Footling breech: one or both feet down so the legs emerge first

Answer 22

When the baby is in footling breach position, the placenta is low lying over the cervix, when the umbilical cord comes out first, and when the labour is not progressing normally

Answer 23

With Latent labour, a warm shower or bath, soothing back or foot massages, warm liquids, and diversional activities. After admission to hospital: a family centred care approach, a pillow for comfort, music, orientation to the room, and nurse reassurance and answering questions

Answer 24

It is the leading cause of maternal death and occurs in 5% of births, it is preventable in more than half of the cases. It is defined as the loss of more than 500 mL of blood during a vaginal birth and more than 1000 mL in a C-section. Early or acute occurs within 24 hours of birth, late or secondary occurs more than 24 hours or less than six weeks after birth.

Answer 25

Over-distended uterus, anaesthesia or analgesic, previous history of uterine atony, high parity, prolonged labour or oxytocin induced labor, the administration of magnesium sulfate, uterine sub-involution, lacerations of the birth canal, trauma during labour and birth, forceps assisted birth, vacuum assisted birth, caesarean birth, ruptured uterus, manual removal of retained placenta, retained placenta fragments, placenta accreta, placenta increta, placenta per creta, placental abruption, placenta previa, and coagulation disorders

Answer 26

If a pregnant woman is RH negative and baby is RH positive antibodies can form, which can cause fetal anemia, jaundice, brain damage, or death. RH immune globin is a blood product that is given whenever there is a chance of RH negative woman giving birth to an RH positive baby.It is given at 29 weeks gestation and at delivery. It can reduce foetal haemolytic disease in 99% of cases.

Answer 27

It is the return of the uterus to nonpregnant state. The process begins after expulsion of placenta with contraction of uterine smooth muscle. At the end of the third stage of labor the uterus is midline, 2 cm above the umbilicus, the fundus is resting on the sacral Promontary. Within 12 hours of birth the fundus may rise to 1 cm above the umbilicus and by 24 hours the uterus is the same size as it was 20 weeks gestation. The uterus descends 1 to 2 cm every 24 hours. Involution progresses rapidly during the next few days and by the sixth day it is located halfway between umbilicus and symphysis pubis. The uterus should not be palpable after two weeks.

Answer 28

It is the failure of the uterus to return to a non-pregnant state. The most common cause is retained placenta fragments or infection

Answer 29

It is one of the three main causes of maternal death and approximately 5 to 10% of pregnancies are complicated by hypertension. It is most common in women over the age of 40 with their first pregnancy. A blood pressure of 140/90 or greater taken at two separate measurements at least 15 minutes apart

Answer 30

Hypertensive disorder’s, infection, and haemorrhage

Answer 31

Hepatic rupture, placental abruption, and eclampsia

Answer 32

Hypertension that predates the pregnancy or appears before 20 weeks gestation

Answer 33

Comorbid conditions include pre-gestational type one or type two diabetes or kidney disease and require tight BP control outside of pregnancy to alleviate the heightened cardiovascular risk

Answer 34

Gestation hypertension with One or more of the following symptoms: - new or worsening proteinuria, - one or more adverse conditions, - one or more severe complications.

Answer 35

Hypertension that appears for the first time at or beyond 20 weeks gestation

Answer 36

It develops after the second trimester and is defined as a hypertensive disorder with new onset proteinuria. It causes reduced maternal Organ perfusion and as a result decrease placental perfusion and fetal hypoxia. Non-severe preeclampsia can be managed at home by monitoring vital signs, deep tendon reflexes, balanced diet, and antihypertensive medications.

Answer 37

It is defined when one or more severe complication is present.

Answer 38

A BP reading of greater than 140/90 on two separate readings 15 minutes apart, proteinuria of less than 0.3 g in a 24 hour specimen, reflexes may be normal, urine output matches fluid intake, headache may be present, there may be visual problems, right upper quadrant or epigastric pain may be present, serum creatinine may be elevated, thrombocytopenia may occur, liver enzymes may be elevated, fetal heart rate may be normal abnormal, placental perfusion is reduced.

Answer 39

A blood pressure of >160/110 on two separate readings that are 15 minutes apart, proteinuria of greater than 0.3 g in a 24 hour specimen, hyperreflexia of >3, decreased urine output to 15 ml per hour, severe headache, blurred vision or Blind spot’s, hepatic haematoma or rupture, elevated serum creatinine to > than 150, platelets are less than 50, hepatic disfunction is present, foetal heartbeat heart rate may be abnormal, decreased perfusion to placenta, foetal heart rate may show late deceleration in labor, placenta appears smaller than normal and premature ageing is apparent with numerous areas of ischemic necrosis

Answer 40

Headache and visual disturbances, chest pain or dyspnea, oxygen saturation of less than 97%, elevated WBC, elevated INR or PTT, low platelets, elevated creatinine, nausea or vomiting, epigastric pain, elevated liver enzymes, abnormal foetal heart rate.

Answer 41

Cortical blindness or retina detachment, a GCS of less than 13, stroke, severe hypertension for greater than 12 hours, oxygen saturation <90 with the need for 50% O2 for one hour, intubation, pulmonary edema, MI, platelet count of <50, transfusion of any blood product, acute kidney injury, hepatic dysfunction, maternal or fetal compromise.

Answer 42

Abstinence from alcohol, smoking cessation, multivitamins containing fully, calcium supplements, regular exercise.

Answer 43

It is when the placenta is implanted in the lower uterine segment and completely or partially covers the cervix or as close enough to cause bleeding when the cervix dilate. A complete placenta previa covers the opening of the cervix entirely. A partial or marginal placenta previa covers less than 2 cm of the cervical opening.

Answer 44

Bright red vaginal bleeding during second or third trimester, vitals may be normal because of the compensatory mechanism of pregnancy, 40% of blood volume can be lost without showing signs of shock, it can result in decreased output, increase fundal height.

Answer 45

The maternal risks are hemorrhage and hysterectomy. the fetal risks are preterm birth, stillbirth, malpresentation, and fetal anemia.

Answer 46

Reduced activity, ultrasound every two weeks, fetal surveillance, lab work to include haemoglobin and hematocrit, antepartum steroids to promote fetal lung maturity, C-section after 37 weeks.

Answer 47

Bleeding is minimal to severe, blood loss varies, blood is bright red, shock is uncommon, uterine tone is normal, there is no pain, ultrasound findings of placenta are abnormal, fetal position is commonly transverse, breech or oblique,There is normal fetal heart rate pattern, station of presenting part is high and not engaged.

Answer 48

Class one: mild separation of 10 to 20%, class two: moderate separation of 20 to 50%, class three: severe separation of greater than 50%.

Answer 49

Minimal bleeding, less than 500 mL blood loss, dark red blood, shock is rare, uterine tone is normal, pain is absent, location of placenta is normal, station of presenting part is variable to engaged, usual distribution of fetal position, normal foetal heart rate.

Answer 50

Bleeding can be moderate, 1000 to 1500 mL of blood loss, dark red blood, mild shock, occasional DAC, uterine tone is increased and may be localized, pain is present and is moderate to severe, location of placenta is normal, the station of presenting part is variable to engaged, there is usual distribution of fetal position, gestational hypertension is common, There is atypical fetal heart rate pattern.

Answer 51

Bleeding can be heavy, blood loss is greater than 1500 mL, blood is dark red, shock is very common and can be sudden, frequent DIC, uterine tone is Tetanic with persistent uterine contractions, pain is agonizing, the location of the placenta is normal the station of presenting part is variable to engaged, there is usual distribution of foetal position, gestational hypertension is commonly present, there is abnormal foetal heart rate pattern and death can occur.

Answer 52

High blood glucose levels during pregnancy. It can begin during the first trimester and can cause problems with fetal development. It usually does not emerge until second or third trimester. Maternal nutrient ingestion induces greater or more sustained levels of blood glucose well insulin resistance is increased.

Answer 53

Preeclampsia, fetal macrosomia which can lead to lacerations and episiotomy, c-section, fetal shoulder dystocia and birth trauma, fetal hyperglycemia, difficulty breathing due to increased surfactant production,

Answer 54

Jitteriness, lethargy, poor feeding, abnormal cry, hypothermia or temp instability, respiratory distress, apnea, and seizures.

Answer 55

It is a normal flora in a woman who is not pregnant and is present in 10 to 30% of healthy pregnant women but can be vertically transmitted from the birth canal to the infant and leads to increased perinatal and neonatal morbidity and mortality.

Answer 56

Positive prenatal culture, preterm labour of less than 37 weeks, prolonged rupture of membranes greater than 18 hours, intrapartum maternal fever, positive history for early onset neonatal GBS. Intrapartum antibiotic prophylaxis should be offered if a culture is not available.

Answer 57

treatment is penicillin G, 5 million units IV loading dose then 2.5 million units IV every four hours during labor. Alternative therapy is ampicillin 2 g IV loading dose followed by 1 g IV every four hours.