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Adv Midwifery Childbearing > Mod 9 + 10 > Flashcards

Mod 9 + 10 Flashcards

1
Q

39 0/7 through 40 6/7 weeks

A

Full Term

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2
Q

41 0/7 through 41 6/7 weeks

A

Late Term

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3
Q

42 0/7 weeks and beyond

A

Post Term

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4
Q

Normal physiologic weakening of membranes combined w/ shearing forces created by contractions
–Associated w/ intraamniotic infection, esp w/ earlier gestation

A

PROM

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5
Q 
Risk Factors for \_\_\_\_\_\_\_\_\_\_\_\_:
Hx of pPROM
Short cervix
2nd and 3rd trimester bleeding
Low BMI
Low socioeconomic status
Smoking
Drug use
A

PROM

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6
Q 
May cause false \_\_\_\_\_\_\_\_\_\_\_ in Nitrazine test:
Blood
Semen
Alkaline antiseptics
BV
A

positives

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7
Q

most common sign of uterine rupture

A

fetal bradycardia

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8
Q

May cause false ___________ in Nitrazine test:
Prolonged rupture
Minimal residual fluid

A

negatives

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9
Q

FFN test has high ___________ and low __________

A

high sensitivity ; low specificity

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10
Q 
Maternal Risks of \_\_\_\_\_\_\_\_\_\_\_\_\_:
Most significant: intrauterine infection (increases w/ increased ROM duration)
C-section
Abruption
Umbilical cord accident
Antepartum hemorrhage
PP endometritis
Thromboembolic complications
PPH
Maternal death
A

PROM

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11
Q 
Fetal Risks of \_\_\_\_\_\_\_\_\_\_\_\_\_\_:
Non-reassuring FHT
Infection
If Pre-term:
Prematurity complications
Respiratory distress most common
Sepsis
Intraventricular hemorrhage
Necrotizing enterocolitis w/ intrauterine inflammation → Increased risk of neurodevelopmental impairment
White matter damage
A

PROM

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12
Q

During induction w/ oxytocin for PROM, a sufficient period of adequate contractions, at least __-__ hours, should be allowed for the latent phase to progress before diagnosing failed induction and moving to C/S

A

12-18

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13
Q

PPROM @ 24 0/7 – 33 6/7 weeks:

_________ recommended to prolong latency if no contraindications

A

Antibiotics

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14
Q

type of breech in which fetal legs are flexed at the hips and extended at the knee

A

Frank Breech

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15
Q

type of breech in which fetal legs are flexed at the hips and flexed at the knee

A

Complete Breech

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16
Q

ACNM recommends against offering ___________ in PROM to GBS+ patients

A

expectant management

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17
Q

Avoid baseline __________ in PROM

A

SVE

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18
Q

infant head swelling that does NOT cross suture lines

A

Cephalahematoma

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19
Q

infant head edema that DOES cross suture lines

A

Caput

Subgaleal Hemorrhage

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20
Q

infant head edema that resolves in a few weeks or months

A

Cephalahematoma

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21
Q

infant head edema that resolves in a few days after delivery

A

Caput

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22
Q

infant head edema that is usually located on the parietal and occipital bones

A

Cephalahematoma

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23
Q

infant head edema that is usually located on the scalp, periorbital, periauricular areas

A

Subgaleal Hemorrhage

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24
Q

Symptoms of _____________:
Decreased or absent movements of the arm on the affected side
Tenderness, deformity, and crepitus may be elicited at the site of injury
Incomplete Moro on the affected side
Nonrespiratory tachypnea caused by discomfort

A

Fractured Clavicle

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25
Q

Symptoms of _____________:

mass caused by hematoma formation or signs of pain during palpation

A

Fractured Humerus

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26
Q

Symptoms of ____________:

A

Erb’s Palsy

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27
Q

Symptoms of ____________:
volves C8-T1
Weakness of the wrist and fingers flexors and of the small muscles of the hand
“good shoulder, bad hand” scenario
Complete or partial paralysis of the forearm and hand muscles

A

Klumpke Palsy

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28
Q

TERMPROM study found higher risk for infection with _____________ than with _____________

A

higher risk with expectant management

than with IOL

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29
Q

Sharp increase in risk of complications after ____ hours of PROM

A

24

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30
Q 
ACOG Criteria for \_\_\_\_\_\_\_\_\_\_:
1 or 2 previous low-transverse C/S
Clinically adequate pelvis
No other uterine scars
No Hx of uterine rupture
Physician immediately available throughout active labor
Physician capable of monitoring labor
Physician able to perform 911 C/S
Anesthesia/personnel available for 911 C/S
A

TOLAC

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31
Q 
ACOG Criteria against attempting \_\_\_\_\_\_\_\_\_\_\_:
Prior classical or T-shaped C/S incision
Other transfundal surgery
Contracted pelvis
Medical/Obstetric complication
Inability to perform 911 C/S
A

TOLAC

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32
Q

Risks to Consider but do not Preclude __________:
Multiple previous c/s
Macrosomia
> 40 week gestation
Unknown type of prior uterine incision - unless highly suspicious of previous classical incision, may still be candidates
Twin gestation - may be considered w/otherwise appropriate candidates
Obesity - high BMI alone is not an absolute contraindication

A

TOLAC

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33
Q 
Signs of \_\_\_\_\_\_\_\_\_\_\_:
Loss of station
Fetal stress - *Bradycardia*
Palpable parts in the abdomen
Continuous abdominal pain - tends to refer to scapular/ shoulder area
Increased vaginal bleeding
Hypertonic or fewer contractions
Lower amplitude
Prolonged, late, or variable decels
(Contraction pattern unreliable and often normal)
(Can mirror s/s of abruption)
Often remarkably little appreciable pain or tenderness
A

Uterine Rupture

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34
Q 
Causes of \_\_\_\_\_\_\_\_\_\_\_\_\_\_:
Before delivery:
Persistent, intense, spontaneous contraction
IOL w/ oxytocin or prostaglandins
Intraamniotic installation w/ saline or prostaglandins
Perforation by IUPC
External trauma
External version
Uterine overdistention due to hydramnios
Multifetal pregnancy
During delivery:
Internal version of second twin
Difficult forceps delivery
Breech extraction
Fetal anomaly distending lower segment
Vigorous uterine pressure during delivery
Difficult manual removal of placenta
Acquired:
Placenta accrete syndromes
Gestational trophoblastic neoplasia
Adenomyosis
Sacculation of entrapped retroverted uterus
A

Uterine Rupture

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35
Q

Risk of ____________ with history of one low transverse cesarean section:
0.2 - 1.5%
Average 0.6% 1 in 170 women

A

Uterine Rupture

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36
Q

Risk of ____________ with history of 2 low transverse cesarean sections:
3.9% 1 in 26 women
3-5 fold higher than in women with only 1 prior C/S

A

Uterine Rupture

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37
Q 
Management of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_:
Urgent delivery - often C/S
(Decision to incision time of <18 minutes associated with best outcomes)
Adequate IV access
Ready for blood transfusion
Call for NICU/Neonatal team
Hysterectomy may be required
A

Uterine Rupture

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38
Q 
Fetal Risks of \_\_\_\_\_\_\_\_\_\_\_\_:
Neonatal convulsions
Meconium Aspiration Syndrome
5-minute APGAR < 4
NICU admission
Postmaturity syndrome**
Oligohydramnios**
Stillbirth
A

Post Term Pregnancy >/= 42+0/7 Weeks

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39
Q 
Fetal Risks of \_\_\_\_\_\_\_\_\_\_\_\_:
Perinatal morbidity and mortality
Macrosomia (double risk) which can lead to:
Operative vaginal delivery
C/S
Shoulder dystocia
A

Late Term Pregnancy 41+0/7 - 41+6/7 Weeks
AND
Post Term Pregnancy >/= 42+0/7 Weeks

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40
Q 
Maternal Risks of \_\_\_\_\_\_\_\_\_\_\_:
Severe perineal laceration
Infection
PP Hemorrhage
C/S
Anxiety
A

Late Term Pregnancy 41+0/7 - 41+6/7 Weeks
AND
Post Term Pregnancy >/= 42+0/7 Weeks

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41
Q 
Symptoms of \_\_\_\_\_\_\_\_\_\_\_\_\_\_:
decreased subcutaneous fat
Lack of vernix
Lack of lanugo
Often MSAF
Often Meconium-stained skin, membranes and umbilical cord
A

Postmaturity Syndrome

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42
Q

Membrane sweeping decreases risk of:

A

late and post term pregnancies

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43
Q

Fetal Surveillance for ____________:
Initiate @ 41-42 wks
Twice weekly NST, BPP, modified BPP, AFV

A

late and post term pregnancies

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44
Q 
Indications for \_\_\_\_\_\_\_\_:
Gestational hypertension
Preeclampsia and eclampsia
Fetal growth restriction
Cholestasis of pregnancy
Diabetes mellitus
Fetal demise
Intraamniotic infection
Oligohydramnios
Nonreassuring fetal status
Other medical indications
Prelabor ROM
Postterm pregnancy
A

IOL

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45
Q

Contraindications for _______:
Elective before 39 weeks
Any situation that precludes vaginal birth
Placenta or vasa previa
Transverse lie
Umbilical cord prolapse
Previous myomectomy entering the endometrial cavity
Previous classical uterine incision
Active genital herpes infection
Presence of Category III fetal heart tracing

A

IOL

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46
Q

Nulliparous Ripe Cervix Bishop Score

A

7

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47
Q

Multiparous Ripe Cervix Bishop Score

A

5

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48
Q

Late-term and post-term pregnancies and PROM are not associated with increased risk of:

A

C/S

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49
Q

Nulliparous IOL are at double risk of:

50
Q

should occur prior to initiation of cervical ripening or pitocin IOL

A

consultation or collaboration w/ physician

51
Q 
Documentation for \_\_\_\_\_\_\_\_\_:
Gestational age w/ criteria used to establish EDD
Bishop score
Indications
No contraindications
Clinical pelvimetry
Confirmation of cephalic presentation
Category I FHT
A

IOL or Cervical Ripening

52
Q

Water immersion may be considered during:

A

IOL w/ pitocin

53
Q

Stimulates the myometrium of the uterus to contract similar to labor, resulting in the evacuation of the products of conception from the uterus

  • Exerts it’s uterine effects via direct myometrial stimulation, but the exact MOA is unknown.
  • Other suggested mechanisms include the regulation of cellular membrane calcium transport and of intracellular concentrations of cyclic 3’,5’-adenosine monophosphate
  • Produces local cervical effects including softening, effacement, and dilation
  • Exact MOA for this effect is also unknown, but it has been suggested that it may be associated with collagen degradation caused by secretion of the enzyme collagenase as a partial response to locally administered drug
A

MOA of Cervidil and Prepidil

54
Q

onset of Cervidil and Prepidil

55
Q

drug that is equal to Prepidil effectiveness for IOL

56
Q

Benefits of ___________:

  • Fewer vaginal exams (greater patient satisfaction)
  • Uterine hyperstimulation w/ FHR changes resolve within 15 minutes of removal and do not lead to operative birth secondary to fetal distress
  • Ability to remove drug quickly and easily
57
Q

SE of _____________:
Diarrhea
Adverse: Uterine Hyperstimulation

A

Cervidil and Prepidil

58
Q

Key Notes on _____________:

  • Requires refrigeration (frozen and does not require thawing before vaginal insertion)
  • 10mg, 0.3mg/hr, vaginal posterior fornix insert
  • FHR and uterine activity (UA) monitoring required after placement AND 15 minutes after removal
  • Remains in place for 12 hours or to onset of active labor
  • May start oxytocin 30-60 minutes after removal of insert
  • Remove if contractions > 5 in 10 minutes
59
Q

Benefits of ___________:

Not associated w/ risk for hyperstimulation w/ FHR changes

60
Q

Key Notes on ____________:

  • Requires refrigeration
  • 0.5mg in 2.5mL syringe endocervical gel
  • Lie recumbent 30 minutes after insertion
  • EFM and uterine activity monitoring 2 hr before and after insertion (may be outpatient for selected patient)
  • May start oxytocin in 6-12 hours for max dose of 3 doses in 24 hours
61
Q

Synthetic prostaglandin E1 analog that stimulates prostaglandin E1 receptors on parietal cells in the stomach to reduce gastric acid secretion

  • Mucus and bicarbonate secretion also increased along with thickening of the mucosal bilayer so the mucosa can generate new cells
  • Binds to smooth muscle cells in the uterine lining to increase the strength and frequency of contractions as well as degrade collagen and reduce cervical tone
  • Ripens cervix and induces contractions
62
Q 
Benefits of \_\_\_\_\_\_\_\_\_\_\_\_\_:
Inexpensive
Overall safe and easy to use
Stable at room temperature
Few systemic side effects
No known drug interaction
Vaginal - fewer failures of birth w/in 24 hours of administration
Less epidural and oxytocin use than dinoprostone or oxytocin
63
Q 
SE of \_\_\_\_\_\_\_\_\_\_\_\_\_:
Diarrhea
Shivering
Headache
Cramps
Nausea/Vomiting
Indigestion
Constipation
Flatulence
Chills
Fever
(Systemic reactions less common w/ vaginal)
64
Q

Cytotec routes that have less risk of C/S than vaginal route

A

PO, buccal, SL

65
Q

Cytotec route with more sustained plasma level, longer exposure, and longer onset of action

66
Q

EFM and UA monitoring 20-30 min before placement and continuously after administration of:

A

PO Cytotec

67
Q

EFM and UA monitoingr 30 min before administration and after for 2-4 hours

A

Vaginal Cytotec

68
Q

Cytotec route: 25-50 mcg q 3-6hours, max of 8 doses

69
Q

Cytotec route: 25mcg q 3-6 hours or 50 mcg q 6 hrs

70
Q

May start pitocin ___ hours after last dose of Cytotec

71
Q

Do not use cytotec if > ___ contractions in 10 min

72
Q

cytotec route that is more effective than placebo and results in fewer cesarean sections than dinoprostone or oxytocin

73
Q

PO and vaginal cytotec have same

A

effectiveness of achieving vaginal birth

74
Q

Perinatal outcomes revealed higher APGAR scores and fewer PP hemorrhages but increased MSAF among those using ____ cytotec

75
Q

insertion most likely triggers a local immune and inflammatory process that triggers cervical remodeling that leads to dilation and cervix softening

A

Foley bulb

76
Q

Use ___ mL of sterile water in foley bulb

77
Q

foley bulb typically falls out in ___-___ hours

78
Q

there is no difference in C/S rate with ____________ than pharmocological methods

A

foley bulb

79
Q

foley bulb causes minimal cervical:

A

effacement

80
Q

Benefits of ___________:
No increase in infectious morbidity
Lower rate of uterine hyperstimulation w/ and w/o FHR changes vs prostaglandins
Can be used for TOLAC/VBAC with unfavorable cervix
Broadly available
Low cost

A

foley bulb

81
Q

Risks of ____________:
May cause discomfort and persistent lower abdominal cramping
Accidental ROM
Lower rate of achieving vaginal delivery w/in 24 hours – often explained by AROM or Pit delayed while awaiting expulsion

A

foley bulb

82
Q

Hygroscopic dilator- also called osmotic dilators which draw water from surrounding tissues and expand to gradually dilate the endocervical canal.
Derived from various species of Laminaria algae that are harvested from the ocean floor.
Made from dried and sterilized seaweed stems

83
Q

Cause slightly higher dilation than misoprostol
Works over the course of 12-24 hours
Left in place for 6-12 hours

84
Q

Benefits of ____________:

Patients can void, ambulate or stool without limitations

85
Q

Risks of ____________:
May be uncomfortable
Device fragmentation with the need to have removal

86
Q

Synthetic osmotic dilator compressed polyacrylonitrile and is entirely synthetic.
Achieve cervical ripening through absorption of water from surrounding tissues without the aide of exogenous pharmaceutical agents-
Commonly used for induced abortion in the late first and early second trimesters- also for cervical stenosis in nonpregnant women before gyn procedures

87
Q

Several studies showed some efficacy without maternal or neonatal morbidity of:

88
Q

Benefits of __________:
Clinical effects in 2 to 4 hours
Left in place for 6-12 hours

89
Q

Risks of ____________:
No data regarding potential harms
Not approved beyond 23+6 weeks
Device fragmentation with the need to have removal

90
Q

Absorbent compressed polyvinyl acetal sponge containing up to 500 mg of magnesium
MOA is theorized to be both mechanical through hygroscopic dilation, and chemical through magnesium- induced cervical stroma collagenolysis

91
Q

Developed for 1st or 2nd trimester pregnancy termination
Proposed to be used for cervical ripening
Not approved beyond 23+6 weeks

92
Q

Hormone primarily produced by hypothalamus (also synthesized and secreted by placenta and fetus) and secreted from the posterior pituitary that is similar to vasopressin and has a direct antidiuretic effect on kidneys

93
Q

Oxytocin
Onset: __-__ minutes
Half-life: ___ minutes
Steady-state uterine response: __-__ minutes

A

Onset - 3-4 minutes
Half-life 15 minutes
Steady-state uterine response 30-40 minutes

94
Q

Possible reason for marked interindividual variability in response to oxytocin

A

receptor dysfunction

95
Q 
Risks of \_\_\_\_\_\_\_\_\_\_\_\_\_:
Increased risk for PPH (with long duration use)
Pulmonary edema (fluid restricted patients) 
Hypotension
Tachycardia
Transient MI (EKG changes w/ bolus dose)
Uterine tachysystole
Uterine rupture
96
Q

High Dose Oxytocin Regimen:
Start @ ___ mu/min
Increase by __-__ mu/min every ___-___ minutes

A

start @ 6

increase 3-6 q 15-40 min

97
Q

Low Dose Oxytocin Regimen:
Start @ __-__ mu/min
Increase every ____ minutes

A

start @ 0.4- 2

increase q 40 min

98
Q

Natural induction method that induces the release of endogenous oxytocin from the pituitary gland which causes uterine contractions similar to administration of synthetic oxytocin

  • Low risk women with a favorable cervix are likely to be in labor within 72 hours using this method
  • Decreases risk of PP Hemorrhage
  • Because existing evidence has not examined this method for women at risk for fetal acidemia, it is discouraged in this instance
A

Nipple Stim

99
Q

Natural method of induction that releases prostaglandins

  • No studies that show harm or increased risk, so use w/ SDM
  • Waiting until 40 weeks and a thinning cervix helps to increase effectiveness
  • Can shorten pregnancy by 1-4 days.
  • *Not endorsed by ACOG or ACNM if woman is GBS+
A

Membrane Stripping

100
Q

2 tsp of castor oil, 1 tbsp of almond butter- apricot juice and 5 drops of essential oil Verbena (obtained from Germany).

A

Canadian Verbena Cocktail

101
Q

Natural induction method that causes shorter labors

and cervical ripening

A

acupressure

102
Q

AVOID this natural induction method due to adverse outcomes

A

blue and black cohosh

103
Q

Limited research on these for natural induction

A

Red raspberry leaf tea

evening primrose oil

104
Q

ECV eligible after ___ weeks

105
Q 
Increases success of \_\_\_\_\_\_\_\_\_:
Multiparous
BMI normal (=25?)
Normal AFI
Posterior placenta
Weight 2500-3000g (also saw 2500-4000g)
106
Q 
Contraindications of \_\_\_\_\_\_\_\_\_\_\_\_:
Placenta previa
Multifetal gestation
Early labor
Oligohydramnios 
Ruptured membranes
Known nuchal cord
Structural uterine abnormalities
FGR
Prior abruption
Abruption risk
Prior C/S
107
Q 
Complications of \_\_\_\_\_\_\_\_\_\_\_:
Uterine rupture
Placental abruption
Preterm labor
Fetal compromise
Fetomaternal hemorrhage
Alloimmunization
Amniotic fluid embolism 
Fetal death (rare)
108
Q

Considerations for ___________:
Location must have ability to do 911 C/S
IV access required
Patient NPO for 6 hours or more
US exam is performed to confirm presentation, AFI, placental location and fetal spine
Pre-procedure NST
Anti D immune globulin is given to Rh-D negative women
Tocolysis and regional analgesia may be elected
Position in left lateral tilt to aid uteroplacental perfusion and Trendelenburg positioning helps during evaluation of the breech.
Monitor FHR
Forward roll of the fetus is usually attempted first
One hand grasps the head, the fetal buttocks are then elevated from the maternal pelvis and displaced laterally. The buttocks are then guided toward the fundus while the head is directed toward the pelvis.
If the forward roll is unsuccessful a backward flip is attempted.
Discontinue in excessive discomfort, persistently abnormal FHR, or after multiple failed attempts
If successful, NST is repeated until a normal test result is obtained

109
Q

Breech Hand Maneuver: Hand up along leg and keep leg flexed. Follow to behind knee, press knee away from midline, spontaneous flexion follows, sweep flexed leg across abdomen to deliver and repeat on other side if needed.

110
Q

Breech Hand Maneuver: Hand up along leg and keep leg flexed. Follow to behind knee, press knee away from midline, spontaneous flexion follows, sweep flexed leg across abdomen to deliver and repeat on other side if needed.

111
Q

Breech Hand Maneuver: hands over hard portion of pelvis and rotate baby to RST and use downward and outward traction to deliver anterior arm, rotate to do with posterior arm

A

Shoulders rotate to oblique

112
Q

Breech Hand Maneuver: allow body to rest on arm. Insert arm into vagina and ring and middle finger press on maxilla to encourage flexion of head while other arm is slid on top of scapula and middle finger is placed along baby’s neck and gentle pressure applied to encourage head flexion (assistant is helping with suprapubic pressure)

A

Mauriceau- Smellie- Veit maneuver

113
Q

Face presentation where chin is __________, vaginal delivery is possible

114
Q

Face presentation where chin is ____________, C/S delivery is needed

115
Q 
85% of \_\_\_\_\_ due to:
Prior cesarean delivery
Dystocia
Fetal jeopardy
Abnormal fetal presentation
116
Q

causes higher rates of facial nerve injury, brachial plexus injury, depressed skull fracture, and corneal abrasion

117
Q

causes higher rates of intracranial hemorrhage

118
Q

Risk Factors for ____________:

A

Stillbirth

119
Q 
Fetal Risks of \_\_\_\_\_\_\_\_\_\_\_\_:
IUFD
Spontaneous abortion
Preterm birth
FGR
Neonatal toxicity
Structural malformations
GI problems
Persistent pulmonary hypertension of the NB (PPHN)
Cardiac malformations
Long-term effects on infant neurocognitive development
A

Antidepressants in Pregnancy

120
Q

Fetal Symptoms of ___________:
15-30% of neonates may experience symptoms of: Tachypnea
Hypoglycemia
Temp instability
Irritability
Weak cry
Seizures within 2 weeks after birth if exposed to SSRI during pregnancy

A

Antidepressant Use in Pregnancy

121
Q

Overlapping of fetal cranial bones seen on US in IUFD

A

Spalding’s Sign

122
Q

Presence of gas in fetal abdomen seen on US in IUFD

A

Robert’s Sign

Adv Midwifery Childbearing (4 decks)

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