Module 3 & 4 Practice Questions Flashcards
A visually apparent, symmetrical, gradual decrease and return of the FHR, delayed in its onset relative to the onset of a uterine contraction with the FHR nadir occurring after the peak of the contraction, and with its return typically occurring after the end of the contraction.
Late deceleration
The mean FHR rounded to increments of 5 beats per minute during a 10-minute segment, excluding periodic or episodic changes is
Baseline
A visually apparent abrupt increase in the FHR with a peak of 15 beats per minute or more above baseline and a duration of 15 seconds or more
Acceleration
A visually apparent decrease in the FHR, at least 15 beats per minute below the baseline, that continues for at least 2 minutes but less than 10 minutes.
Prolonged deceleration
With IA, categorizing fetal assessment as Category I or Category II is based on:
presence of decelerations
baseline rate
baseline rhythm
According to the ACOG bulletin on FHR monitoring, for a pregnant person without complications, what is the best choice for fetal assessment?
Either continuous electronic fetal monitoring or intermittent auscultation is acceptable
The presence of accelerations in the FHR generally indicates
The fetus is not acidemic
What are examples of effective intrauterine resuscitation techniques:
Lateral positioning, d/c Pitocin, IVF bolus, O2 admin (possibly-no current recommendations)
Continuous electronic fetal heart rate monitoring is associated with
Increased cesarean births
A fetal heart rate in the 170s for 15 minutes should be described as:
Tachycardia
Recurrent decelerations occur:
With at least 50% of contractions in a 20-minute period.
If a Category II based on IA findings, what is an appropriate action?
Change the birthing person’s position and increase frequency of ausculation
The presence of early decelerations means:
head compression
When a patient is having variable decels the FIRST action should be:
Reposition the patient
A common cause of late decelerations noted after an epidural is:
hypotension
Susie has an EFM with FHR baseline 145, moderate variability, no accelerations but repetitive decelerations noted to have smooth gradual descent to 130 starting with contraction and smooth gradual ascent to baseline by the end of the contraction. What category is this strip?
Cat I
Admission to the hospital in the latent phase of labor may result in:
An increased rate of intrapartum interventions
Rationale: Latent phase labor can be a long process with very little measureable progress. Its appropriate management requires patience. When a woman is admitted to the hospital in this phase, prior to active labor, there is a tendency for care providers and family members to want to see progress and to demonstrate impatience, both leading to increased interventions. The evidence shows that increased interventions are associated with hospital admission in latent phase, including increased use of pain medication and more cesarean births. Perinatal outcomes are not improved.
According to Friedman, active labor begins when the:
Rate of dilatation changes abruptly
Rationale: Responses ‘a’, ‘b’, and ‘c’ are loosely associated with the onset of active labor but, according to Friedman, the distinguishing characteristic of active labor onset is the significant increase in the rate of dilatation.
A G1 P0 is in active labor. At 1600 her cervical exam is 7cm/100%/0 station. Two hours later her VE reveals 8cm/100%/+1 station. According to Friedman’s criteria, her labor progress is:
Protracted
A G1 P0 in active labor. At 1600 her cervical exam is 7cm/100%/0 station. Two hours later her cervical exam is 8cm/100%/+1. According to contemporary research, her labor progress is:
Normal
Rationale: Contemporary research shows that the upper limit of active phase length is about twice as long as Friedman’s findings from ~50 years ago. Some researchers recommend a rate of .5cm/hr as the criterion for normal progress. In this scenario, Michelle’s progress is .5cm/hr so this would be considered normal progress using this alternative criterion.
What was the outcome for most women diagnosed with a secondary arrest of dilatation in Friedman’s research?
Vaginal birth without intervention
Researchers have found the following maternal outcome(s) to be associated with a longer duration of second stage:
Increased cesarean birth
Increased operative vaginal birth
Increased third and fourth degree lacerations
Rationale: Although a longer second stage was not shown to result in increased perinatal complications, the research did consistently show an increase in cesarean birth, operative vaginal birth, and third and fourth degree lacerations.
A G2 P1001 is in active labor. Her cervical exam is 10cm/100%/0 station. She has no urge to push. According to Friedman’s criteria, the phase of labor is
Second stage
Rationale: Friedman defines second stage based on cervical dilatation alone. Complete dilatation = second stage, with or without an urge to push.
A G2 P1001 is in active labor. Her cervical exam is 10cm/100%/0 station. She has no urge to push. A short time later, Nicki begins spontaneous bearing down efforts with each contraction. An hour later, Nicki’s cervical exam is 10cm/100%/+2 station. According to Friedman’s criteria, this labor progress is:
Normal
Rationale: Friedman’s criterion for normal progress in second stage is at least 2cm/hr descent for a multiparous woman. Nicki has made 2cm/hr progress in descent, which is normal.
Which labor hormones are present in myometrial tissue throughout pregnancy?
Prostaglandin
Active management of labor originating in Dublin in the 70’s included which parameters:
continuous labor support by a midwife
Active management of labor originating in Dublin in the 70’s included which parameters:
continuous labor support by a midwife
A G3 P2 is in active labor. She was 7 cm 80% -2 at 2 pm. At 4 pm her cervical exam was the same. According to Friedman, this is a
Secondary arrest of dilation
A G1 P0 is in active labor. She has been 6 cm 80% -2 for the last 4 hours. Her contractions are every 4-6 minutes, moderate by palpation and 60-70 seconds long. The FHR monitor shows a category one tracing. What is the best next step?
Use shared decision making with the patient
A G4 P2 is in active labor. At noon her cervical exam is 6 cm, 80%,-1. At 3 pm her cervical exam is 8 cm, 100% -1. According to contemporary research criteria, which accurately describes her labor progress
normal active phase
ACOG recommends consideration of a cesarean birth when a woman
is greater than 6 cm with rupture membranes and no cervical change in 4 hours
A G1 P0 has the urge to push at noon. She is 10 cm, 100%, -1. Two hours later she is 10cm, 100%, -1. According to Friedman, this is a/n
arrest of descent
What is the most common reason for primary C/S?
Slow labor
What term us currently being used for labors that are to slow?
Per ACOG/SMFM “abnormally progressing labor”
There are many terms that are used for this
Per Friedman, what is labor protraction in active labor?
Progress occurring, but slower than normal
Friedman <1.5 cm/hr nullip, <1.2 cm/h multip
Contemporary <0.5 cm/h OR 0.5-0.7/0.5-1.3 cm/h (nullip/multip, with faster dilation as labor progresses)
Per Friedman, what is labor arrest in active labor?
1) No progress for X hours
Friedman=2hrs
Updated=4hrs
2) Oxytocin with no progress in 4 hours (with adequate contractions) or 6 hours with inadequate contractions
When should we intervene in labor according to Friedman?
Consider intervention for protraction or arrest of labor
When should we intervene in labor according to contemporary recommendations?
ACOG: when first stage is protracted or arrested, oxytocin is recommended
Neal and Lowe: “at >5cm, oxytocin augment may be considered for a >4 hour delay in cervical change
What other factors should be considered for abnormally slow labor?
-Maternal and Fetal Wellbeing
-Pt’s willingness or interest in other interventions
What outcomes are associated with early intervention in arrested or protracted labor according to the evidence reviewed in Module 4?
There are no differences in outcomes regarding maternal and fetal wellbeing, labor is shortened.
How should we intervene with abnormally slow labor?
-Shared Decision Making!!
-Oxytocin, amniotomy
-Doulas/cont. labor support
-Position changes/activity changes
-Assess fetal positioning
-Assess pain/coping
***Can start with least invasive options first if it is safe to do so and that is what the patient wants
When is a cesarean indicated for abnormally slow labor alone?
**NOT indicated in latent labor or for slow but progressive labor
ACOG: Reserve for women at 6cm+ with ROM and failure to progress with 4 hours of adequate labor or 6 hours of Pitocin
