Module 6 Practice Questions Flashcards
You admit a multipara at 39 weeks in active labor. They are 4 cm/90%/0 station. They ask you to break her water. You should explain that routine amniotomy:
may increase risk of cesarean section
[Evidence suggests that routine early amniotomy may increase risk of cesarean section. In addition, there are no benefits to routine early amniotomy as it does not substantially shorten labor. In summary, there is no evidence of benefit and some evidence of possible harm when amniotomy is done routinely in early labor.]
A 39 year old nullipara at 41 weeks is in active labor. She has an unremarkable medical, surgical, obstetrical, and prenatal history. She is 7 cm/100%/0 station and has had no medications. She has progressed 3 cms in the past 3 hours. What is the best plan for her oral intake?
Diet as tolerated
[This woman is at low risk for anesthesia-related pulmonary aspiration. (Her age, gestational age, and labor progress are not risk factors.) Therefore, NPO and ice chips only are not appropriate. In addition, NPO does not result in an empty stomach. Also, a full liquid diet is not easily digestible as it contains fat and milk products, so there is no advantage to this type of diet.]
A nullipara at 40 weeks is in active labor. A dipstick urinalysis shows 3+ ketones. This result indicates:
inadequate caloric intake
[It is a common misconception that ketonuria indicates dehydration. When caloric needs exceed caloric intake, fat is burned for energy. A byproduct of this process is ketones in the urine (ketonuria). During labor, it is common to see dehydration from inadequate fluid intake with concurrent ketonuria from inadequate caloric intake. This is because the reasons for inadequate intake of calories (for example nausea, vomiting, believing they should not eat and drink) often results in inadequate intake of fluids as well. In addition, if the dipstick is done on concentrated urine, the degree of ketonuria may be artificially magnified.]
A nullipara at 40 weeks is in active labor. She is 7 cm/100%/0 station. A urine dipstick shows 3+ ketones. Which of the following questions is MOST relevant?
a) Can she tolerate oral intake?
b) Is her labor progressing normally?
c) What is her blood pressure?
d) What is her temperature?
a) Can she tolerate oral intake?
[If a woman can tolerate oral intake, this is the preferred approach to resolve ketonuria. While the other questions are relevant to labor management generally in that they address possible indications for IV fluids, they are not directly relevant here because they are not related to ketonuria.]
What is associated with a reduced cesarean birth rate?
Continuous one-on-one labor support
[Continuous one-on-one labor support is associated with shorter labors, fewer cesarean births, less need for analgesia and anesthesia, less use of synthetic oxytocin, greater maternal satisfaction, and increased maternal coping. Admission during latent phase and continuous fetal monitoring are associated with more cesarean births. The evidence on the effect of epidural analgesia on cesarean birth rates is conflicting.]
You admit a multipara at 40 weeks in active labor. A routine temperature is obtained reading is 101.9 degrees Fahrenheit. This temperature is most likely caused by:
an infectious process
[A temperature increase of 1-2 degrees Fahrenheit may be normal in labor due to an expected increase in metabolism. While it may be normal, when a temperature elevation of 1-2 degrees Fahrenheit occurs, the midwife should rule out dehydration. This temperature elevation is more than 3 degrees Fahrenheit and most likely reflects an infectious process.]
Giving large amounts of IV fluids with dextrose during labor is associated with:
newborn jaundice and hypoglycemia
[This is from page 2 of the ACNM bulletin on Oral Nutrition in Labor: “In the 1960s and 1970s, IV dextrose was given in an attempt to reduce ketosis. It soon became clear that in large doses, IV dextrose caused fetal lactic acidosis and newborn jaundice and hypoglycemia and this practice was discontinued.”]
Which of the following medications has the longest half life (and because of this, a greater risk of respiratory depression in the newborn for the longest time period)?
Meperidine (Demerol)
[Demerol has a significantly longer half life than the other three medications. This is in part due to the action of its active metabolites. This means that there is a long time period during which the neonate may experience respiratory depression if born following administration of Demerol to the mother in labor.]
Side effects of epidural analgesia include:
fever and hypotension
The use of epidural analgesia is associated with:
an increased rate of operative vaginal birth
[Labor epidurals are associated with longer labors, more operative vaginal births, and more use of synthetic oxytocin. The effect of labor epidurals on cesarean birth rates is conflicting.]
Water immersion during labor is associated with:
a decrease in epidural use
[Water immersion during labor for pain relief is associated with decreased epidural use and reported pain. It is associated with no difference in labor duration, type of birth (i.e., cesarean or operative vaginal birth as compared to spontaneous vaginal birth), five minute Apgar Scores, neonatal infection, and admission to neonatal units. It should be noted that water immersion during labor for pain relief is considered separately from water birth. (Water birth is covered in module 7.)]
A nulliparous person at 40 weeks is in labor. At 3 pm a cervical exam was 6 cm/100%/-1 station. At 7 pm a repeat exam is 7 cm/100%/-1 station. They are not experiencing back pain. The anterior fontanel is palpated in the right anterior portion of the pelvis. Which of the following statements is correct?
Protracted labor and vaginal exam findings suggest a posterior fetal position.
[It can be difficult to diagnose a posterior fetal position because there are no completely reliable signs or symptoms of this position. People may or may not experience back pain with any position, and vaginal exam findings are not always accurate. However, the combination of the vaginal exam findings indicating a posterior position along with the slow labor is suggestive of a posterior position. Further, it should be noted that changes in the position of the laboring person used to facilitate optimal fetal positioning and promote labor progress are not harmful, even if the fetus is not malpositioned.]
