Module 7 & 8 Practice Questions Flashcards
The traditional, biomedical definition of second stage labor is:
the time from complete dilatation of the cervix to the birth of the baby.
[Rationale: The biomedical definition of second stage is the stage of fetal expulsion beginning when the cervix is completely dilated and ending when the baby is born. ‘a’ is transition. ‘c’ is basically a physiological definition. ‘d’ includes two contradictory possibilities.]
The alternative or physiological definition of second stage labor is:
the time beginning with involuntary, expulsive efforts to the birth of the baby.
T/F: The Ferguson Reflex results in a surge of oxytocin that enhances contraction strength and pushing effectiveness in second stage labor.
True
T/F: Nearly all women feel the urge to push at about the same time that their cervix reaches complete dilatation.
False
By delaying pushing until a woman has an urge to push when she is complete but does not yet have an urge to push, i.e., allowing her to labor down, all of the following are possible benefits to maternal outcomes EXCEPT:
Less need for amniotomy
An evidence-based technique for perineal management during birth that decreases or minimizes genital tract trauma is:
working with the woman to facilitate a gentle, controlled birth of the baby.
Prenatal perineal massage in the final weeks of pregnancy has been shown to reduce the risk of genital tract trauma in which cohort of birthing women?
Nulliparous
[There is some benefit of perineal massage once or twice weekly during the final weeks of pregnancy for women giving birth for the first time. However, benefit decreases when the frequency of perineal massage is > or equal to 3 times weekly. There is no benefit from prenatal perineal massage for women with a prior vaginal birth.]
Which of the following is a symptom of lidocaine toxicity?
Metallic taste
Active management of the third stage of labor (AMTSL), according to the current ICM/FIGO Joint Statement (2004) includes:
administration of oxytocin right after the baby is born, controlled cord traction, and uterine massage after the placenta is expelled.
[Rationale: The three steps of the current evidence-based ICM/FIGO recommendations are: 1. Administration of a uterotonic medication within one minute of the birth of the baby, after ruling out a multiple gestation. Oxytocin is the preferred medication; 2. Controlled cord traction to assist with placental expulsion; and, 3. Uterine massage immediately after placental expulsion, and then as needed. Cytotec is not recommended in settings where oxytocin is available. The available evidence strongly favors oxytocin for its safety and side effect profile. Immediate clamping and cutting of the umbilical cord is no longer recommended. There is adequate evidence to support delayed clamping and cutting of the cord for neonatal/infant benefit without significant risk, and there is no difference in maternal outcomes between immediate and delayed clamping and cutting of the cord.]
AMTSL has been shown to:
-reduce risk of postpartum hemorrhage.
-result in less overall blood loss.
-result in less anemia.
[Rationale: There is abundant research to support all of these benefits of AMTSL. There is also less need for therapeutic uterotonics with AMTSL than when expectant management is used to manage the third stage of labor.]
Expectant management of third stage labor includes all of the following EXCEPT:
a) watchful waiting.
b) expertise in identifying signs of placental separation.
c) controlled cord traction only with a uterine contraction.
d) spontaneous expulsion of the placenta.
c) controlled cord traction only with a uterine contraction.
The first-line uterotonic medication, with evidence of the best effectiveness and side-effect profile, is:
Pitocin.
[Rationale: Pitocin, Methergine, and Hemabate are all considered evidence-based medications for use with postpartum bleeding. Pitocin is the first-line medication based on its side effect and effectiveness profile. It is the medication recommended by international organizations for use with AMTSL unless it is not available, then Cytotec can be considered an acceptable option. There is evidence that Cytotec is not as effective as Pitocin and that it has a poorer side effect profile. There are also some concerns about its safety. The Cochrane reviewers will not endorse Cytotec for a practice change recommendation with the existing evidence on safety.]
T/F: The research findings on AMTSL provide us with a definitive, evidence-based management protocol for use with all births.
False
According to the current ICM/FIGO AMTSL guidelines, uterine massage is:
the third step of the recommended three steps of AMTSL, after the placenta is expelled.
Clinical signs of placental separation include
a change in the shape of the uterus
[Clinical signs of placental separation include a sudden trickle or gush of blood, lengthening of the umbilical cord, and change in the shape of the uterus as the uterus contracts.]
A laceration involving the vaginal mucosa, posterior fourchette, perineal skin and perineal muscles is of what degree?
Second
With a velamentous cord insertion, the umbilical cord
blood vessels separate and leave the cord prior to the insertion into the surface of the placenta
Water intoxication (from hyponatremia) is a potential side effect of what uterotonic?
Oxytocin
A G3P2, now G3P3, has just given birth to her third child. You have previously discussed her plan for third stage management with her using shared decision-making, and her preference and plan is for expectant management. She had a normal prenatal course without complications and required a brief period of oxytocin augmentation during her second stage of labor when her contractions became less frequent and strong. At this time, you will:
Inform her that you now recommend AMTSL due to her risk factor for excessive bleeding, remind her of the evidence supporting your recommendation, and talk with her about her choice in light of her second stage.
Second stage ends with this event
Birth
The reflux responsible for the urge to push is
ferguson
The Cardinal movement that allows the fetal head to be born is
extension
A second stage defined as beginning with when a woman experiences a reflexive urge tp push
physiological
The active work of second stage increases the need for this, so attend to these maternal self-care measure
Hydration and Nutrition
Monitor this during second stage, as it can interfere with fetal descent
Bladder
A procedure that is warranted with extreme fetal jeopardy
Episiotomy
A type of pushing that can result in decreased fetal oxygenation
coached
The time when the largest diameter of the fetal head remains on the perineum in between contractions
Crowning
Expectant management of third stage consists of:
Watchful waiting, delayed cord clamp/cut, possible non-pharm measures to help placental expulsion (do NOT do cord traction or uterine massage)
Active management consists of:
Pitocin within 1 minute of birth, controlled cord traction, uterine massage after placental expulsion (do NOT give pit before birth or uterine massage before birth of placenta)
For a G2P1, spontaneous labor without interventions or risk for PPH. Should we recommend AMTSL, Expectant, or either?
Either
G3P2, Hx c/s who desires a TOLAC. Should we recommend AMTSL, expectant, or either?
AMTSL
G1P0, H&H at 28w 9.6/29.8, iron deficiency anemia resolved by 36w with PO supplementation and diet changes. Should we recommend AMTSL, Expectant, or either?
Either
