Normal Labor and Delivery (Moulton)

Question 1

Labor is a progressive cervical dilation from regular uterine contractions that occur how often and last how long?

Answer 1

1) every 5 minutes

2) 30-60 seconds

Question 2

False Labor (Braxton-Hicks contractions) is defined as?

Answer 2

Irregular contractions without cervical change

Question 3

What is Anterior Fontanelle shape

What is Posterior Fontanelle Shape

Answer 3

1) Diamond

2) Y/Triangle

Question 4

What is the longest anterior posterior diameter of the head?

Answer 4

Supraoccipitomental

Question 5

What are the 4 pelvic shapes?

What are the Prognosis of each

What position do they come in?

Answer 5

Gynecoid-Good- Occiput Anterior

Anthropoid -Good- Occiput Posterior

Android (male)- Poor- Occiput Posterior

Platypelloid- Poor- Transverse

Question 6

Which pelvis shape is characterized by a much larger anteroposterior than transverse diameter, creates a long narrow oval shape, and has a narrow pubic arch?

Which pelvis shape is characterized by the widest transverse diameter closer to the sacrum, prominent ischial spines, and a narrow pubic arch?

Which pelvis shape is characterized by a short AP and wide transverse diameter, wide bispinous diameter, and a wide suprapubic arch?

Which pelvis shape is characterized by round at the inlet, wide transverse diameter only slightly greater then the anteroposterior diameter, and a wide suprapubic arch (>90 degrees)?

Answer 6

1) Anthropoid
2) Android
3) Platypelloid
4) Gynecoid

Question 7

The diagonal conjugate is approximated by measuring from the inferior portion of what to what?

If the diagonal conjugate is greater than 11.5 cm, then what is adequate?

Answer 7

1) Pubic symphysis to the sacral promontory

2) >11.5 cm, then AP diameter of pelvic inlet is adequate

Question 8

What is the obstetric conjugate?

It is measured by?

Answer 8

1) The narrowest distance the fetal head must pass through during a vaginal delivery
2) Subtracting 2.0 cm from the diagonal conjugate

Question 9

1) Pelvic outlet is assessed by measuring what?

2) What distance between ischial tuberosities is good for transverse diameter?

Answer 9

1) Measuring Ischial tuberosities and Pubic Arch

2) 8.5 cm

Question 10

When assessing the infrapubic angle you want to place thumb next to each inferior pubic ramus and estimate the angle at which they meet, greater than ____ degrees is good.

Answer 10

90

Question 11

1) What is the reference for fetal lie?

2) It determines if the infant is what?

Answer 11

1) Maternal spine to fetus spine

2) Longitudinal, transverse, or oblique

Question 12

The Leopold maneuvers are a series of 4 maneuvers:

Answer 12

Palpate

1) Fundus
2) Spine
3) Suprapubic
4) Cephalic prominence (chin)

FSSC

Question 13

How is Cervical Exam done?

What are the ranges?

Answer 13

1) Dilation (at internal os)
2) Cervical effacement (Thinning of the cervix)
3) Station- Degree of descent (-5 to 5 cm)
4) Consistency and position- to calculate Bishop Score

*DCSC

Question 14

What is the first stage of labor

What is the second stage of labor is from

What is the third stage of labor

What is the fourth stage of labor

Answer 14

1) Onset of true labor to complete cervical dilation
2) Complete cervical dilation to delivery of infant
3) Delivery of infant to delivery of placenta
4) Delivery of placenta to stabilization of patient

Question 15

1) How is Latent phase characterized as?
2) How is Active phase characterized as?
3) When does active phase begin?
4) What stage of labor?

Answer 15

1) Slow cervical dilation
2) Faster dilation
3) when cervix is 6 cm dilated
4) First stage of labor

Question 16

1) The duration of the first stage is typically 6-18 hours and the rate of cervical dilation is 1.2 cm per hour for which types of mothers?
2) The duration is typically 2-10 hours and the rate of cervical dilation is 1.5 cm per hour for which type of mothers?
3) With maternal position in the first stage is recommended if they are lying in bed?

Answer 16

1) Primiparas
2) Multiparas
3) Left Lateral Recumbant

Question 17

If uncomplicated, fetal monitoring every

1) active phase?
2) second stage of labor?

Complicated, Fetal Monitoring every

3) Active Phase?
4) Second Stage?

Answer 17

1) 30 minutes
2) 15 minutes

3) 15 minutes
4) 5 minutes

Question 18

What can be used to monitor uterine activity by allowing you to assess the strength of the contractions?

Answer 18

Internal pressure catheter

Question 19

1) With Vaginal Examinations what do you do during active phase and for how often?
2) What do you record?
3) 4/50/-2 is recorded, what does this mean?

Answer 19

1) Cervical check every 2 hour
2) Dilation, effacement, station
2) 4 cm dilated/ 50% effaced/ -2 cm station

Question 20

SECOND STAGE DURATION

1) The duration of the second stage of labor is about 2 hours for?
2) The duration is about 3 hours for?
3) The duration is about 1 hour for?
4) The duration is also about 2 hours for?

Answer 20

1) Primipara without epidural
2) Primipara with epidural
3) Multipara without epidural
4) Multipara with epidural

Question 21

Cardinal Movements
* What are the steps

__1__ is presenting part at “zero” station.

__2__ is brought about by the force of uterine contractions and maternal valsalva efforts.

__3__ is baby’s chin moves to its chest thus changing the presenting part from occipitofrontal to the smaller suboccipitobregmatic.

__4__ occurs usually at the ischial spines and the fetal head enters pelvis in transverse diameter, rotates so the occiput turns anteriorly or posteriorly toward the pubic symphysis.

__5__ occurs when largest diameter of the fetal head is encircled by the vaginal introitus and station is +5.

__6__ the delivered head now returns to its original position at the time of engagement to align itself with the fetal back and shoulders.

__7__the anterior shoulder then delivers under the pubic symphysis, followed by the posterior shoulder and the remainder of the body.

Answer 21

1) Engagement
2) Descent
3) Flexion
4) Internal rotation
5) Extension
6) External rotation
7) Expulsion

*Every Darn Fool In Egypt Eats Raw Eggs

Question 22

Second Stage management

1) Avoid what position
2) What should mother do with each contraction

Answer 22

1) Supine

2) hold breath and bear down

Question 23

During delivery of the fetus as the perineum becomes flattened by the crowning head a ____ may be warranted (Routinely it is not recommended).

Answer 23

Episiotomy (cut perineum)

Question 24

1) What is modified Ritgen Maneuver used for?

2) How is it done?

Answer 24

1) Delivery of Fetal head

2) Fingers of right hand used to extend head while counterpressure to occiput by left hand

Question 25

1) Once head is delivered, What do you do first?
2) Then what?
3) Why?

Answer 25

1) Suction oral cavity
2) Nares after
3) Clear airway of blood and amniotic fluid

Question 26

During delivery of the fetus, use an index finger to assess for a __1__.

If it is __2__, you can manually reduce over the infant’s head.

If it is __3__, you need to clamp x 2 and cut.

Answer 26

1) Nuchal cord
2) Loose
3) Tight

Question 27

1) During delivery of the fetus, How do you deliver anterior shoulder?
2) How is posterior shoulder delivered?

Answer 27

1) Gentle downward traction on head

2) Elevating Head

Question 28

Episiotomy Indications?

Answer 28

1) Likelihood of laceration

2) Expedite delivery (by enlarging hole)

Question 29

What location of episiotomy is the most commonly performed, causes less postpartum pain, but has a greater risk of extension into third or fourth degree?

What location of episiotomy causes greater blood loss, more difficult to repair, has more postpartum pain, and an increased risk of dyspareunia?

Answer 29

1) Midline episiotomy

2) Mediolateral episiotomy

Question 30

1) First degree perineal laceration?
2) Secondary Degree?

3) Third Degree ?
4) Fourth Degree?

Answer 30

1) Vaginal mucosa and/or perineal skin
2) Extends to muscle
3) Extend to Anal sphincter
4) Extend Rectal mucosa

Question 31

1) What stage of labor does interval between delivery of infant and delivery of placenta occur?
2) What is retained Placenta

Answer 31

1) Third stage

2) Placenta Does not deliver within 30 minutes

Question 32

1) Gush of blood from the vagina
Lengthening of the umbilical cord
Fundus of the uterus rises up
Change in shape of the uterine fundus from discoid to globular are classic signs of?

2) What do you NOT want to do until these classic signs are noted?
3) What happens if you do?

Answer 32

1) Placental separation
2) Pull on cord
3) Uterine inversion

Question 33

1) What stage does Postpartum hemorrhage occur in?

2) What are the causes?

Answer 33

1) Fourth Stage

2) Uterine Atony, Retained Placenta, Unrepaired laceration

Question 34

Goal of ____ is to facilitate the process of cervical softening, thinning and dilating in hopes to reduce the rate of failed inductions.

Answer 34

Cervical Ripening

Question 35

1) What is the process by which labor is brought about by artificial means.
2) What is the artificial stimulation of labor which has already begun

Answer 35

1) Induction of labor

2) Augmentation

Question 36

Abruptio placentae, Chorioamnionitis, Fetal demise, Preeclampsia, eclampsia, Gestational hypertension, and Premature rupture of membranes are all indicated for?

Answer 36

Induction

Question 37

What is contraindicated for the following?

• Unstable fetal presentation
• Acute fetal distress
• Placental previa or vasa previa
• Previous classical cesarean section
• Transfundal uterine surgery

Answer 37

Induction

Question 38

1) What is unfavorable Bishop score?
2) With a Bishop score of what does the probability of vaginal delivery after labor induction is similar to that of spontaneous labor.

Answer 38

1) < 6

2) > 8

Question 39

1) What type of drug is Cervidil (Dinoprostone)?
2) How is it inserted?
3) It is contraindicated in patients with?

Answer 39

1) Prostaglandin E2
2) Vaginally
2) Previous c-sections

Question 40

What type of drug is Cytotec (Misoprostol) which is vaginally or orally inserted?

What downside does this medication have?

It is contraindicated in patients with?

Answer 40

1) Prostaglandin E1
2) Cannot be readily removed if concerns arise
3) Previous c-sections

Question 41

What are the 2 types of mechanical dilators?

Answer 41

Foley Bulb catheter

Laminara Japonicum

Question 42

1) Pitocin is used for what?
2) What is it a version of?
3) What does it cause?
4) What are the side effects?
5) What can it also lead to from it being similar to ADH
6) What is prolonged usage a risk for?

Answer 42

1) Induction and Augmentation
2) Synthetic Oxytocin
3) Myometrial contractions
4) Uterine Tachysystole (high contractions)
5) Water reabsorption
6) Postpartum hemorrhage secondary to Uterine Atony

Question 43

1) What can Regional anesthesia lead to if hypotension occurs?
2) What can stop hypotension if given 30-60 min before anesthesia given?

Answer 43

1) Decreased Uterine Blood flow

2) Hydration (IV bolus of 1000cc LR)

Question 44

1) What levels do Uterine contraction and cervical dilation affect? (Visceral Pain)
2) What does Pudendal Nerve (S2-S4) affect? (somatic pain)
3) Regional Anesthesia is partial to complete loss of pain below what level?

Answer 44

1) T10-T12 through L-1

2) Descent of fetal head
Pressure from pelvic floor, vagina, perineum

3) T8-T10

Question 45

1) Morphine, Fentanyl, Meperidine, and Nalbuphine are more effective in the early first stage of labor as they all have very little efficacy for relief of labor pain because their primary mechanisms of action is?
2) These opioids readily cross the placental barrier which can lead to?
3) What is given if this occurs?
4) What is the most effective form of pain relief and is used by most women in the U.S.

Answer 45

1) Heavy sedation
2) Neonatal respiratory depression
3) Naloxone (opioid antagonist)
4) Epidural

Question 46

What interspace levels are Large bore needle used to locate epidural space between?
*Catheter is then placed over the needle.

Answer 46

1) L2-3
2) L3-4
3) L4-5

Question 47

1) What is contraindicated 12 hours within an epidural?
2) What can help in vaginal delivery for those not using regional anesthesia?

3) What is the most common induction anesthetic agent used?
4) What does it cause?
5) What must it be accompanied by?

Answer 47

1) Heparin
2) Pudendal Block

3) Propofol
4) Loss of maternal consciousness
5) Airway management