Problems with the Passageway

Question 1

Locations which problems with the passageway can occur

Answer 1

1. Inlet
2. Midpelvis
3. Outlet

Question 2

Causes of the narrowing of the passageway

Answer 2

1. CPD
2. Disproportion between the size of the fetal head
3. Pelvic diameters

Question 3

It is the narrowing of the anteroposterior diameter of the pelvis to less than 11cm or the transverse diameter to 12cm or less

Answer 3

Inlet contraction

Question 4

Caused by rickets in early life or an inherited small pelvis

Answer 4

Inlet contraction

Question 5

Caused by the lack of Vitamin D or Calcium

Answer 5

Rickets

Question 6

If engagement does not happen in a primigravida, what conditions should be suspected?

Answer 6

1. Fetal abnormality (larger than usual)
2. Pelvic abnormality (smaller than usual)

Question 7

If CPD exists because the fetus may not engage but instead remains “floating”, the possibility of what condition might occur?

Answer 7

Possibility of cord prolapse might occur

Question 8

Narrowing of the transverse diameter, the distance between the ischial tuberosities at the outlet, to less than 11cm

Answer 8

Outlet contraction

Question 9

To determine whether labor will progress normally

Answer 9

Trial labor

Question 10

Trial labor continues as long as what two conditions continues to occur?

Answer 10

1. Decent of the presenting part
2. Dilatation of the cervix

Question 11

What should be monitored during the trial labor?

Answer 11

1. Fetal heart sounds
2. Uterine contractions

Question 12

How frequent to urge the patient to void?

Answer 12

Every 2 hours

Question 13

What is the rationale to urge the patient to void every 2 hours?

Answer 13

To make the urinary bladder empty - allowing the fetal head to use all the space available

Question 14

What conditions to discontinue trial labor?

Answer 14

1. A definite period (6-12hrs), adequate progress in labor cannot be documented
2. Fetal distress occurs anytime

Question 15

Turning of a fetus from a breech position to a cephalic position before birth

Answer 15

External Cephalic Version

Question 16

Contraindications of External Cephalic Version

Answer 16

1. Multiple gestation
2. Severe oligohydramnios
3. Small pelvic diameters
4. Cord that wraps around the fetal neck
5. Unexplained third trimester bleeding - possible placenta previa

Question 17

Rationale of the indication of epidurals

Answer 17

To help discomfort and provide additional muscle relaxation

Question 18

Patients who are Rh negative should receive ______________ after the procedure in case undetected bleeding occurs

Answer 18

Rh immunoglobulin

Question 19

Forceps may be necessary with any of the following conditions

Answer 19

1. A patient is unable to push with contractions in cases where someone has received regional anesthesia or has a spinal cord injury
2. Cessation of decent in the second stage of labor occurs
3. A fetus is in an abnormal position
4. A fetus is in distress but very low in the pelvis

Question 20

What to be mindful of before forceps are applied?

Answer 20

1. Membranes must be ruptured
2. CPD must not be present
3. The cervix must be fully dilated
4. The patient’s bladder must be empty

Question 21

A kind of procedure will be performed if a fetus, positioned far enough down the birth canal

Answer 21

Vacuum Extraction

Question 22

One disadvantage of Vacuum Extraction

Answer 22

More perineal lacerations may occur (over natural birth)

Question 23

Major disadvantage of Vacuum Extraction

Answer 23

1. It will cause a marked caput on the newborn head
2. Tentorial tears from extreme pressure will occur

Question 24

Contraindication of Vacuum Extraction

Answer 24

Preterm infants because of the softness of the preterm skull