Problems with the Passenger

Question 1

Problems with the Passenger

Answer 1

1. Immature
2. Preterm birth
3. The fetus does not tolerate the stress of labor
4. Umbilical cord prolapse
5. If more than one fetus is present
6. Fetus is malpositioned
7. Fetus is too large for the birth canal

Question 2

Umbilical cord prolapse can be detected by

Answer 2

Fetal monitoring

Question 3

Umbilical cord prolapse may occur with what conditions?

Answer 3

1. Premature rupture of the membranes
2. Fetal presentation other than cephalic
3. Placenta previa
4. Intrauterine tumors preventing the presenting part from engaging
5. A small fetus
6. CPD preventing firm engagement
7. Polyhydramnios
8. Multiple gestation

Question 4

This may occur at any time after the membranes rupture if the presenting fetal part is not fitted firmly into the cervix

Answer 4

Cord prolapse

Question 5

Cord prolapse may occur at any time after the membranes rupture if the presenting fetal part

Answer 5

It is not fitted into the cervix

Question 6

The time allowed for parents to inspect multiple gestation infants depends on two important variables

Answer 6

1. Weight of infant
2. Condition of infant

Question 7

If the infant is preterm, it is usually at risk of what condition?

Answer 7

Hypothermia

Question 8

If the parents worry about the healthcare team to be confused by their infants, review with them the measures used such as

Answer 8

Armbands

Question 9

The infants need careful assessment to determine their

Answer 9

True gestational age and whether a phenomenon such as twin-to-twin transfusion could have occured

Question 10

If parents are unable to inspect their infant immediately after birth, what would be the next course of action?

Answer 10

Be certain and inform them that they have the opportunity to do so as soon as possible

Question 11

Assessment for cord prolapse

Answer 11

1. Always assess fetal heart sounds immediately after rupture of the membranes
2. Cord prolapse be discovered only after the rupture of membranes
3. During a vaginal examination, the cord may be felt as the presenting part or visualized on ultrasound

Question 12

Therapeutic management for Cord prolapse

Answer 12

1. Placing a gloved hand in the vagina and manually elevating the fetal head of the cord
2. Placing the patient in a knee-chest or Trendelenburg position
3. Administer oxygen by face mask (10L)
4. Prescription/administration of tocolytic agents

Question 13

Cord prolapse is always an emergency situation because it leads to

Answer 13

1. Cord compression
2. Decreased oxygenation of the fetus or fetal anoxia

Question 14

Rationale

Placing the patient in a knee-chest or Trendelendburg position

Answer 14

To cause the fetal head to fall back from the cord

Question 15

Rationale

Administration of tocolytic agents as part of the therapeutic management of a cord prolapse

Answer 15

To reduce uterine activity and pressure on the fetus

Question 16

If the cord is exposed fully, what will happen afterwards?

Answer 16

Drying of the cord begins

Question 17

Drying of the cord leads to what condition

Answer 17

Constriction and atrophy of the umbilical vessels

Question 18

True or False: Do not attempt to push any exposed cord back to the vagina because this could add to the compression by causing knotting or kinking

Answer 18

True

Question 19

Rationale

Do not attempt to push any exposed cord back to the vagina

Answer 19

This could add to the compression by causing knotting or kinking

Question 20

Therapeutic management for an exposed umbilical cord

Answer 20

Cover any exposed portion with a sterile saline compress to prevent drying

Question 21

If the cervix is fully dilated at the time of the prolapse, what would be the next course of action?

Answer 21

Deliver the infant quickly - possibly with forceps - to prevent fetal anoxia

Question 22

If dilatation is incomplete, what would be the next course of action?

Answer 22

The birth method of choice is upward pressure on the presenting part

Question 23

Addition of a sterile fluid into the uterus to supplement the amniotic fluid and reduce compression of the cord

Answer 23

Amnioinfusion

Question 24

Rationale of amnioinfusion or addition of a sterile fluid into the uterus

Answer 24

1. Supplement the amniotic fluid
2. Reduce compression of the cord