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Narm Labor & Birth > theresa maurer > Flashcards

theresa maurer Flashcards

1
Q

When is the first time fetal heart tones are heard by the doppler?

A

10-12 weeks

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2
Q

Molly is newly pregnant. She has two children living at home. A third child died of birth defects at 4 days of age. She has never had an abortion or miscarriage. Which of the following accurately describes her now?

A

Gravida 4 para 3 AB 0

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3
Q

Excessive use of antibiotics may result in a vaginal infection with

A

Candida albicans

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4
Q

study of anatomy

A

the study of the structure and shape of the body and the body parts, and their relationship to one another

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5
Q

study of physiology

A

the study of how the body and its parts work or function

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6
Q

Immediately following fertilization, the fertilized egg is called a

A

zygote

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7
Q

During what period of pregnancy is the baby most susceptible to teratogens (from conception)

A

2-12 weeks

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8
Q

A typical human gestation from conception is:

A

266 days

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9
Q

typical human gestation from LMP

A

280

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10
Q

low lying placenta may result in

A

labor induction

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11
Q

TPAL

A

Term births -Preterm births - Abortions - Living children

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12
Q

FPAL

A

full term, pre-term, aborted, living

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13
Q

fetal presentation

A

presenting part

cephalic, breech, shoulder

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14
Q

cephalic

A

vertex, sinciput, brow, face

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15
Q

attitude characteristic

A

well flexed, extended

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16
Q

straight sinciput with straight attitude aka

A

military attitude

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17
Q

fetal lie

A

relationship of long axis of fetus to long axis of mother

longitudinal, transverse, oblique

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18
Q

position of fetus

A

ROA, LOA, RST…

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19
Q

variety of fetus

A

same arbitrarily chosen point on the fetus in relation to mothers pelvic
anterior
posterior
transverse

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20
Q

vertex

A

head down

most popular is the occipital bone as leading part

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21
Q

breech types

A

frank- legs up near head
complete- both legs crossed
incomplete- one leg crossed
footling- one foot down

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22
Q

complete breech

A

both legs crossed

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23
Q

frank breech

A

legs at or near to head

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24
Q

incomplete

A

one leg crossed

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25
Q

kneeling breech

A

This is a very rare position in which the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees.

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26
Q

ventouse

A

vacuum extraction in 2nd stage of labor alt. to forceps or csection

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27
Q

uterine souffle

A

A blowing sound, synchronous with the cardiac systole of the mother

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28
Q

placental souffle

A

a hissing souffle synchronous with fetal heart sounds, probably from the umbilical cord.

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29
Q

engagement

A

station 0 level of ischial spines

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30
Q

synclitism

A

sagittal sutures is midway between the symphysis pubis and sacral promontory

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31
Q

asynclitism

A

sagittal suture is directly toward the symphysis pubis or or sacral promontory
anterior or posterior

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32
Q

woods maneuver

A

screw maneuver

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33
Q

lightening

A 
two weeks before labor, descent of present part in true pelvis
decrease in dysnpea
increased urination
pelvic pressure
leg cramps 
venous stasis causing edema
position is similar to 8 months
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34
Q

proteinuria

A

1+ 2+ on stick, .1 or higher in urine culture

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35
Q

glucosuria

A

2+ to 4+ glucose, diabetes

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36
Q

supine hypotension

A

when women lay on back it puts pressure on vena cava and thoracic aorta shutting blood flow to heart, fainting

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37
Q

chloasma

A

pregnancy mask, coloration from extra hormones

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38
Q

asepsis

A

no bacteria present

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39
Q

antisepsis

A

the practice of using antiseptics to eliminate the microorganisms that cause disease

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40
Q

sterile

A

free from bacteria or other living microorganisms

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41
Q

sequelae

A

condition that is the consequence of a previous disease or injury

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42
Q

Iatrogenic complication

A

caused by a medication or physician.

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43
Q

Cranial sutures

A

saggital suture, coronal, lambdoidal

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44
Q

Fontanelles

A

ossification is not complete and the sutures not fully formed
anterior - Diamond
posterior-Triangle
“Id rather be holy then have diamonds” 1

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45
Q

bandls right

A

A pathological retraction ring of the uterus is a constriction located at the junction of the thinned lower uterine segment and the thick retracted upper uterine associated with obstructed labor.

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46
Q

contraction

A

muscle shortens and stays short

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47
Q

retraction

A

muscle lengthens

muscles in between ribs pull upward signaling trouble breathing

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48
Q

Leukorrhea

A

a profuse, thin or thick vaginal secretion that begins in the first trimester

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49
Q

what percent of women have PROM?

A

12%

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50
Q

what percent of women start labor in 24 hrs after PROM?

A

80 %

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51
Q

blood show is a sign of labor within

A

24-48 hours

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52
Q

when does an energy spurt happen before labro

A

24-48 hours before

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53
Q

best way to listen to a ctx

A

start midpoint between two ctx listen through to midpoint after the next
listen in 5 second intervals

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54
Q

when do you listen to contractions to establish a baseline

A

in between ctx

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55
Q

1st stage : latent phase

A

start of labor to progressive dilation
3-4 cm
every 10-20 minutes lasting 20 seconds

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56
Q

1st stage : active phase

A

active progression of dilation to complete dilation
ctx every 5-7 minutes lasting 40 secs or every 5 minutes lasting 60 sec 411, 511
3/4 cm to 10 cm

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57
Q

progressive descent occurs in what stages

A

end of active labor and 2nd stage

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58
Q

primigravida entering labor V/E

A

50-60% effaced, 1 cm dilated (paper thin active)

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59
Q

multipara entering labor V/E

A

1-2 cm dilated no effacement

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60
Q

acceleration phase of labor

A

starts at active phase of labor

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61
Q

true labor can be intensified by walking T or F

A

true

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62
Q

walking will calm a false labor T or F

A

true

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63
Q

maximum slope phase of labor

A

stage 1 most rapid dilation from 3/4 cm to 8 cm

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64
Q

decleration phase of labor

A

end of the active phase, transitional phase, ctx 2-3 mintues lasting 60 seconds
8-10cm
constant dilatin, average 3 cm an hour

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65
Q

triple gradient pattern

A

40-50 mmHg at acme and return to rest of 10 mmHg

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66
Q

transition s/s

A

shaking legs, belching, burping, nausea, vomit, restless, cant comprehend directions, decreased modesty, toes curl, severe low back pain

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67
Q

hydrocephaly palpation

A

breech presentation

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68
Q

to determine base FHR listen when?

A

in between ctx

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69
Q

3 phases of uterine ctx

A

increment- longer
acme-strongest
decrement

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70
Q

contractions constrict placenta blood flow T or F

A

true

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71
Q

contractions of muscle fiber

A

muscle fibers contract and shorten an dont return to original lenght, the fundus gets thicker to expel fetus

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72
Q

retraction of uterine fibers

A

lengthen and dont return to original shape, lower segment of uterus, thins and becomes part of upper segment

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73
Q

effacement

A

shortening of cervical length

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74
Q

dilation

A

enlargement of the external os, amniotic fluid hydrostatic pressure as dilating wedge

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75
Q

engagement

A

widest part of the fetal head has passed through the pelvic inlet

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76
Q

station 0

A

ischial spines

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77
Q

widest diameter of fetal head

A

biparietal 9.5 cm

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78
Q

largest diameter of fetal head

A

occipitomental brow presentation 13.5cm

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79
Q

most common diameter presenting

A

suboccipitobregma- vertex presentation 9.5cm

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80
Q

military or siniciput presentation diameter

A

occipitofrontal- 11.5cm

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81
Q

face presenation

A

submentalbregma 9.5 cm

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82
Q

percent of breech presentations

A

3 - 3.5%

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83
Q

% of breech before 32 weeks

A

50%

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84
Q

molding

A

change in the shape of head-bones overriding and overlapping

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85
Q

caput

A

dilating wedge, edemateous swelling CROSSING suture lines

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86
Q

cephalhematoma

A

bleeding beneath periosteam over more than one bone DOES NOT CROSS sutures

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87
Q

FHT eval based on

A

combo of rate and pattern

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88
Q

periodic fetal heart rate

A

changes in FHR associated with uterine contractions

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89
Q

baseline fetal heart rate

A

HR between contractions

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90
Q

FHR 161-180

A

tachycardia

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91
Q

Bradycardia

A

FHR 110-119

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92
Q

normal FHR

A

120-160 bpm

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93
Q

baseline change if

A

must be at new level for at least 10 minutes

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94
Q

marked bradycardia

A

below 100 bpm

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95
Q

abormal FHR

A

no variablity
marked variabilty
brady/tachy
periodic fetal heart rate changes

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96
Q

internal fetal monitor

A

most reliable comprehensive data of all methods

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97
Q

maternal changes stage 1 labor

A 
increase metabolic activity that:
increases temp 1-2 degrees (max at delivery)
increase BP 10-20+/5-10 mmHg
increase respiration- hyper = alkalosis
polyuria- empty every 2 hours
decrease gast motility
increase WBC
decrease blood sugars
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98
Q

short term variability

A

beat to beat

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99
Q

long term variabilty

A

rhythmic waves in cycles - 5 min readings

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100
Q

Friedman

A

acceleration- start of dilation
max slope- 4-8 cm active labor
deceleration- 8-10 cm transition

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101
Q

pulse rate through contaction

A

increment- increase
acme- decrease
decrement- increase

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102
Q

IV indication

A

gravida 5, overdistended uterus, multip, polyhydraminos, SGA, induction, Hx PPM hemorrhage, dehydration, meds
125 cc per hour, or 300cc initial for dehydration then 125 cc per hour

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103
Q

positions for risk of cord prolapse

A

supine, lateral recumbent(left side lying), knee chest

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104
Q

stadol

A

sedating with pain relief, active labor

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105
Q

risk of prolapse cord

A

SGA, polyhydraminos, transverse lie, PROM

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106
Q

demoral

A

pain relief, active labor

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107
Q

nubain

A

pain relief, active labor

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108
Q

phenergan

vistaril

A

atartic, anti anxiety, early and active labor

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109
Q

reasons for enema

A

stim labor, clean field, womens desire

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110
Q

vitals in Active labor frequency

A

FHT - every 30 minutes
BP- every 1 hour
Temp/pulse/resp- every 2 hours
Bladder- void every 2 hours

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111
Q

distention of bladder signs of

A

needing to void, posterior baby

bulge above symphysis pubis

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112
Q

risks of AROM
indications
management

A

inc risk of infection, cord prolapse, cord compression, head compression, limited mobility

indications: active labor, 4-5 cm, cephalic vertex
management: leave fingers in til next ctx to see effect, check for cord prolapse, FHT, get mother standing to apply head

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113
Q

VE indications

A

initial for baseline, verify pushing, after ROM w/suspected cord prolapse, if decels and suspected prolapse

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114
Q

progressive relaxation

A

tighten muscles group let go and relax-promotes sleep

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115
Q

controlled relaxation

A

keep one muscle group relaxed while other group is contracted

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116
Q

what happens between 1st and 2nd stage

A

a lull

  1. lull
  2. bearing down until head does not retract
  3. perineal crown to birth
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117
Q

early decel cause

A

head compression, cord compression

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118
Q

late decel cause

A

uteroplacental deficiency

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119
Q

FHT eval frequency in 2nd stage

A

every 5-15 minutes

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120
Q

position for extreme varicosities

A

dorsal (on back slight knees bent)

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121
Q

mechanisms of labor 8

A

engagement biparietal diameter passes inlet
descent- forces
flexion-meets resistance-cervix, sidewalls, pelvic floor
internal rotation- 45 degrees to anterioposterior position of midplane pelvis-shoulders in oblique
birth of head- by extension curve of carus
restitution-45 degrees right angle to shoulders
external rotation
birth of shoulders

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122
Q

internal rotation 45 degrees to the ______position

A

anterioposterior

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123
Q

birth of the head by______________

A

extension

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124
Q

restitution 45 degrees to the ___________position

A

OA, occiput anterior postion, L or R,

sagittal suture oblique, shoulders other oblique

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125
Q

external rotation 45 degrees to the

A

LOT, ROT position, bisacromial aligns with anteroposterior diameter of outlet

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126
Q

birth of the shoulders by____________

A

curve of carus and lateral flexion

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127
Q

PICA can indicate deficiency in

A

iron

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128
Q

when do braxton hx begin

A

6 weeks gestation

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129
Q

station of a well flexed cephalic baby landmark

A

occipital bone

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130
Q

most positive sign of ROM

A

visualizing amniotic fluid escaping os

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131
Q

majority of progressive descent take place

A

(deceleration phase)end of 1st stage and 2nd stage labor

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132
Q

impending 2nd stage s/s

A

increase bloody show, rectal pressure, bear down, ROM, rectal bulging, expulsive grunt at exhale

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133
Q

most common position at onset of labor

A

LOT

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134
Q

exam ROT and sagittal suture is tilted toward the symphysis pubis

A

posterior asynclitic

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135
Q

normal labor the head usually enters inlet with moderate

A

posterior synclitic

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136
Q

changes in FHR associated with ctx

A

periodic changes

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137
Q

fetal scalp ph for immediate delivery

A

second reading of pH less than < 7.2

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138
Q

no VE following

A

prolonged walk or period in shower

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139
Q

how much water daily in pregnancy

A

2 quarts daily

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140
Q

sims position

A

lie on their left side, left hip

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141
Q

variable decels thought to be from

A

cord compression

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142
Q

innominate bones of pelvis

A

ischium, illeum, pubis

143
Q

attitude

A 
relationship of head to trunk
how flexed or extended compared to body
straight body sinciput
curved body vertex
arched body face
144
Q

The lithotomy position is when the mother

A

flat back in stirrups

145
Q

When performing an emergency episiotomy, the midwife must cut

A

during a contraction as head crowns

146
Q

Respiratory distress in a newborn is evidenced by

A

fever

147
Q

If the client continues to hemorrhage in third stage, the most important thing is to

A

get placenta out

148
Q

If a baby is delivering in face presentation, he must rotate to:

A

mentum anterior position

149
Q

abrupt persistent bradycardia is a sign of

A

uterine rupture

150
Q

VBAC’s at risk for what placenta complication

A

placenta accreta

151
Q

preterm/premature labor how many weeks

A

any labor after 20th weeks before 37 weeks

152
Q

preterm birth accounts for what percent of perinatal deaths

A

70%

153
Q

preterm birth predisposing factors

A

non white, low status, poor nutrition, previous hx, hx of baby less than 2500, 1+ SAB 2nd trimester, multip, drugs, no prenatal care, uterine anomalies, DES, incompetent cervix, UTI, GBS. STD’s, chorioamnionitis, palcenta previa/abrupto, polyhydraminos

154
Q

previous preterm has a % chance of recurring preterm

A

20-40 % chance

155
Q

diagnosis of preterm labor

A

between 20-36 weeks

ROM, ctx 5-8 mins apart, 4 ctx in 20 minutes, 8 ctx in 60 minutes.cervical progressive change, 80% effaced.

156
Q

tocolytics may be used for preterm labor when ?

A

the women is less then 34 weeks

less then 4 cm dilated

157
Q

tocolytics may stall labor for how long

A

24-48 hours or

3-7 days

158
Q

contraindications to tocolytics

A

chorionamnionitis, fetal maturity, fetal distress, cervix more then 5 cm

159
Q

tocolytic agents

A

magnesium sulfate
deta adrenergic
extremely toxic w side affects

160
Q

PROM

A

2- 17% incidence
ferning is from protein in amniotic fluid
if term: 12 hours start induction
if preterm: repeat, weekly GBS screening and 2 x a week BPP and NST

161
Q

FHR in chorioamnionitis

s/s

A

tachy above 160
high WBC
foul, tinged waters
progressing fever

162
Q

febrile morbidity

A

100.4 degrees

163
Q

amnionitis & chorioamnionitis
s/s
treatment

A

amnion-inflammation of the amnion and sac
chorio- inflammation of chorion, amnion and sac
highest risk of developing A or C is PROM over 24 hours
fever, tachycardia maternal and fetal, tender uterus, vag walls hot to touch, foul smell, WBC increased
treatment- IV antibiotics unless delivery is 1-2 hours away, otherwise IV antibiotic after delivery, baby is cultured.

164
Q

infection rate of PROM

A

within 24 hours- 1.6 to 29 %

increases when more then 24 -72 hours

165
Q

management of PROM

A 
assess temp every 4 hours
fhr every 1 hour
no V/E unless prolapse or induction
hydration
color/odor of fluid
166
Q

cesection rate for women at term induced to deliver in 24 hrs from PROM

A

30-50%

167
Q

frank cord prolapse

A

through cervix

168
Q

occult

A

alongside presenting part but not out cervix

169
Q

ROM immediate action

A

FHR, and vag exam to rule out cord prolapse

170
Q

cord prolapse immediate action

A

put whole hand in vag and hold presenting part up off cord
get mom into knee chest- trendleburg
call transfer STAT
FHT
if cord is out wrap with warm, sterile saline
do NOT remove hand until csection

171
Q

fetal sleep cycle average

A

80 minutes

172
Q

fetal distress

A

fetus is intermittently experiencing hypoxemia
definition reserved for hypoxic fetus
intermittent late decels
variable decels with average variability and normal baseline

173
Q

chronic fetal stress

A

secondary to uteroplacenta insufficiency

late decels and prolonged decels

174
Q

acute fetal distress

A

variable decelerations with:
with ctx
cord compression, decreased AFI
rapid descent

175
Q

when fetal distress occurs in 2nd stage management depends on anticipated delivery which should be…and…

A

30 minutes
color of fluid (mec)
fhr (baseline, variability, progressive decels)

176
Q

management of fetal distress

A 
transfer
IV
oxygen
left side lying
FHT 
csection
177
Q

depression of the autonomic nervous system can be identified by what kind of FHR

A 
marked variability or 
absent variability(hypoxia, acidosis)
178
Q

acceleration FHR

A

fetal movement, stimulation, partial cord occlusion,

179
Q

deceleration patterns

A

periodic fetal heart rate changes associated with uterine contractions

180
Q

type of decelerations

A

early, late and intermittent decels

181
Q

early decels

A

head compression 4-7cm -uniform shape-ends when ctx end
not under 100 bpm
normal baseline of 120-160
no intervention

182
Q

late decels

A

uteroplacental insufficiency
uniform shape with ctx
occurs in acme or decrement
intervention

183
Q

causes of uteroplacental insufficiency

A 
fetal anemia Rh sensitized
maternal sickle cell
IUGR, maternal hypertension, 
abnormal placenta, previe, vasa previa, infection
PIH
hypotension 
postmaturity
hypertonic uterus
placental abruption
184
Q

management of late decels

A 
prepare transfer
IV
oxygen
assess length of delivery
correct hypotension, elevate legs
terbutaline to quiet uterus
185
Q

variable decels caused

A

caused by cord compression

186
Q

seriousness of variable decels depends on

A

frequency, depth, rate of return to baseline, effect on baseline, and variability

187
Q

shape of variable decels

A

V, U , W
variable shape
different times in ctx

188
Q

characteristics of variable decels

A

shoulders- small accelerations come before decel and right after decel- reassuring
overshoot-blunt acceleration at end of decel with slow return to baseline- immediate delivery nonreassuring

189
Q

FHR during decels

A

decreases to below 100 and as low as 50-60 bpm

190
Q

management of variable decels

A

change position
VE check for cord prolapse, rapid descent
IV
oxygen

191
Q

prolonged deceleration pattern

A

decels lasting longer then 60-90 seconds

if it does not recover transfer

192
Q

factors of prolonged decelerations

A

cord compression, profound uteroplacental insuff, hypertonic ctx, maternal hypoxia, maternal shock, maternal valsalva, rapid head descent.

193
Q

Valsalva pushing

A

When this technique is used, a woman is instructed to take a deep breath at the beginning of the contraction, to hold her breath and push as long and hard as she can in synchrony with her contractions.
can cause prolonged decels

194
Q

sinusoidal pattern

A 
undulating repetitive uniform fhr equally distributed and below baseline for more then 10 minutes, no relationship to ctx or fetal movement
ominous sign, immediate transfer
Rh sensitizion
fetal anemia
fetal hypoxia
placenta abruption
195
Q

lambda pattern

A

immediate acceleration followed by a decel, benign, risk is confusing with other FHR

196
Q

wandering baseline

A

late development of progression of fetal distress
within in normal 120-160 but NO short term variability
ominous right before fetal demise
immediate delivery

197
Q

CPD body types

A 
shoulders wider than hips, 
short square
short broad hands and feet
history of pelvic injury
spinal deformity
large fetus
malpresentation
malposition
only TRUE test is labor
dysfunctional labor pattern
deep transverse arrest, poor flexed head, caput, asynclitic, molding
198
Q

CPD management of

risks of

A

position change, ROM, walking, IV hydration, increase uterine activity, epidural,
may cause fetal damage, brain damage, death, infection, uterine rupture, maternal death

199
Q

deep transverse arrest
s/s
management

A

platypelloid and android pelvis
sagittal suture of the fetus in transverse diameter
2nd stage hypotonic dysfunction
extendsive molding, caput

leopolds 4th maneuver for presentation
maternal hydration, position change, left side lying, improved ctx, good pushing positions, squat, kneel

200
Q

uterine dysfunction

A

a prolonged stage of labor beyond expected length

201
Q

progression measurements

A

dilation, effacement, descent

efficacy of ctx

202
Q

hypotonic uterine dysfunction

A

follows gradient patter with no pain, or intensity or tone
stalled labor
infrequent short mild ctx
lack of progress in dilation or descent

203
Q

limits of normality of labor

A

primi- latent phase 20 hrs, active-less than 1 cm an hours, second stage- 2 hours
multip- latent 14 hrs active- less than 1.5 cm an hour
second stage 1 hour

204
Q

management of hypotonic

A

environment and stress factors
correct maternal exhaustion, hydration
fears, concerns, walking, bath, enema(improves 1 hrs)
ROM-(effective if ctx increase within 2 hours)
nipple stim
pitocin
epidural

205
Q

hypertonic uterine dysfunction

A

distorted gradient pattern, midpoint of uterus contracts most, exhaustion!, cause uteroplacental problems leading to fetal problems
occurs in primips, latent phase, freq irregular ctx, lack of progress.
slow ctx, with induced rest period, terbutaline

206
Q

uterine rupture
predisposed risks
% of mortality
s/s

A

uterine surger of fundus or corpus, classical cesarean, removal of fibroids, too much pitocin,
5% maternal mortality, 50% fetal mortality
s/s cry out, sharp shooting pain, sudden cessatoin of uterine ctx, slight bleed or hemorrhage
fetus outside uterus, dramatic fetal position change, head unengages, parts easily palpated, violent movement to cessation of fhr.
shock

207
Q

shock

s/s

A

elevated pulse, rapid, thready, hypotension, pallor, cold clammy, short breath, restless, visual disturbance

208
Q

quiet uterine rupture

A

hematuria, tender ab, pain, hypotonic, lack of progress, faint, bledding, rapid pulse

209
Q

uterine rupture management

A

IV 16 gauge two routes-electrolytes (ringers), blood transfusion
oxygen
immediate surgery, hysterectomy
aortic compression and pitocin

210
Q

diagnostic of shoulder dystocia

A

anterior shoulder wedge above symphysis pubis
posterior shoulder jammed at sacral promontory or jammed on sacrum.
key to defining is anterior shoulder

211
Q

fosters shoulder dystocia

A

if shoulders attempt to enter the true pelvis with shoulders in anteroposterior of the pelvic inlet instead of the oblique diameter which is larger then the AP diameter in the inlet

212
Q

the oblique diameter is the roomiest diameter in the outlet.

A

true

213
Q

the anterior posterior diameter is roomiest in the pelvic inlet

A

true

214
Q

baby usually enters the inlet in ROT LOT position then turns to oblique in true pelvis/outlet

A

true

215
Q

differential diagnosis of shoulder dystocia

A

true, snug shoulder, or bed dystocia

216
Q

turtle sign

A

retraction of the head snug on perineum

217
Q

exaggerated lithotomy

A

legs elevated and knees drastically bent with mom on her back

218
Q

snug shoulders

A 
slow to birth head, no turtle sign, restitution present, external rotation present,
make sure shoulders are oblique
light suprapubic pressure
ex lithotomy position
hands and knees
219
Q

fowlers postion

A

propped upright lying in bed

220
Q

bed dystocia

A

baby being born down
soft bed
elevated hips, reduce upright angle, bring buttocks to edge of bed, hands and knees

221
Q

erbs palsy

A

brachialplexus damage from delivery of SD

222
Q

Shoulder dystocia incidence

A

1% .1-.6%

223
Q

shoulder dystocia increases when what is present

A

increased fetal weight, prolonged 2nd stage, midpelvic delivery (forcepts, venthouse extract)

224
Q

delivery times of shoulder dystocia

A

3 minutes best outcome

5 minutes to 10 depending how compromised

225
Q

management of shoulder dystocia

A

have someone call for immed transfer
request full newborn resus
request immediaton ppm hemorrhage support

tell the mother NOT to push!
McRoberts maneuver
rotate shoulders to oblique with 2 hands on both sides
suprapubic pressure
— 45 SECONDS TO
catheterize, episotomy,
VE- short cord, enlarged fetal ab, twins, bandl ring,
Attempts-
Woods Corkscrew- 180
Deliver posterior arm
Suprapubic pressure and downward outward
pressure on head
still no delivery- rotate 180 degrees again
NO delivery
break clavicle
Zavanelli Maneuver- replace head!- csection

snug shoulders= side lying, hands and knees to deliver posterior arm

226
Q

McRoberts

A

mother on back, knees to chest, close together widens the outlet, pushes pubis back and horizontal to free anterior shoulder, straightens sacrum

227
Q

Woods corkscrew (Rubin)

A

degrees two hands, only back up. clockwise. hands on back pushing forward, hand on chest pushing back toward posterior shoulder

posterior shoulder substituted for anterior shoulder, baby rotated, 180 degrees
not delivered go counter clockwise 180 degrees

228
Q

Delivery of posterior arm

A

find arm, if extended press cubital space to cause flexion

if extended and jammed splint lower arm and sweep across the babys abdomen, grasp hand, deliver arm

229
Q

flip FLOP Gaskin Maneuver

A

Flip into hands and knees knees in, Lift leg to running start, rotate to Oblique, remove posterior arm

230
Q

Face presentation

A

occipital bone prominent! head feels large
no fontanelles and face
anterior fontanelle and face

231
Q

brow presentation VE landmarks

A

feel brow only and maybe anterior fontanelle

232
Q

movements of face presentation and delivery

A

Mentum leads the way!
LOP or ROP converts to RMA or LMA as it deflexes
70% enter true pelvis as MA or MT
30% enage as MP
Mentum in posterior CANNOT be delivered
Mentum in anterior can be delivered with extension and flexion of the birth of the head

233
Q

before delivery of breech

A 
complete dilation
empty bladder
effective pushing
prep for resus
position mom at edge of bed
hands off until umbilicus
234
Q

Pinard Maneuver for breech

A

follow posterior thigh
press on in the popliteal fossa causing leg to flex at knee
draw leg down sweeping across ab for delivery

235
Q

% of Frank breech

A

70 %

236
Q

movements of breach delivering head

A

head HAS to be in occiput anterior to deliver
keep head flexed-supra pubic pressure or Smellie Veit manuever
apply downward outward traction on body until occiput
the upward traction to deliver chin

237
Q

Twins

A 
deliver baby as presentation and position
quickly clamp and cut cord
determine presentation of 2nd baby
extreme FHR, signs of bleeding
optimal time for 2nd is 3-15 minutes
deliver 2nd baby before placenta separates
rule out cord prolapse
ROM with no pressure from ctx or fundal
maternal pushing

Hemorrhage likely

238
Q

monozygotic twins

A

one placenta, one chorion and two amnions

239
Q

3rd Stage of Labor - 2 parts

A

first phase- placental separation

2nd phase- placenta expulsion

240
Q

retroplacental hematoma

A

forms behind placenta when uterine size decreases along with placenta site

241
Q

placental separation

A

happens as result of decrease in size of uterine cavity

242
Q

signs of placental separation

A

sudden trickle
cord lengthens
discoid to globular shape uterus
uterus displaced upward

243
Q

schultz mechanism

A

separations begins central

fetal side up, majority of bleeding is not seen until after delivery because of inverted placenta

244
Q

duncan

A

eparations begins margin
blood escapes between membranes
maternal side up

245
Q

mismanagment of 3rd stages is biggest cause of hemorrhage

A

true

246
Q

management of 3rd stage

A

evaluate progress of labor and mothers condition
guard uterus so not to massage
do not massage before placenta separation
do not pull cord before separation
do not attempt delivery before complete separation

collect cord blood-

247
Q

Brandt Andrews

A

to check placenta separation
hold cord taut with other hand put fingers close together and push straight down into low ab of mother just about pubis sym,
if cord recedes= not separated
if cord elongates spearated

OR follow cord with hand to placenta, if it extends into cervix it is not separated, if it is at external os or upper vault it is separated

248
Q

facilitating placenta birth

A

place one hand palm surface on uterus above sym pubis and press down and up towards umbilcus check it is contracted
exert cord traction
ask mom to push
follow carus downward and upward

249
Q

never exert cord traction if uterus is not contracted

A

true

250
Q

methergine IM can be given to a mother PPM

A

false

251
Q

retained placenta definition

A

not separated and no visible bleeding

not delivered after 30 minutes

252
Q

3rd stage placenta timing

A

average 5-10 minutes, normal for longer

253
Q

gestational age and placenta separation

A

lower gestational ages longer 3rd stage

most preterm delivery= manual removal

254
Q

management of retained placenta

A

baby to breast, nipple stim, squatting, privacy for oxytocin effects, empty bladder
intraumbilical oxytocin injection with solution of 10 IU diluted with 20cc of normal saline

255
Q

third stage hemorrhage

A 
from partially separated placenta
call for transfer
thoroughly massage- only with hemorrhage cause by non separation
uterine ctx combined with cord contraction usually releases
IV 
position for shock- check pulse and BP
catheterize
10 IU of Pitocin
256
Q

Pitocin causes

A

intermittent contractions, upper segment

257
Q

methergine

A

sustained contraction, lower segment

258
Q

placenta accreta

A

abnormal or partial or total adherence of the placenta to uterin wall. adhered to myometrium with little to no decidua in between.
definitive diagnosis- microscopic

259
Q

placenta increta

A

chorionic villi goes farther than myometrium to uterine wall

260
Q

placenta precreta

A

chorionic vill go through all the way to the uterine wall and to the serosa layer

261
Q

placenta acreta increased incidence with

A

placenta accreta, previa, previous csection, or unexplained elevated MSAFP

262
Q

second stage is known as

A

expulsion stage

263
Q

average length of second stage for primip according to Friedmans curve

A

1 hour

264
Q

which cephalic presentations means that the largest diameter will be presenting

A

brow

265
Q

which mechanism occurs without

A

descent

266
Q

external rotation accomplishes what?

A

brings the bisacromial diameter of the fetus into alignment with the anteroposterior diameter of the pelvic outlet

267
Q

internal rotation accomplishes what

A

brings the anteoposterior fetal head into alignment with the anteroposterior diameter of maternal pelvis

268
Q

if the baby enters in the ROP position how many degrees does it have to rotate for internal rotation to be occiput anterior?

A

135 degrees

269
Q

generally an accepted frequency of blood pressure checks in 2nd labor is

A

every 15 minutes

270
Q

lithotomy for delivery is contraindicated for which condition

A

varicositites

271
Q

Ritgen maneuver

A

to control fetal head at birth

272
Q

the best gauge for the perineal body

A

22 gauge

273
Q

primary disadvantage of local lidocain

A

distorts local tissue

274
Q

Which one of the following is the most important nutrient of the pregnant and lactating woman by helping to build strong muscles, adequate blood volume, and healthy skin?uter

A

protein

275
Q

A rubella titer of <1:10 indicates:

A

non immunity

276
Q

What is the most frequent reason for seizures in the neonatal period?

A

hypoxic-ischemic encephalopathy

277
Q

Which of the following findings of fetal heart assessment is most ominous

A

repeated late decelerations with loss of short-term fetal heart variability

278
Q

The basic shape of the android pelvis is:

A

heart

279
Q

uterine atony is the major cause of immediate ppm hemorrhage

A

true

280
Q

immediate ppm size of uterus

A

2/3 3/4 between pubis and umbilicus

281
Q

uterus above the umbilicus

A

clots need to be expelled

282
Q

above umbilicus and to one side after immediate ppm

A

full bladder

283
Q

hard to pee after birth

A

trauma caused by pressure and compression on bladder and urethra

284
Q

vital signs after birth

A

every 15 minutes or more until stable at prelabor levels
BP=- prelabor
Temp-slightly elevated
pulse- prelabor

285
Q

average blood loss of vag delivery

A

500ml

286
Q

average blood loss of csection

A

1000ml

287
Q

PPM hemorrage definition

A

500ml +

288
Q

80-90% of immediate PPM hemorrhage cause

A

uterine atony from incomplete placenta

289
Q

80-90% of immediate PPM hemorrhage cause

A

uterine atony from incomplete placenta
cervical lacerations
vag perineum lacerations

290
Q

methergine

A

ergot prep of methylergonovine
tetanic sustained ctx
increase in blood pressure -vaso constrict peripheral
acts directly on myometrium

0.2 mg oral, 0.2 injection
repeat in 2-4 hours if needed

291
Q

pitocin

A

synthetic oxytocin no inc in blood pressure IM

10 USP units

292
Q

hembate

A

contracts smooth muscle of uterus and other parts of body-increasesBP
contraindicated for PID, asthma, cardiac,hepatic disease
may work if others havent

293
Q

before 1900 what percent of women gave birth in hospital?

A

5%

294
Q

Postpartum assessments after leaving

A

24hours, check pediatrician appt, 2 weeks, 6 weeks

295
Q

60-70% women will give vag birth after cesection and or CPD diagnosis

A

true

296
Q

The cord is wrapped around the baby’s neck approximately 1 out of every 3 births

A

true

297
Q

A respiratory rate consistently higher than 60 breathes per minute wth or without flaring grunting or retractions is abormal at 2 hours of life

A

true

298
Q

clamping the cord or (dave clarke) :) physiological occlusion of the cord shuts down the low pressure system, the newborn circ is now freestandingand is a….

A

closed, high pressure system, with a rise in resistance. The foreman ovale shuts ductus arteriosus shuts, blood now goes to the lungs and travels to all tissues

299
Q

fetal circluation is defined as a …..

A

low pressure system

300
Q

thermoregulation in a newborn is not completely stable until?

A

2 days

subcutaneous fat helps insulate

301
Q

neonate generates heat 3 ways

A

shivering, voluntary muscle activity, non shivering thermogenesis

302
Q

non shivering thermogenesis

A

utilizing brown fat for heat production

303
Q

brown fat energy resource

A

glucose and glycogen help cells produce energy that converts fat into heat

304
Q

hypoglycemia thermoregulation

A

doesnt happen because of inadequate glucose to convert fat into heat

305
Q

heat loss in newborns, sequelae

A

hypoglycemia, hypoxia, acidosis

306
Q

normla newborn temp

A

97.7-99.5

307
Q

glucose levels for newborn

A

60-70 mgdL

from 4-72 hours

308
Q

signs of hypoglycemia in newborn

A

jittery, apnea, cyanosis, weak cry, lethargy, limp, not feeding

309
Q

low glucose blood level

A

< 40-45 and should be followed up with blood draw check

310
Q

rbc lifespan of newborn

A

8o days

311
Q

6% of newborns will need some form of resuscitation

A

true

312
Q

asphyxia the most common reason for resus

A

true

313
Q

adequate ventilation is the most important part of resuscitation of the newborn

A

true

314
Q

ABC of resuscitation

A

Airway, Breathing, Circulations

315
Q

common reasons for resuscitation

A

TAMM

trauma, asphyxia, medications, malformations

316
Q

atleast 30 seconds of effective PPV is given before chest compressions

A

true

317
Q

heart rate above 100 bpm

A

no PPV

318
Q

heart rate below 100 bpm

A

PPV

319
Q

gasping with labored breather or lack of

A

PPV

320
Q

compressions are postitioned where on the newborn

A

Xiphoid

321
Q

PPV count

A

breath, 2, 3 breath 2, 3

assess HR every 15 seconds

322
Q

chest compressions

A

90 compressions + 30 PPV += 120 events
90 compressions per minute
one and two and three and BREATHE AND one and two and three and BREATHE AND
3:1

323
Q

reassess after 60 seconds of effective compressions to check HR

A

true! dont pause

324
Q

stop chest compressions when HR is 60pm or above and continue PPV

A

true

325
Q

ET tube

A

3.5-4 mm, 13 inches long

326
Q

% of babies that pass meconium before birth

A

10-30%

327
Q

healthy newborns spend 60% time sleeping

A

true

328
Q

healthy newborns gain 1 oz a day and 1 inch per motnh

A

true

329
Q

breastfed babies may gain less than 1 oz a day

A

true

330
Q

during the first 3-5 days newborns may lose 5-10% of their birth weight

A

true

331
Q

By 10 days after birth the baby should be atleast at birth weight

A

true

332
Q

physiological jaundice

A

not in 24 hours
seen 3-4 days at peak at 13 mg
not seen after 10 days

333
Q

pathological jaundice

A

visible in first 24 hours
rises quickly > 13 mgdL
visible after 7 days

334
Q

tachynpea

A

> 60 respirations per min
nasal flare
retraction

335
Q

respiratory disease

A

mec aspiration, pneumonia, pneumothorax, tachypnea

336
Q

signs of mec aspiration

A

uneven breath sound, barrel chest, rales cyanosis,

337
Q

TTN transient Tachy newborn

A

inadequate fluid lung absorption 48-72 hours

rales, tachy, nasal flare, intercostal retract

338
Q

late onset bacterial infection

A

after a few days, problems sucking, lethary, color apnea, abnormal temps

339
Q

most common sign of neurological disease

A

seizure

340
Q

hernias

A

unilateral, decreased left side breath sounds, heart sounds on right, resp distress

341
Q

IDM infants of Diabetic Mothers

A

increased birth weight, hypoglycemia, jitters, early jaundice, resp distress

342
Q

maternal ppm pulse rate above 100 bpm

A

abnormal

343
Q

postpartum blues occur

A

3- 5 days ppm,

344
Q

B12 deficiency in what diet

A

vegetarian

345
Q

peurperal morbidity

A

100.4 temp in first 10 days or 24 hours

346
Q

endometritis diagnosis

A

urine and lochia cultures

347
Q

postpartum depression

A

can start within a year after birth

348
Q

Placenta succenturiate

A

lobes extending from main area of placenta

349
Q

Placenta circumvallata

A

a ring from amnion and chorion around placenta

350
Q

battledore

A

cord insertion on margin

351
Q

velamentous

A

blood vessels separate and leave the cord

352
Q

vasa previa

A

unprotected blood vessels covered only covered with amnion and chorion

353
Q

1/3 rd of babies born with one um artery have malformation

A

true

354
Q

largest muscle of pelvic floor

A

levator ani

Narm Labor & Birth (1 decks)

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