Unit 3 Module 4 Labor A&A (Exam 3) Flashcards
..are we already on Exam 3?
Yes.
Now remember to drink water and everything is going to be ok.
don’t tell me what to do
What fetal position is associated with a more difficult delivery?
A. Occiput Anterior
B. Occiput Posterior
C. Occiput Transverse
D. Occiput Superior
B. Occiput Posterior
The back of the baby’s head is facing the spine aka “sunny side up”
slide 3
Which of the following is the preferred fetal position for delivery?
A. Occiput Superior
B. Occiput Posterior
C. Occiput Anterior
D. Occiput Transverse
C. Occiput Anterior
The back of the baby’s head is facing the anterior abdomen
Slide 3
AROM is best defined as:
A. Amniotic rupture of muscle
B. Artificial rupture of membranes
C. Acute rupture of membranes
D. Abnormal rupture of membranes
B. Artificial rupture of membranes
“Amniotomy”
Slide 3
What does the acronym SROM stand for?
A. Surgical rupture of membranes
B. Scheduled rupture of membranes
C. Sudden release of mucus plug
D. Spontaneous rupture of membranes
D. Spontaneous rupture of membranes
Slide 3
New Terminology Matching
Example: G2 P0101
Gravida (pregnancies) and then the numbers after the Para you have TPAL
A → 2 Term >37wks
B → 1 Preterm <37wks
C → 3 Abortions (Miscarriage or other loss)
D → 4 Living Children
Therefore a G2 P0101 = G2 pregnancies, P = 0 term births, 1 preterm, 0 abortions and 1 living child
Slide 4
What does G4 P2102 indicate?
A. 4 pregnancies, 2 term births, 1 preterm, 0 abortions, 2 living children
B. 4 pregnancies, 2 term births, 1 abortion, 0 preterm, 2 living children
C. 4 pregnancies, 1 term birth, 2 preterm, 0 abortions, 2 living children
A. 4 pregnancies, 2 term births, 1 preterm, 0 abortions, 2 living children
Gravida, Para = (Term, Preterm, Abortions, Living)
slide 4
Which of the following is a function of intact amniotic membranes?
A. Stimulates uterine contractions
B. Allows oxygen exchange to the fetus
C. Prevents maternal weight gain
D. Protects uterine contents from bacteria
D. Protects uterine contents from bacteria
Slide 5
What is one major risk if the amniotic sac remains ruptured for more than 12 hours?
A. Chorioamnionitis
B. Protection of the fetus
C. Normal birth
D. OP presentation of fetus
A. Chorioamnionitis
slide 5
What is the typical duration of the first stage of labor for a primiparous patient?
A. 2–4 hours
B. 5–8 hours
C. 8–12 hours
D. 12–16 hours
C. 8–12 hours
Slide 6
What is the typical duration of the first stage of labor for a multiparous patient?
A. 2–4 hours
B. 5–8 hours
C. 8–12 hours
D. 10–14 hours
B. 5–8 hours
slide 6
First stage - Latent phase
Which of the following statements is TRUE regarding the latent phase of labor?
A. It begins after the cervix is fully dilated
B. It includes rapid fetal descent and minor dilation
C. It involves minor cervical dilation and effacement
D. It involves effacement and rapid fetal dscent
C. It involves minor cervical dilation and effacement
slide 6
Which of the following best describes cervical dilation during the first stage - latent phase of labor?
A. 0–1 cm
B. 2–4 cm
C. 5–7 cm
D. 8–10 cm
B. 2–4 cm
slide 6
In the first stage of labor, the latent phase is characterized by:
Select 2
A. Contractions every 8-10min
B. Contraction duration of 30–40 seconds
C. Cervical dilation from 4 to 7 cm
D. Contraction duration of 30-60 seconds
E. Contractions every 5-7min
B. Contractions lasting 30–40 seconds
E. Contractions every 5-7min
Slide 6
First Stage - Active Phase
What cervical dilation range defines the active phase of labor?
A. 0–2 cm
B. 2–4 cm
C. 4–6 cm
D. Up to 10 cm
D. Up to 10 cm (complete)
Cervical dilation ‘ramps up’
slide 7
Which of the following contraction patterns is consistent with the active phase?
A. Every 10–15 minutes, lasting 20 seconds
B. Every 5–7 minutes, lasting 30–40 seconds
C. Every 2–5 minutes, lasting 50–70 seconds
D. Every 60seconds, lasting 2 minutes
C. Every 2–5 minutes, lasting 50–70 seconds
slide 7
Second stage
What is the typical duration range of the second stage of labor?
A. 5–60 minutes
B. 15–120 minutes
C. 2–6 hours
D. 30–180 minutes
B. 15–120 minutes
Slide 8
Which of the following marks the beginning of the second stage of labor?
A. Delivery of the placenta
B. Cervical dilation of 4 cm
C. Full cervical dilation to 10 cm
D. Rupture of membranes
C. Full cervical dilation to 10 cm
Slide 8
During the second stage of labor, how often do contractions typically occur and how long do they last?
A. Every 5.5–7 minutes, lasting 30–40 seconds
B. Every 3–4.5 minutes, lasting 40–60 seconds
C. Every 2–3.5 minutes, lasting 50–70 seconds
D. Every 1.5–2 minutes, lasting 60–90 seconds
D. Every 1.5–2 minutes, lasting 60–90 seconds
Slide 8
Which of the following occurs during the second stage of labor?
A. Cervical effacement
B. Fetal descent
C. Formation of the mucus plug
D. Placental separation
B. Fetal descent through the birth canal
Ace Ventura pet detective :)
Slide 8
The second stage of labor ends with:
A. Full cervical dilation
B. Expulsion of the placenta
C. Delivery of the fetus
D. Onset of active labor
C. Delivery of the fetus
Slide 8
When is the second stage of labor considered prolonged?
A. If it lasts longer than 1-2 hour
B. If it lasts longer than 2-3 hours
C. If it lasts longer than 3–4 hours
D. If it lasts longer than 5-6 hours
C. If it lasts longer than 3–4 hours
Slide 9
Which of the following are risks associated with a prolonged second stage of labor?
Select 2
A. Cephalopelvic disproportion
B. Postpartum hemorrhage
C. Elevated blood glucose
D. Polyhydramnios
E. Hypocalcemia
A. Cephalopelvic disproportion
B. Postpartum hemorrhage
Slide 9
Which fetal or neonatal outcomes are possible with a prolonged second stage of labor?
Select 3
A. NICU admission
B. Neonatal hypoglycemia
C. Severe umbilical cord compression
D. Polycythemia
E. Maternal trauma
A. NICU admission
C. Severe umbilical cord compression
E. Maternal trauma (physical & emotiona)
Slide 9
Which of the following are increased risks due to a prolonged second stage?
Select 2
A. Uterine fibroids
B. Increased risk for infection
C. Ovarian cyst rupture
D. Retained placenta
E. Fetal trauma
B. Increased risk for infection - d/t aminiotic sac rupture for long time - chorio
E. Fetal trauma
Slide 9
Third stage
When does the third stage of labor begin?
A. With the onset of active labor
B. With full cervical dilation
C. After delivery of the placenta
D. After delivery of the baby
D. After delivery of the baby
Slide 10
What event marks the end of the third stage of labor?
A. Delivery of the fetus
B. Delivery of the placenta
C. Uterine involution
D. Cord clamping
B. Delivery of the placenta
Slide 10
The third stage of labor is considered prolonged if it lasts longer than:
A. 10 minutes
B. 20 minutes
C. 30 minutes
D. 60 minutes
C. 30 minutes
Slide 10
Fourth Stage
True or False
The fourth stage is considered the 1st hour postpartum
True
Slide 11
The fourth stage of labor is the time of highest risk for _____.
A. Umbilical cord prolapse
B. Uterine rupture
C. Uterine atony
D. Cervical insufficiency
C. Uterine atony
Slide 11
Which of the following is the primary clinical concern during the fourth stage of labor?
A. Postpartum hemorrhage
B. Hypertension
C. Fetal distress
D. Premature rupture of membranes
A. Postpartum hemorrhage (PPH)
Especially if their 2nd stage of labor has been prolonged
Slide 11
Which of the following best describes labor pain?
A. Predictable and mild
B. Uniform and easily managed
C. Caused only by fetal distress
D. Variable and complex
D. Variable and complex
slide 13
Which factors can affect the perception and intensity of labor pain?
Select 3
A. Genetic influence
B. Natural vs. induced labor
C. Amniotic fluid index
D. Fetal weight percentile
E. Pelvic size and shape
A. Genetic influence
B. Natural vs. induced labor (augmented with pitocin)
E. Pelvic size and shape
Slide 13
Which of the following are TRUE statements about labor pain?
Select 2
A. It is always mild during natural labor
B. It is influenced by fetal presentation
C. Women rarely report pain during pushing
D. Severe during contractions & pushing
E. It is more intense with a smaller pelvis
B. It is influenced by fetal presentation
D. Severe during contractions & pushing
slide 13
Labor pain: Stage 1
During the first stage of labor, _______ are stimulated due to _______ of the lower uterine segment and cervix.
A. Baroreceptors; pressure and stretching
B. Mechanoreceptors; stretching and distention
C. Chemoreceptors; inflammation and distention
D. Mechanoreceptors; pressure and temperature
B. Mechanoreceptors; stretching and distention
slide 15
What type of pain is experienced during the first stage of labor?
A. Somatic pain
B. Neuropathic pain
C. Sharp localized pain
D. Visceral pain
D. Visceral pain
“diffuse- not specific”
Slide 15
Which characteristics describe the nerve fibers involved in transmitting the first stage labor pain?
Select 2
A. Unmyelinated
B. Myelinated
C. A-delta fibers
D. C fibers
E. Large-diameter sensory fibers
A. Unmyelinated
D. C fibers
Small
Slide 15
Pain signals from the first stage of labor enter the spinal cord at levels _____.
A. T4–T6
B. L3–L5
C. T10–L1
D. S2–S4
C. T10–L1
slide 15
What is one reason why visceral pain from labor can be difficult to treat with opioids?
A. It is transmitted through thick, myelinated nerves
B. It is not mediated by neural pathways
C. It is hard to localize
D. It does not activate mechanoreceptors
C. It is hard to localize
“could be from the back, sacrum, abdomen”
Slide 16
Pain during the latent phase of labor is primarily carried through spinal levels _______, while the active phase is associated with _______.
A. T10–12; T12–L1
B. T6–T8; L1–L3
C. T12–L1; S1–S3
D. T4–T6; L3–L5
A. T10–12; T12–L1
Slide 16
Pain from the first stage of labor can be challenging to treat, but may respond to _______ of peripheral __________.
A. NSAIDs; afferents
B. Opioids; afferents
C. Corticosteroids; efferents
D. Antiemetics; efferents
B. Opioids; afferents
Slide 16
Labor pain: Stage 2
Which type of pain becomes more prominent during the second stage of labor?
A. Visceral pain
B. Neuropathic pain
C. Somatic pain
D. Referred pain
C. Somatic pain
Still have visceral pain as contractions continue
Slide 19
Somatic pain during the second stage of labor is transmitted by _______ fibers, which are _______.
A. C fibers; unmyelinated
B. B fibers; sympathetic
C. A-beta fibers; unmyelinated
D. A-delta fibers; myelinated
D. A-delta fibers; myelinated
Slide 19
Which nerve is primarily responsible for transmitting second stage labor pain?
A. Sciatic nerve
B. Pudendal nerve
C. Femoral nerve
D. Ilioinguinal nerve
B. Pudendal nerve
Slide 19
Somatic labor pain in the second stage is generally described as:
A. Diffuse and aching
B. Dull and poorly localized
C. Sharp and easily localized
D. Burning and radiating
C. Sharp and easily localized
Slide 19
Which factors contribute to second-stage somatic pain?
select 2
A. Compression of perineal structures
B. Cervical dilation
C. Stretching of the pelvis
D. Uterine involution
E. Rupture of membranes
A. Compression of perineal structures
C. Stretching of the pelvis
Slide 19
Second-stage pain travels through spinal segments from _______ to _______, reflecting sacral nerve involvement.
A. T10 to L1
B. T12 to S4
C. L3 to S1
D. T6 to L2
B. T12 to S4
Sacral dermatomes
Slide 19
Labor pain management
Which of the following describe the role of a doula?
Select 3
A. Provides emotional support
B. Administers IV fluids
C. Offers physical comfort measures
D. Performs vaginal exams
E. Serves as an advocate for the patient
A. Provides emotional support
C. Offers physical comfort measures
E. Serves as an advocate for the patient
Slide 22
What is a key difference between a doula and a nurse?
A. Doulas perform deliveries
B. Doulas are typically non-medical support persons
C. Doulas administer medications
D. Doulas assist only in emergency care
B. Doulas are typically non-medical support persons
They do not perform deliveries
Slide 22
Which of the following are considered complementary therapies for labor pain?
Select 2
A. Hypnosis
B. Amniotomy
C. IV narcotics
D. Aromatherapy
E. Spinal anesthesia
A. Hypnosis
D. Aromatherapy
Slide 23
Which complementary approaches may be used for emotional and physical support during labor?
A. Continuous fetal monitoring
B. Music
C. Foley catheter insertion
D. Fundal massage
E. Acupressure
B. Music
E. Acupressure
..one of my friends watched Bob Ross painting videos on Youtube during her labor..
Slide 23
Complementary therapies such as _______ and _______ may help reduce anxiety and promote comfort during labor.
A. Pitocin; IV fluids
B. Oxygen; fundal pressure
C. Antibiotics; Foley catheter
D. Reflexology; massage
D. Reflexology; massage
Slide 23
Intradermal sterile water injections are a form of _______, which can trigger natural _______ release.
A. Massage; serotonin
B. Noxious stimulation; endorphin
C. Heat therapy; cortisol
D. Reflexology; dopamine
B. Noxious stimulation; endorphin
Slide 24
Which of the following are effective non-pharmacologic strategies for managing back pain in labor?
Select 3
A. Counterpressure
B. Stadol
C. Peanut ball
D. Epidural anesthesia
E. Supine positioning
F. Swaying
A. Counterpressure
C. Peanut ball
F. Swaying
Position changes
Slide 24
Which theory explains why techniques like squeezing a comb may reduce labor pain?
A. Gate control theory
B. Inflammatory theory
C. Central sensitization theory
D. Somatic referral theory
A. Gate control theory
- Small fibers: carry pain signals -> Gate opens = pain
- Large fibers: Carry touch/pressure signals -> Gate closes= Pain reduced
Physiologic distraction - Squeezing the comb activates large fibers and helps reduce pain by closing the gate.
Slide 24
Which of the following best describes the concept of counterirritation in labor pain management?
A. Applying pressure to the cervix to stimulate labor
B. Distracting stimulus to reduce perception of pain
C. Administering opioids to reduce inflammatory pain
D. Using epidural anesthesia to interrupt nerve transmission
B. Distracting stimulus to reduce perception of pain
Slide 24
Inhaled Anesthetics
Which of the following inhaled agents is currently used for labor pain management?
A. Chloroform
B. Sevoflurane
C. Nitrous oxide
D. Isoflurane
C. Nitrous oxide
Slide 25
Who was historically known for using chloroform during labor for Queen Victoria👸🏼?
A. Joseph Lister
B. John Snow
C. Ignaz Snow
D. William Morton
E. Hodor
B. John Snow
This guy
Slide 25
Why must sub-anesthetic concentrations be used for inhaled labor analgesia?
A. To avoid uterine hyperstimulation
B. To keep the partner alert
C. To ensure the parturient remains conscious
D. To prevent fetal scalp swelling
C. To ensure the parturient remains conscious
Partner/Coach is ALWAYS in verbal contact
Slide 25
During labor, nitrous oxide is used in a way that allows the patient to “_______” themselves.
A. Inject
B. Stimulate
C. Sedate
D. Dose
D. Dose
Slide 25
In ________, Stanislav Klikovitch described the use of nitrous oxide (N₂O) for labor analgesia in ________.
A. 1865; England
B. 1881; Russia
C. 1902; France
D. 1873; Germany
B. 1881; Russia
Slide 26
Which of the following best describes the mechanism of nitrous oxide in labor analgesia?
A. Inhibition at NMDA glutamate receptors
B. Direct stimulation of oxytocin receptors
C. Blocking of GABA receptors
D. Inhibition of voltage-gated calcium channels
A. Inhibition at NMDA glutamate receptors
Slide 26
Which of the following is TRUE about nitrous oxide use in labor?
Select 2
A. It decreases uterine contractility
B. It does not cause neonatal depression
C. It causes neonatal depression
D. It is associated with spinal cord suppression
E. It does not reduce uterine contractility
B. It does not cause neonatal depression
E. It does not reduce uterine contractility
Slide 26
Which of the following receptors are stimulated by nitrous oxide during labor analgesia?
Select 4
A. Opioid receptors
B. Dopaminergic receptors
C. Muscarinic receptors
D. Histaminergic receptors
E. ⍺2-adrenergic receptors
F. β2-antagonist receptors
G. ⍺1-adrenergic receptors
A. Opioid receptors
B. Dopaminergic receptors
E. ⍺2-adrenergic receptors
G. ⍺1-adrenergic receptors
Slide 26
What is the typical gas ratio used when patient is self administering nitrous oxide for labor analgesia?
A. 25% nitrous / 75% oxygen
B. 100% nitrous
C. 50% nitrous / 50% oxygen
D. 75% nitrous / 25% oxygen
C. 50% nitrous / 50% oxygen
Slide 27
Which best describes the activation mechanism of a nitrous oxide system during labor?
A. Activated by continuous flow
B. Triggered by anesthetist using a button
C. Activated by patient’s negative pressure
D. Administered via automatic ventilator
C. Activated by patient’s negative pressure
Demand valve connected to face mask or mouthpiece
Slide 27
What prevents overdose when using nitrous oxide during labor?
A. Intermittent delivery through IV tubing
B. Timer-controlled release
C. Rapid metabolism in the liver
D. Fast onset and offset
D. Fast onset and offset
“Patient just drops the mask and they wake up”
Slide 27
What happens to nitrous oxide use in some facilities after an epidural is placed?
A. It is converted to continuous administration
B. It is discontinued
C. It is given through the epidural catheter
D. The concentration is increased
B. It is discontinued
Slide 27
Which of the following are true side effects or precautions with nitrous oxide use during labor?
Select 3
A. May cause paresthesias
B. Causes muscle rigidity
C. Can cause dry mouth and dizziness
D. Always requires general anesthesia backup
E. Issues with nausea
A. May cause paresthesias
C. Can cause dry mouth and dizziness
E. Issues with nausea
Slide 28
What serious complication can result from combining opioids and nitrous oxide?
Select 2
A. Elevated blood pressure
B. Seizure activity
C. Hypoxia
D. Excessive uterine contractions
E. Loss of protective airway reflexes
C. Hypoxia
E. Loss of protective airway reflexes (aspiration risk d/t patient being considered full stomach)
Decreased LOC
Slide 28
Which nerve block can be used to augment nitrous oxide analgesia during labor?
A. Pudendal nerve block
B. Sciatic nerve block
C. Saphenous nerve block
D. Femoral nerve block
A. Pudendal nerve block
Slide 28
Volatile Anesthetics
Which of the following is a key requirement when using volatile agents for labor?
A. Continuous fetal monitoring only
B. Obstetrician must be present
C. Anesthesia provider must be present
D. Nitrous oxide must be administered simultaneously
C. Anesthesia provider must be present
Slide 29
True or False
Isoflurane, Sevoflurane are not as good as Nitrous oxide for Labor analgesia
False
Volatile anesthetics cause _______ of uterine smooth muscle, which is _______ dependent.
A. Constriction; time
B. Relaxation; dose
C. Relaxation; pH
D. Spasm; temperature
B. Relaxation; dose
Slide 29
Why is a scavenging system required when using volatile anesthetics?
A. To prevent overdose in the fetus
B. To recycle the gas
C. To mix with oxygen
D. To reduce environmental pollution
D. To reduce environmental pollution
Slide 29
What is a significant maternal side effect of volatile anesthetics during labor?
A. Increased uterine tone
B. Maternal alertness
C. Loss of airway reflexes and amnesia
D. Fetal bradycardia
C. Loss of airway reflexes and amnesia
Slide 29
Volatile agents may be used for deliveries that require _______, such as twin deliveries.
A. Cesarean section only
B. Spontaneous delivery
C. Instrumentation
D. Water birth
C. Instrumentation
Or a twin birth in the Operating Room..
Freeman addition to lecture
Slide 29
Acetaminophen is a _______ analgesic that works through **_______ inhibition of COX enzymes.
A. Sedative; strong
B. Multimodal; weak
C. Single-use; selective
D. Antispasmodic; irreversible
B. Multimodal; weak
COX 1 & COX2
Slide 30
The maximum effect of acetaminophen occurs approximately _______ after administration.
A. 1 hour
B. 30 minutes
C. 15 minutes
D. 90 minutes
A. 1 hour
Slide 30
Ketamine provides analgesia primarily through which receptor mechanism?
A. GABA-A agonism
B. NMDA receptor antagonism
C. Alpha-2 adrenergic stimulation
D. Mu opioid receptor activation
B. (Noncompetetive) NMDA receptor antagonism
Nice read refresher
Slide 31
Ketamine is contraindicated in which patient population?
Select 2
A. Patients with preeclampsia
B. Patients with asthma
C. Patients receiving spinal anesthesia
D. Patients undergoing cesarean delivery
E. Patients with hypertension
A. Patients with preeclampsia
E. Patients with hypertension
Slide 31
Ketamine is a _______ derivative and acts as a noncompetitive NMDA receptor antagonist.
A. Morphine
B. Barbiturate
C. Phencyclidine
D. Diazepam
C. Phencyclidine
Slide 31
Which of the following effects may a patient experience with ketamine?
Select 3
A. Increased blood pressure
B. Decreased blood pressure
C. Hallucinations
D. Decreased Heart rate
E. Increased Heart rate
A. Increased blood pressure
C. Hallucinations 🍄
E. Increased Heart rate
“trippin’ down the k-hole”
Slide 31
When might ketamine be especially useful in obstetric anesthesia?
A. During a long cesarean section
B. For cervical ripening
C. During early labor induction
D. During fetal scalp electrode placement
A. During a long cesarean section
“A good time to use ketamine is during cesarean sections when neuraxial anesthesia is wearing off”
Slide 31
What is the typical IV dose range for ketamine used for analgesia or sedation?
A. 0.05–0.1 mg/kg
B. 0.2–0.5 mg/kg
C. 1–2 mg/kg
D. 3–5 mg/kg
B. 0.2–0.5 mg/kg
slide 32
What is the typical onset time after IV ketamine administration?
A. 1 minute
B. 45 seconds
C. 30 seconds
D. 15 minutes
C. 30 seconds
Slide 32
What is the duration of effect after a single IV dose of ketamine?
A. 1–2 minutes
B. 5–10 minutes
C. 15–30 minutes
D. 45–60 minutes
B. 5–10 minutes
Slide 32
Which of the following describes a proper loading dose for ketamine infusion?
A. 1 mg/kg over 5 minutes
B. 0.5 mg/kg over 15 minutes
C. 0.2 mg/kg over 30 minutes
D. 0.2 mg/kg/hr for 1 hour
C. 0.2 mg/kg over 30 minutes
Slide 32
IM ketamine has an onset of _______ minutes and a duration of _______ minutes.
A. 2–8; 10–20
B. 1–3; 30–60
C. 10–15; 45–60
D. 5–10; 60–90
A. 2–8; 10–20
Slide 32
After a ketamine bolus, the infusion dose is typically set at _______ mg/kg/hr.
A. 0.1
B. 0.2
C. 0.4
D. 0.6
B. 0.2 mg/kg/hr
Slide 32
Benzodiazepines
Benzodiazepines bind to a specific site on the _______ receptor, enhancing inhibitory neurotransmission.
A. NMDA
B. Dopamine
C. GABA
D. Nicotinic
C. GABA
Slide 33
Which of the following are true about IV benzodiazepine use in labor?
Select 3
A. Causes amnesia
B. Maternal respiratory depression
C. Does not cross the placenta
D. Increases neonatal tone
E. Crosses the placenta
A. Causes amnesia
B. Maternal respiratory depression
E. Crosses the placenta
Slide 33
Which of the following are potential effects on neonatals due to the use of maternal benzodiazepine use during labor?
Select 3
A. Neonatal hypotonicity
B. Decreased thermoregulation
C. Hyperreflexia
D. Enhanced alertness
E. Respiratory depression
A. Neonatal hypotonicity
B. Decreased thermoregulation
E. Respiratory depression
Slide 33
Opioids
Which of the following is an advantage of using IV or IM opioids for labor analgesia?
Select 2
A. Low cost
B. No placental transfer
C. Requires specialized monitoring
D. Ease of administration
E. No risk of nausea
A. Low cost
D. Ease of administration
No need for specialized equipment or personnel
Slide 34
Which of the following are disadvantages of IV/IM opioid use in labor?
Select 2
A. Itching
B. Requires an anesthesia provider
C. Placental transfer to fetus
D. Always leads to prolonged labor
E. Improves fetal tone
A. Itching
C. Placental transfer to fetus
Sedation, N/V
Slide 34
Meperidine
What is the typical IM dose of meperidine during labor?
A. 25–50 mg IM q2h
B. 50–100 mg IM q4h
C. 100–150 mg IM q6h
D. 10-50 mg IM q2h
B. 50–100 mg IM q4h
Slide 35
What is the typical IV dose of meperidine during labor?
A. 25 mg IM q2-4h
B. 50 mg IM q4-5h
C. 100 mg IM q5-6h
D. 10 mg IM q1-4h
A. 25 mg IM q2h
Slide 35
Meperidine is _______ soluble, allowing it to cross the placenta _______.
A. Water; poorly
B. Lipid; readily
C. Protein; slowly
D. Ionized; minimally
B. Lipid; readily
Slide 35
Meperidine can cause multiple side effects, including _______ and _______.
A. Seizures; fever
B. Tachycardia; urinary retention
C. Vomiting; bronchospasm
D. Respiratory depression; itching
D. Respiratory depression; itching
Slide 35
Which of the following is a significant active metabolite of meperidine?
A. Norhydromorphone
B. Norfentanyl
C. Normeperidine
D. Noroxycodone
C. Normeperidine
Slide 35
Morphine
What is the typical IV dose of morphine used during labor?
A. 0.01–0.03 mg/kg
B. 0.05–0.1 mg/kg
C. 0.15–0.3 mg/kg
D. 1–2 mg/kg
B. 0.05–0.1 mg/kg
Slide 36
What is the typical IM dose range for morphine used during labor?
A. 0.01–0.05 mg/kg
B. 0.05–0.1 mg/kg
C. 0.1–0.2 mg/kg
D. 1–2 mg/kg
C. 0.1–0.2 mg/kg
Slide 36
The active metabolite of morphine, _____, can accumulate in neonates and contribute to respiratory depression.
A. Morphine-6-glucuronide
B. Morphine sulfate
C. Norfentanyl
D. Normeperidine
A. Morphine-6-glucuronide
Slide 36
Morphine is a _______ opioid, contributing to its _______ onset.
A. Lipophilic; rapid
B. Hydrophilic; slower
C. Hydrophobic; unpredictable
D. Fat-soluble; faster
B. Hydrophilic; slower
Slide 36
Fentanyl
What is the typical IV dose range of fentanyl per hour for labor analgesia?
A. 5–10 mcg/hr
B. 25–50 mcg/hr
C. 50–100 mcg/hr
D. 100–200 mcg/hr
C. 50–100 mcg/hr
Slide 37
Which of the following is true about fentanyl?
A. It has multiple active metabolites
B. It is hydrophilic and has a slow onset
C. It does not cross the placenta
D. It is lipophilic and works quickly
D. It is lipophilic and works quickly
Slide 37
One consideration with repeated fentanyl doses is that the drug may _______.
A. Accumulate
B. Cause uterine atony
C. Convert to normeperidine
D. Lose potency
A. Accumulate
Slide 37
True or False
Fentanyl has multiple metabolites
False
It has No metabolites
Slide 37
Remifentanil
What is the typical PCA bolus dose of remifentanil for labor analgesia?
A. 5–10mcg with 1 min lockout
B. 10–20mcg with 5 min lockout
C. 20–40mcg with 2–3 min lockout
D. 50–100mcg with 10 min lockout
C. 20–40mcg with 2–3 min lockout
Slide 38
What is the primary method of metabolism for remifentanil?
A. Hepatic cytochrome P450 enzymes
B. Renal excretion
C. Glucuronidation
D. Plasma esterases
D. Plasma esterases
Slide 38
Which of the following best describes remifentanil’s duration?
A. Prolonged effect
B. Ultra-short acting
C. Moderate duration
D. Unpredictable
B. Ultra-short acting
Slide 38
slide 39-73
What is the dose of Butorphenol (stadol)?
A. 5-10mg IV/IM
B. 2-4mg IV/IM
C. 1.5-2.5 mg IV/IM
D. 1-2mg IV/IM
D. 1-2mg IV/IM
every 3-4 hours
slide 39
What is the half life of butorphenol?
A. 4.6 hours
B. 1-2 hours
C. 3-6 hours
D.5-7 hours
A. 4-6 hours
slide 39
True or false
Butorphenol is known for improved analgesic score over fentanyl
true
slide 39
What is the dose of Nalbuphine (nubain)
A. 1-2mg
B. 3-8mg
C.5-20mg
D. 10-30mg
C. 5-20mg IV, IM, subq Q4-6 hours
slide 39
What is the half life of nalbuphine
A. 4 hours
B. 5 hours
C. 2 hours
D. 3.5 hours
B. 5 hours
slide 39
What can Nalbuphine cause?
A. fetal decelerations
B. fetal tachycardia
C. fetal demise
D. fetal bradycardia
D. fetal bradycardia
slide 39
What can help with fetal bradycardia caused by Nalbuphine
A.Glycopyrolate
B. Epinephrine
C. Naloxone
D. Phenylephrine
C. Naloxone
slide 39
Which drug will suppress uterine contractions, promote premature constriction of fetal ductus arteriosus and inhibit platelet aggregation?
A.toradol
B. fentanyl
C. stadol
D. nubain
A. toradol
NSAIDS
slide 40
What is the goal of the paracervical block?
A. block transmision to the postcervical ganglion
B. block transmision to the intracervical ganglion
C. block transmission thru paracervical ganglion
D. facilitate transmission thru paracervical ganglion
C. block transmission thru paracervical ganglion
slide 41
The paracervical block is normally administered by the _______ provider.
A. Janitor
B. nurse
C. anesthesia
D. OB
D. OB provider
slide 41
The paracervical block is for short term pain relief in the ________ stage of labor
A.first
B.second
C.third
D.fourth
A. First
What are the 3 complications associated with the paraceervical block? (select 3)
A. maternal bradycardia
B. injection into fetal scalp
C. maternal LAST
D. syncope
E. rupture of membrane
B. injection into fetal scalp
C. maternal LAST
D. syncope
also fetal LAST and fetal bradycardia
slide 41
Which complication is considered the MOST severe fetal complication
A. fetal demise
B. fetal LAST
C. fetal bradycardia
D. fetal tachycardia
B. Fetal LAST
slide 41
What is the most COMMON fetal complication
A. fetal demise
B. fetal LAST
C. fetal bradycardia
D. fetal tachycardia
C. fetal bradycardia
slide 41
Which patient populations is the paracervical block (select 2)
A. uteroplacental insufficiency
B. stage 2 of labor
C. non-reassuring fetal heart rate
D. anterior placenta
A. uteroplacental insufficiency
C. non-reassuring fetal heart rate
slide 41
The pudendal nerve block will (select 2)
A. minimize bleeding
B. reduce fetal movement
C. have rapid absorption of LA
D. minimize urge to push
C. have rapid absorption of LA
D. minimize urge to push
slide 43
The pudendal nerve block is an alternative to pharmacologic pain management in the _____ stage of labor
A. first
B. second
C. third
D. fourth
B. second
slide 43
What are the 3 risk factors of the pudendal nerve block (select 3)
A. injection into pudendal artery
B.LAST
C. fetal trauma or injections of LA
D. maternal bradycardia
E. fetal tachycardia
A. injection into pudendal artery
B.LAST
C. fetal trauma or injections of LA
slide 43
