Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is chorionic villus sampling (CVS)?

A

Aspiration of a small amount of placental tissue (chorion) for chromosomal, metabolic, or DNA testing for fetal abnormalities caused by genetic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when is chorionic villus sampling done?

A

Around 10-12 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how is chorionic villus sampling done?

A

Using a catheter either transvaginally through the cervix using an ultrasound guide or abdominally through a needle and ultrasonography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are some advantages of chorionic villus sampling versus amniocentesis?

A

Can be performed earlier than amniocentesis but is not recommended before 10 weeks
examination of fetal chromosomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what position would a woman be to do a chorionic villus sampling?

A

Lithotomy for transvaginal aspiration
supine for trans abdominal aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how many times would you assess the fetal heart rate after a chorionic villus procedure?

A

Twice in 30 minutes post procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is amniocentesis?

A

A needle is inserted through the maternal abdominal wall to gather amniotic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when is amniocentesis commonly performed during pregnancy?

A

14 to 20 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are some risk factors for fatal genetic disorders that might warrant amniocentesis?

A

Older than 35 years
history of genetic disorders
positive screening test such as alpha fetal protein
known or suspected hemolytic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does amniocentesis test for?

A

Genetics, assessment of fetal lung maturity, and assessment of hemolytic disease, or interuterine infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the advantages of amniocentesis?

A

Examines fetal chromosomes for genetic disorders
direct examination of biochemical specialists
accuracy rate of 99%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what might elevated bilirubin levels indicate on a amniocentesis?

A

Fetal hemolytic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

positive PG indicates what on an amniocentesis?

A

Fetal lung maturity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

L:S ratio >2:1 indicates what?

A

Fetal lung maturity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the risks of amniocentesis?

A

1% fetal loss rate after 15 weeks which increases to 2% to 5% earlier in gestation
Trauma to the fetus
Bleeding
Preterm labor
Maternal infection
RH sensitization from fetal blood to maternal circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is delta OD 450?

A

Diagnostic evaluation of amniotic fluid obtained via amniocentesis product life threatening anemia in the fetus during the second or third trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is an indication of delta OD 450?

A

When alloimmunzation exists from the increase risk for fetal anemia from RBC hemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is a safer alternative to delta OD 450for Rh alloimunized pregnancies?

A

Umbilical artery Doppler flow to measure the peak velocity of systolic blood flow in the middle cerebral artery of a fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are some risks to Delta OD 450?

A

Membrane rupture
Infection
Worsening sensation
Fetal loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is alpha - fetoprotein?

A

Glycogen produced in the fetal liver, GI tract, and yolk sac in early gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what does AFP screen for?

A

Maternal blood screening for developmental defects in the fetus such as NTD and ventral abdominal wall defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when is AFP screening done?

A

15-20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Increased levels of AFP are associated with what defects?

A

NTD, ventral abdominal wall defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Decreased levels of AFP are associated with what defects?

A

Trisomy 21 also known as Down syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are some advantages of AFP testing?

A

Many types of neural tube defects and open abdominal wall defects can be detected early in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is a big risk of AFP results?

A

There is a high false positive rate that kind of curve with low birth weight, oligohydramnios, multifetal gestation, decreased maternal weight, and underestimated fetal gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are two types of multiple marker screens?

A

Triple marker and quad screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is the difference between triple marker and quad screen?

A

The triple marker has all three chemical markers– AFP, human chorionic gonadotropin, and estriol levels, but quad screen adds inhibin-A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

when might the multiple marker screen be done?

A

15-16 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

low levels of MSAFP mean what?

A

Maternal serum alpha fetoprotein and unconjugated estriol levels suggest an abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Elevated gCG and inhibin-A levels mean what?

A

twice as high in pregnancies with trisomy 21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

decreased estriol levels are an indicator of what defect?

A

Neural tube defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What do multiple marker tests screen for?

A

Down syndrome and neural tube defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is chorioamnionitis?

A

Ascending infection from the lower GI tract and migrating to the amniotic cavity when amniotic sac is broken for a long time before birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Risk factors for chorioamnionitis

A

amniotic SAC breaks long before you deliver
Long labor
Frequent vaginal exams during labor
First pregnancy
STI
Alcohol or tobacco use
Internal fetal monitoring
Epidural anesthesia during labor
GBS positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are the symptoms of chorioamnionitis?

A

Fever
Fetal and maternal tachycardia
Sore or painful uterus
Bad smell from amniotic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Many women start feeling fetal movements?

A

Around 16 to 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how many times a day for how long should a woman track fetal movements?

A

One to two hours once a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

how many fetal movements in two hours is normal?

A

10 fetal movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

how many fetal movements in one hour is normal?

A

4 fetal movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

when should fetal movements be reported to the provider?

A

Fewer than four in two hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How should a woman be positioned while counting Fetal movements?

A

By lying on her side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

why are fetal movements important to evaluate?

A

It is an important evaluation of fetal well-being

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What should a woman do if fetal movement is decreased?

A

Eat, rest, and focus on fetal movement for one hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what is the most widely accepted method of evaluating fetal status especially for high risk pregnancies with hypertension?

A

Non stress test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what might a provider do if a woman comes in reporting decreased fetal movements daily?

A

Use a non stress test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what is a non stress test for fetal monitoring?

A

Assesses the heart rate of physiologically normal fetus with adequate oxygenation and intact autonomic nervous system which accelerates in response to movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

when is the NST considered reactive in fetuses more than 32 weeks gestation?

A

When the FHR increases 15 beats above baseline for 15 seconds twice or more in 20 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

how long will a fetal heart rate monitor take?

A

Up to 20 to 40 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

when is the NST considered reactive in fetuses less than 32 weeks gestation?

A

Two accelerations peaking at least 10 beats per minute above baseline and lasting 10 seconds and 20 minutes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is a non reactive NST?

A

Insufficient fetal heart rate accelerations in 40 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what might repetitive variable decelerations that are less than 30 seconds on a NST indicate?

A

possible abnormalities of amniotic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what might a non-reactive NST be followed up with?

A

BPP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what might you do after no 15 by 15 within 20 minutes of a non stress test?

A

Use a vibroacoustic stimulator and then repeat the test for 20 more minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are the advantages of a non stress test?

A

It is non invasive
Easily performed
Reliable indicator of fetal well-being

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

how would you prep the patient for a non stress test?

A

Explain the procedure
Have the patient void before
Light and semi Fowler or lateral position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is a biophysical profile?

A

Ultrasound assessment of fetal status along with an NST.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What does a biophysical profile evaluate?

A

Fetal status through ultrasound observation of various fetal reflex activities that are controlled by the central nervous system and sensitive to fetal hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

For what complications is the biophysical profile assessment indicated?

A

Pregnancies involving increased risk of fetal hypoxia and placental insufficiency such as maternal diabetes and hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what does the biophysical profile Assessment assess for (5)?

A

breathing movement
body movement,
fetal tone
fluid volume (amniotic), and
heart rate activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

4 indicators of ultrasound observation are what?

A

Fetal breathing movements, fetal movements, fetal tone, and measurement of amniotic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What assessments does the BPP consist of?

A

NST with additional 30 minutes of ultrasound observation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is normal fetal movement?

A

Three or more discrete body or limb movements in 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is normal fetel breathing movement rate?

A

One or more episodes of rhythmic breathing movements of 30 seconds or movement within 30 minutes is expected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is normal fetal tone?

A

One or more fetal extremity extension with return to fetal flexion or opening and closing of the hand is expected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what is normal amniotic fluid volume?

A

A pocket of amniotic fluid that measures at least 2cm in two planes perpendicular to each other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How would you interpret a BPP?

A

A score of two which means present or 0 which means absent is assigned to each of the five components

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what do the numbers of a BPP scoring mean?

A

Eight is reassuring
6 out of 10 is equivocal and may indicate delivery depending on gestational age
4 out of 10 means delivery is recommended
two out of 10 or less means immediate delivery
activity decrease or sensation warrants reversal order of normal development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

___ is the activity that appears earliest in pregnancy and last to cease

A

fetal activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Activities that are the ____ to develop are usually the ___ to diminish

A

last, first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are the five factors that affect labor?

A

Powers, passage, passenger, psyche, position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what are some signs of impending labor?

A

Lightning
Braxton Hicks contractions
cervical changes
Surge in energy sometimes referred to nesting
GI changes like weight loss
Backache due to relaxation of pelvic joints
Bloody show or discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

during the first stage of Labor the uterus becomes ___?

A

Shorter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

when does lightening usually occur?

A

Two weeks before term and first time pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what does powers include?

A

Uterine contractions and bearing down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what are responsible for the dilation and effacement of the cervix in the first stage of Labor?

A

Uterine contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

the resting phase allows what to happen in the uterus and placenta?

A

Blood flow to return back to the uterus and placenta so that the fetal exchange of oxygen, nutrients, and waste products occurs in the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

which segment of the uterus contracts to push the fetus down?

A

The upper 2/3 of the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How are uterine contractions described? (3)

A

frequency, duration, intensity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

with every contraction___ mL of blood leaves the utero-placental unit and moves back into maternal circulation.

A

500 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

how would you describe frequency in uterine contractions?

A

Timing from the beginning of 1 contraction to the beginning of other in minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

how would you evaluate the intensity of a uterine contraction ?

A

The strength of a contraction evaluated with the palpation using fingertips on the maternal abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what are the three levels of intensity of a uterine contraction?

A

Mild, moderate, and strong where the uterine wall cannot be indented during a contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

how would you describe the duration of a uterine contraction?

A

starts from the beginning of a contraction to the end of a contraction recorded in seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

in which level of uterine contraction intensity does the uterine wall easily indent during a contraction?

A

Mild intensity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

how much indentation would a moderate intensity contraction have?

A

Uterine wall is resistant to indentation Contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

what are the three phases of a contraction?

A

Increment, Acme, decrement phases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

in which phase of a contraction is the peak of intensity the shortest part of contraction?

A

Acme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

the increment phase is characterized by what?

A

Ascending or buildup of the contraction that begins in the fundus and spreads throughout the uterus also the longest part of the contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

____ facilitates cervical changes

A

Contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

which is the longest part of the contraction?

A

Increment phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

____ and ____ occurs during the _____ stage of Labor when the uterine contractions pushed the presenting part of the fetus towards the cervix causing it to open and then out

A

dilation, effacement, and 1st

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

in which phase is a descending or relaxation of the uterine muscle?

A

Decrement phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

at what diameter is the cervix considered fully dilated and no longer palpable on examination?

A

10 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

____ Is the shortening and thinning of the cervix

A

effacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

the degree of effacement is measured in ____ and goes from _____ to _____

A

percentage and it goes from 0% to 100%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

effacement often_____ dilation in a ____- times pregnancy, but occurs_____ in ____ pregnancies

A

Precedes, first
Simultaneously, subsequent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

the urge to push is triggered by the _____ reflex, activated when the_____ part stretches the pelvic floor muscles

A

Ferguson, presenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What receptors are activated to release what hormone?

A

Stretch, oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what is the most common type of pelvis shapes ?

A

Gynecoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what is referred to as the relationship of the ischial spines to the presenting part of the fetus and assist in assessing for fetal descent during labor?

A

Station

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

what station is the narrowest diameter the fetus must pass through during a vaginal birth?

A

0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

At station zero, where is the baby’s head?

A

In line with the ischial spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

how is the relationship between the fetus and the passageway described?

A

Fetal skull, fetal attitude, fetal life, fetal presentation, fetal position and fetal size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

what would you call a head first delivery?

A

cephalic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what are some factors that might influence a woman’s psyche?

A

Coping mechanisms including culture, expectations, a strong support system and type of support during labor , expectations such as past experience and current pregnancy experience, fear and anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what does position refer to in the five factors that affect labor?

A

The maternal position during labor and birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

what kind of position is encouraged in the first stage of Labor?

A

Upright such as walking, sitting, kneeling, or squatting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

why is an upright position encouraged in the first stage of Labor?

A

Decrease compression of the maternal descending aorta and ascending vena cava to prevent supine hypotension
also good for heating the scent of infant and more effective contractions for a shorter labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

why might it be good to frequently change positions during the first stage of Labor

A

to reduce fatigue, increase comfort, and improve circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What are the passage portions that affects labor?

A

The pelvis and vaginal canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is the most common kind of pelvis?

A

Gynecoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What axes are important in fetal lie?

A

The long access the spine of the fetus in relationship to the long axis or spine of the woman

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Which fetal position are the long axis of the fetus and mother are parallel?

A

longitudinal lie

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

a fetus cannot be delivered functionally in the____ lie

A

transverse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

what would you call the relationship of fetal parts to one another?

A

Fetal attitude or posture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what determines fetal presentation?

A

The part or pull of the fetus that first enters the pelvic inlet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

what would you call presentation that has partial extension of the neck with a brow as the presenting part?

A

Frontal or brow presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

how would you describe a complete breach?

A

Complete flexion of the thighs and legs extending over the anterior surfaces of the body like they are cross legged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

what would you call a frank breach?

A

When the babies bottom is facing the mouth of the pelvis and its feet are near its head so complete flexion of the thighs and legs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

any compound presentation which part is presenting usually

A

arm or hand presenting alongside the presenting part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

When the babies bottom is facing the mouth of the pelvis and its feet are near its head so complete flexion of the thighs and legs

A

Extension of one or both thighs and legs so that one or both feet are presenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

In a transverse presentation which part is presenting usually?

A

Shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what is the relation of the denominator or reference point to the maternal pelvis?

A

Fetal position

111
Q

what is the specific fetal structure for a cephalic presentation?

A

Occiput

112
Q

what is the specific fetal structure for a shoulder presentation?

A

Acromion

112
Q

Which position occiput position is bad for birth?

A

Occiput posterior because it can press on the mom’s sacrum and cause prolonged labor

112
Q

position is designated by a ___ letter abbreviation

A

three

113
Q

what does the 2nd letter of fetal position designate?

A

Specific fetal part presenting such as O for occipital S for sacrum M for mentum and a for shoulder

113
Q

what does the 1st letter of fetal position designate?

A

Designate which side are presenting part the left or the right L or R

114
Q

what does the 3rd letter of fetal position designate

A

relationship of presenting fetal heart to the woman’s pelvis such as A for anterior P for posterior or T for transverse

115
Q

What are some signs of false labor?

A

Contractions but no change in cervix
Activities or position changes does not change pattern of contraction
hydration or sedation slows or stops contractions

116
Q

what is in the second stage of Labor?

A

10 centimeters to birth of baby

116
Q

what are some signs of true labor?

A

Regular contractions increase in frequency and intensity
Change in cervix
Causing effacement and dilation

117
Q

What is in the first stage of Labor?

A

Latent phase up to 5 centimeters
active phase up to 6 centimeters and transition phase from 8 to 10 centimeters

118
Q

what is in the fourth stage of Labor?

A

Postpartum

118
Q

what would you assess in the first stage of Labor?

A

Maternal vital signs
Women’s response to labor and pain
Fetal heart rate and uterine contractions
Cervical changes
Fetal position and descent in the pelvis

119
Q

which stage of Labor is the longest?

A

Stage 1

119
Q

what is in the third stage of Labor?

A

The delivery of the placenta

120
Q

What should a laboring women eat and drink?

A

Once a minute typically clear liquids and women can dictate their oral intake of carbs to decrease maternal ketosis

121
Q

what is the latent phase of labor?

A

Right before active labor

122
Q

what will you do during latent labor stage?

A

Assess fetal heart rate every 30 minutes or per protocol
Leopold’s maneuver for fetal position
Sterile Vaginal Exam of Patient
take the patient off her back
Another term for completely dilated

123
Q

Another term for completely dilated

A

100% effaced

124
Q

In what stage of labor would you perform Leopold’s maneuver and SVE?

A

latent

125
Q

What would you look for with an SVE?

A

Cervical dilation, position, and effacement, station, presentation, and fetal position

126
Q

What are different techniques to confirm rupture of the membranes?

A

Speculum exam
nitrazine paper
ferning
lab tests not test for proteins in the amniotic fluid

127
Q

What color will nitrazine paper turn it touches amniotic fluid?

A

Blue

127
Q

What shape will amniotic fluid become if is placed on a slide?

A

Ferning pattern

127
Q

What is amnisure?

A

Tests for proteins and the amniotic fluid and 99.9% accurate

127
Q

what would you do if a woman’s water broke?

A

Assess the fetal heart rate, amniotic fluid for color, amount, and odor, and document the date and time

127
Q

Why would you assess the fetal heart rate when a woman’s water breaks?

A

There’s an increased risk of umbilical cord prolapse
Higher risk of umbilical cord prolapse when the presenting part is not engaged

128
Q

how should normal amniotic fluid be?

A

Clear or cloudy with normal odor similar to ocean water

128
Q

what might meconium indicate?

A

Indication of fetal compromise in utero

128
Q

what are the four maneuvers of Leopold’s maneuvers?

A

1st- determine what part of the fetus is located in the fundus of the uterus
2nd- determine location of fetal back
3rd- determine presenting part
4th- determine the location of cephalic prominence

129
Q

what are some characteristics of the transition phase?

A

Cervical dilation from 8 to 10 centimeters with complete effacement
intense contractions every one to two minutes lasting 60 to 90 seconds
Exhaustion and increased difficulty concentrating
Increase of bloody show
Nausea and vomiting
Backache and back pressure
Trembling
Diaphoresis
Strong urge to bear down or push

129
Q

What is the number one uterotonic?

A

Oxytocin/pitocin, which helps contract the uterus

129
Q

When is methergine contraindicated?

A

hypertension

129
Q

What happens in the third stage?

A

Placental delivery
Quantification of blood loss
Uterotonic medications

130
Q

What will be given if the mother is still bleeding after placental delivery?

A

Methylergonovine
Hemabate
Oxytocin
Tranexamic acid
misoprostol

130
Q

When is hemabate contraindicated?

A

Asthmatic

130
Q

What is misoprostol used for?

A

To stop bleeding and induction of labor

130
Q

What is tranexamic acid?

A

Control bleeding

130
Q

How often should FHR be assessed in active labor?

A

Every 15-30 minutes

130
Q

How often should FHR be assessed in the second stage of labor?

A

Every 5-15 minutes

130
Q

How often should UC be assessed in active labor?

A

Every 15-30 minutes

130
Q

How often should UC be assessed in the second stage of labor?

A

Every 5-15 minutes

131
Q

what are some goals in the fourth stage 2 facilitate newborn family attachment?

A

Early contact with newborn
Encouragement of eye contact and touch
Allowing time to hold newborn
Talking to the baby, smiling, and cuddling
Initiate breastfeeding

131
Q

what are 6 care practices that support and promote normal physiologic birth?

A

Labor begins on its own
Freedom of movement throughout labor
Continuous labor support
No routine interventions
Spontaneous pushing and non supine positions
No separation of mother and baby

131
Q

____ Is an incision in the perineum to provide more space for the presenting part at delivery

A

episiotomy

131
Q

what are two types of episiotomies?

A

Median or midline versus medilateral

131
Q

what does a first-degree laceration involve?

A

Perennial skin and vaginal mucous membranes

131
Q

what does a second-degree laceration involve

A

skin, mucousmembrane, and fascia of the perineal body

131
Q

what does a third-degree laceration involve?

A

skin, and muscle of the perineal body extending to the rectal sphincter

131
Q

what does a fourth-degree laceration involve?

A

Extends into the rectal mucosa and exposes the lumen of the rectum

131
Q

what are signs that signify impending delivery of the placenta?

A

Upward rising of the uterus into a ball shape
lengthening of the umbilical cord at the introitus
sudden gush of blood from the vagina
active management of placental delivery consists of urogenital, control or traction, and uterine massage

131
Q

what is normal blood loss for a vaginal birth?

A

About 500 milliliters

132
Q

What are indications of oxytocin?

A

Labor induction and augmentation. Control of postpartum bleeding after placental expulsion

132
Q

how does oxytocin work?

A

Stimulates uterine smooth muscle that produces intermittent contractions
Also has vasopressor and antidiuretic properties

132
Q

what is the indication of methylergonovine?

A

Prevent or treat postpartum hemorrhage, uterine atony, sub involution

132
Q

what is the action of methylergonovine?

A

Directly stimulates smooth and vascular smooth muscles causing sustaining uterine contractions

133
Q

how does carboprost work?

A

Contracts uterine muscle

133
Q

What is the indication of carboprost?

A

Uterine atony

133
Q

how does misoprostol work?

A

Acts as a prostaglandin analog causes uterine contractions

133
Q

what is the indication of misoprostol?

A

Control postpartum hemorrhage

133
Q

what are analgesic medications during labor?

A

meperidine or Demerol
butorphanol (stadol)
sublimaze (fentanyl)
morphine
remifentanil
all opiates

133
Q

what type of block is an epidural?

A

Reginal

134
Q

When can an epidural be administered?

A

1st and/or second stage of Labor

134
Q

what would you administer before an epidural? Why?

A

IV fluid bolus with normal saline or lactated ringers to prevent hypertension

134
Q

how often would you monitor maternal vital signs and fetal heart rate after an epidural?

A

Every 5 minutes initially and every 15 minutes thereafter

134
Q

What are the five physiological signs of an apgar score?

A

Heart rate based on auscultation
Respiratory rate based on observed movement of the chest
muscle tone based on degree of flexion and movement of the extremities
Reflex irritability based on response to tactile stimulation
Color based on observation

134
Q

what does a score of 0 to 3 on the apgar scale indicate?

A

Severe distress

134
Q

what does a score of four to six indicate on the apgar scale?

A

Moderate difficulty with transition to extrauterine life

134
Q

what does an apgar scale of seven to 10 indicate?

A

Stable status

134
Q

when would you give a score of one for muscle tone?

A

If there is only some flexion of extremities

134
Q

when would you give a score of 1 for reflex activity?

A

grimacing

134
Q

when would you give a score of one for color?

A

If the baby has a pink body but blue extremities

134
Q

when would you give a 2 for heart rate?

A

If the heart rate is above 100 beats per minute

134
Q

when would you give a 2 for respiratory effort?

A

Good cry

135
Q

how often would you assess apgar scores?

A

At 1:00 and 5:00 minutes

135
Q

if a baby had a score of 6, what would you do?

A

Assess every 5 minutes up to 20 minutes until the baby has a score above 6

135
Q

if a baby had zero to three apgar score then what would you do?

A

Indicates severe distress, so may need extra help

135
Q

what does a score of four to six mean you have to do for a baby?

A

Give them supplemental oxygen, maybe a warm blanket, extra stimulation.

135
Q

What type of monitoring is more accurate for urine contractions?

A

Intrauterine

135
Q

what is a consideration for intra uterine monitoring devices?

A

infection

135
Q

when is the best part on a strip to assess fetal heart rate?

A

Place where there is resting tone in the contraction and no accelerations or decelerations

136
Q

What is a baseline fetal heart rate?

A

The mean or average fetal heart rate rounded to increments of five beats per minute during a 10 minute window excluding accelerations and decelerations

136
Q

what is baseline variability?

A

Fluctuations in the baseline fetal heart rate that are irregular in amplitude and frequency which are visually quantified as the amplitude of the peak to trough in beats per minute. Determined by a 10 minute window excluding accelerations and decelerations

136
Q

What are the four types of baseline variability?

A

Absent
Minimal
Moderate
Marked

136
Q

Baseline variability is the interaction between what and what?

A

Fetal sympathetic and parasympathetic nervous systems

136
Q

what would an absent baseline variability look like?

A

Amplitude range is undetectable

136
Q

what would a minimal baseline variability look like?

A

Amplitude range is visually undetectable and less than 5 beats per minute

136
Q

what would a moderate baseline variability look like?

A

Amplitude from peak to trough is 6 to 25 beats per minute

136
Q

what would a marked baseline variability be?

A

Amplitude range is greater than 25 beats per minute

136
Q

What do accelerations in FHR look like?

A

Visually apparent with an abrupt increase in FHR above baseline where the peak of the acceleration is greater than 15 beats per minute over the baseline fetal heart rate 4 greater than 15 seconds and greater than two minutes

136
Q

what do decelerations look like in an FHR?

A

Transitory decrease in the FHR from baseline

136
Q

what are the four types of decelerations?

A

Early deceleration
Variable
Late
Prolonged
Sinusoidal

136
Q

what does an early deceleration look like and is it good or bad?

A

visually apparent gradual decrease in FHR below baseline where the lowest point of deceleration occurs simultaneously with peak of uterine contraction. This is good

136
Q

What does a variable deceleration look like?

A

Visually abrupt decrease in the FHR below baseline where the FHR is greater than 15 beats per minute lasting more than 15 seconds and less than two minutes in direction

136
Q

what is late deceleration?

A

A visually apparent gradual decrease of FHR below baseline where nadir is after the peak of uterine contraction

136
Q

what is prolonged deceleration?

A

Are you visually apparent abrupt decrease in FHR below baseline that is greater than 15 and two BPM but less than 10 min

136
Q

what is considered fetal tachycardia?

A

10 or more minutes of greater than 160 BPM

136
Q

what is considered fetal bradycardia?

A

10 or more minutes of less than 110 BPM

136
Q

Normal fetal heart rate is hey FHR pattern that reflects a _________ to the_______.

A

Physiological response, maternal fetal environment

136
Q

The FHR is measured via a(n)________.

A

Ultrasound transducer.

136
Q

External EFM detects what four things?

A

Fetal heart rate baseline, variability, accelerations, and decelerations

136
Q

what are some reasons for erratic FHR recordings or gaps?

A

Inadequate conduction of the ultrasound signal displacement of the transducer, fetal or maternal movement, inadequate ultrasound gel, or fetal arrhythmia

136
Q

what is the device that measures contractions?

A

Tocodynamometer

136
Q

the _______ and ____ of uterine contractions, ____, which is the tone of the uterus between contractions can be measured by a tocodynamometer

A

relative frequency, duration of uterine contractions, relative resting tone

136
Q

how must the pressure or intensity of the contractions be measured?

A

By palpation

136
Q

Where toco transducer be positioned?

A

On the area of uterus palpated to be the strongest area of contraction where the resting tone is not dialed to 15 to 20mm of mercury when the uterus is relaxed, basically where the contraction feels strongest to palpation

136
Q

what does an internal electric fetal monitoring system do?

A

Apply directly to the fetus to detect fetal heart rate

136
Q

where is the intrauterine pressure catheter placed?

A

In the uterine cavity

136
Q

who can attach the IETF or ISE?

A

A nurse or care provider certified to attach it

137
Q

what are some contraindications to direct methods of monitoring?

A

Chorioamnionitis, active maternal genital herpes and HIV

137
Q

what are some indications for internal monitoring?

A

Lack of progress in labor
Obesity When external monitoring is inadequate
Treat worsening category 2 tracing

137
Q

how are uterine contractions measured with an intrauterine pressure catheter?

A

In millimeters of mercury; peak pressure minus the baseline pressure in MMHg

137
Q

contraction intensity varies during labor, from ____in early spontaneous labor to ____ and transition to ____ in the second stage

A

30, 70, 70-90

137
Q

what is resting tone also known as?

A

baseline pressure of contractions

137
Q

what should the baseline pressure be?

A

5-25 mm Hg

137
Q

contraction intensity varies during labor, from ¬¬¬-____in early spontaneous labor to ____ and transition to ____ in the second stage

A

contraction intensity varies

137
Q

which category of FHR interpretation is normal?

A

Category one

137
Q

which category of FHR interpretation is abnormal?

A

Category 3

137
Q

what are the components of category one FHR interpretation?

A

Include all of the following
Baseline rate 110 to 160 beats per minute
Baseline variability is moderate
Late or variable deceleration absent
Early decelerations are absent or present
Accelerations absent or present

137
Q

Components of category 3 FHR interpretation

A

either absent variability with any of the following
Recurrently late decelerations
Recurrent variable decelerations
Bradycardia
or sinusoidal pattern

138
Q

what are the maternal causes of minimal or absent variability?

A

Supine hypotension
Cord compression
Uterine tachysystole
Drugs such as prescription, illicit or alcohol

138
Q

what are the fetal-related causes of minimal or absent variability?

A

Fetal sleep or prematurity

138
Q

the presence of FHR accelerations is predictive of_____ and reflects____

A

adequate central fetal oxygenation, absence of fetal acidemia

138
Q

what would you do for an FHR acceleration?

A

nothing

139
Q

when are decelerations recurrent versus intermittent

A

recurrent when occurring at least 50% of uterine contractions over 20 minutes and intermittent when fewer than 50% of contractions

139
Q

what is the most common deceleration seen in labor?

A

Variable decelerations

139
Q

what type of deceleration is a compensatory response to hypoxemia?

A

An acceleration that precedes or follows a deceleration

139
Q

what is the relationship between the FHR and uterine contraction In variable decelerations?

A

May vary in duration, depth and timing in relation to uterine contraction

140
Q

Variable decelerations can take the shape of what?

A

U, W, or V

140
Q

what are three characteristics of a normal variable deceleration?

A

Duration of less than 60 seconds
Rapid return to baseline
Accompanied by normal baseline and variability

140
Q

what are some causes of variable decelerations

A

umbilical cord occlusion
Compression that triggers A vagal response
Sudden descent of vertex late in active phase of Labor such as head compression

140
Q

what are some management techniques for variable deceleration?

A

Consider amnio infusion, tocolytics, delivery

140
Q

what is amnioinfusion?

A

When as a result of decreased amniotic fluid room temperature saline is infused into the uterus through the cervix to increase intra amniotic fluid to cushion the umbilical cord and reduce compression

140
Q

late deceleration can be a sign of______ to labor

A

fetal intolerance

140
Q

when does the nadir of a late deceleration occur?

A

After the peak of the contraction and mostly after the end of the contraction occurs

140
Q

what are some causes of late decelerations?

A

Fetal response to transient or chronic uteroplacental insufficiency
suppression of the federal myocardium
decreased availability of O2 because you’re a placental insufficiency

140
Q

what kinds of decelerations are not re occurrent and preceded and followed by normal baseline and moderate variability not associated with fetal hypoxemia?

A

Prolonged deceleration

140
Q

how long might a prolonged deceleration last four?

A

Greater than two minutes but less than 10

141
Q

what are some causes of prolong deceleration?

A

Any mechanism that causes a profound change in the fetal O2 level
vagal stimulation
interruption of umbilical blood flow

141
Q

what are the medical managements for prolonged decelerations?

A

Treat the cause
Consider Amy on fusion
Consider tocolytics
Consider delivery

141
Q

in what kind of deceleration would you do nothing?

A

Early decelerations

141
Q

What is reglan used for?

A

Antiemetic

141
Q

What antibiotic would you give for GBS+?

A

Penicillin

141
Q

According to veal chop what is the physiological reason for variable deceleration?

A

Cord compression; move mother

141
Q

According to veal chop what is the reason for early deceleration?

A

Head compression; no intervention necessary

141
Q

According to veal chop what is the reason for acceleration?

A

Oxygenation- lack of; no intervention needed

141
Q

According to veal chop what is the reason for late deceleration

A

placental insufficiency evaluate reason,

141
Q

what are the POOF interventions?

A

Position or reposition
Oxygenate
Oxytocin (stop oxytocin or Pitocin)
Fluid administration

141
Q

How would you determine uterine activity?

A

Assessing the contractions frequency, duration, and intensity, and uterine resting tone

141
Q

how would you count the frequency of contractions?

A

Count the number of contractions in a 10 minute., counting from the start of 1 contraction to the start of the next contraction in minutes

141
Q

What is a normal amount of contractions?

A

Five or fewer contractions in 10 minutes average over a 30 minute window

142
Q

what would you call more than five contractions in 10 minutes over 830 minute window?

A

Tachysystole

142
Q

Characteristics of tachysystole?

A

More than five contractions in 10 minutes
Contractions lasting 2 minutes or longer
Contractions occurring within one minute of each other
Increasing resting tone greater than 20 to 25mm Hg with peak pressure greater than 80

142
Q

what are some causes of tachysystole?

A

Spontaneous or simulated labor
Medications used for cervical ripening, induction, and augmentation of Labor

142
Q

what are some actions to take for tachysystole?

A

Changing positions, providing hydration, IV fluid bolus, reducing anxiety or pain, administering tocolytics such as terbutaline, supporting woman and family

142
Q

___ and ___ are considered the up and down of a contraction

A

Increment, decrement

142
Q

which is shorter a duration or frequency of a contraction

A

duration because it only counts the increment peak and decrement of a contraction

142
Q

how is a external versus internal uterine monitoring device different?

A

The intrauterine device can measure the intensity of a contraction

142
Q

what drug can cause fetal tachycardia?

A

terbutaline

142
Q

what can cause fetal tachycardia?

A

Early fetal hypoxemia
Maternal fever
Terbutaline

142
Q

what can fetal bradycardia lead to?

A

100 decreased cardiac output
Decrease in umbilical blood flow
Decrease oxygen to the fetus leading to fetal hypoxia

142
Q

what does terbutaline do?

A

It stops the contractions

143
Q

what is considered a fever?

A

Body temperature of above 100.4°F

143
Q

what are some tocolytics?

A

Nifedipine, nicardipine, terbutaline

143
Q

what is an indication of beta methadone?

A

Women at 24 to 34 weeks gestation with signs of preterm labor or at risk to deliver preterm

143
Q

what is an adverse reaction to betamethasone?

A

Adverse reactions include and may require temporary insulin coverage to maintain euglycemia

144
Q

what is the action of betamethasone?

A

Stimulates the production of more mature surfactant in the fetal lungs to prevent respiratory distress syndrome and premature infants

144
Q

what is the difference between a variable deceleration and early deceleration?

A

Variable decelerations have sudden drops with or without contractions such as the letters U, V, or W

144
Q

Amniotic fluid index

A

measures the volume of amniotic fluid with ultrasound to assess fetal well-being and placental function

144
Q

contraction stress test

A

Assess fetal well-being and utero placental function with external fetalmonitor and women with non reactive NST at term gestation to identify a compromised fetus

144
Q

multiple marker screening

A

triple marker and quad screen

144
Q

alpha fetoprotein screening

A

glycoprotein produced in the fetal liver GI tract and yolk sack to assess for developmental defects in the fetus such as neural tube defects

144
Q

when would you conduct an umbilical artery Doppler flow?

A

to assess fetal status and intrauterine growth restricted fetuses

144
Q

which test is both a screening and diagnostic?

A

Ultrasound

144
Q

nuchal translucency

A

looks at the space at the back of your baby’s neck called the nuchal fold to help assess risk for down syndrome and other genetic problems in the baby.

144
Q

umbilical artery Doppler flow

A

uses advanced ultrasound technology to assess resistance to blood flow in the placenta to evaluate rate and volume of blood flow through the placenta and umbilical cord vessels

145
Q

vibroacoustic stimulation

A

screening tool that uses Tory simulation to assess fetal well-being with EFM when non stress test is reactive to startle the fetus

145
Q

what kind of information can you get with an ultrasonography? (8)

A

Gestational age
Fetal anatomy, growth, and activity
Placental abnormalities and location
Amount of amniotic fluid
Visual assistance for invasive procedures

145
Q

What trimester would you detect placenta previa or abruption from an ultrasound?

A

3rd trimester

145
Q

when is the best time to check for fetal anomalies on an ultrasound?

A

Best after 18 weeks or intrauterine growth restriction

145
Q

when is umbilical artery Doppler considered abnormal?

A

If the systolic diastolic ratio is above the 95th percentile for gestational age
Or ratio above 3.0, or the end diastolic flow is absent or reversed

145
Q

when should you not use vibroacoustic stimulation?

A

When there is a deceleration or bradycardia

145
Q

Components of a biophysical profile

A

MRI
US
Doppler (umbilical artery)

146
Q

What are some maternal triggers of labor?

A

Stretching of uterine muscle
oxytocin release
release of prostoglandins
estrogen/progesterone changes

147
Q

Fetal factors to trigger labor

A

Prostaglandin
Increase to cause c
ontractions
Cortisol changes of fetus
Aging placenta

OB (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions