High Risk Obstetrical Emergencies

Question 1

What is the mauriceau maneuver?

Answer 1

A method of delivering the head in an assisted vaginal breech delivery in which the infant body is supported by the right forearm while traction is made upon the shoulders by the left hand. Head is maintained in a flexed position by placing the index and middle finger of the maxillary prominence on either side of the nose.

Question 2

Which type of breech presents with buttocks flexed at the hip and extended at the knees?

Answer 2

Frank Breech
65-70% of breechs

Question 3

Which type of breech presents with hips and knees flexed so that the baby is sitting cross legged with feet beside the buttocks?

Answer 3

Complete Breech

Question 4

Which type of breech presents with one or both feet come first with the buttocks at a higher position.

Answer 4

Footling Breech

Question 5

Which type of breech presents with one or both legs extended at the hips and flexed at the knees?

Answer 5

Kneeling

Question 6

What is a hypertonic Uterus?

Answer 6

Hyperstimulated.
An overdose of oxytocin may cuase this type of uterine activity

Question 7

V C
E H
A O
L P

Answer 7

Variable Cord compression
Early Head compresion
Accelerated Okay
Late Placenta

Question 8

What is the first stage of labor?

Answer 8

Onset of labor and ends when the cervix is 100% effaced and completeley dilated to 10cM 12-17 hrs

Question 9

What is the second stage of labor?

Answer 9

When cervix is completely effaced and dilated and ends with birth. 1-2 hours

Question 10

What is the third stage of labor?

Answer 10

Begins with birth and ends at delivery of placenta. 15-20 minutes

Question 11

What is the fourth stage of labor?

Answer 11

Delivery of placenta and ends after 1-2 hours after delivery

Question 12

Fetus of preelcamptic mother during labor will comonly experence

Answer 12

Late Decelerations

Question 13

Normal Magnesuim level is

Answer 13

1.5-2.5

Question 14

Theraputic serum magnesium to prevent seizures in OB

Answer 14

4-8mEq/L

Question 15

What are the main assessment fingings in pregnacy induced hypertension (PIH)

Answer 15

Hypertension, Edema, proteinuria

Question 16

Fesus’s variability is

Answer 16

expected to increase during active labor, normal 10-15 beats per minute and the best indicator of fetal viability

Question 17

What is minimal variability

Answer 17

<5

Question 18

What is moderate variability

Answer 18

6-25

Question 19

What is Marked variability

Answer 19

> 25

Question 20

Causes of Sinusoidal pattern on EFM

Answer 20

Fetal hypovolemia, accidental tap of the umbilical cord during amniocentesis, placetal abruption

Question 21

What does HELLP stand for?

Answer 21

Hemolysis, Elevated Liver enzymes and Low Platlets
complication of severe preeclampsia, life threatening
Platelet count lower than 100,000 is characteristic of HELLP
High biliruben, lower platelet and red blood cell fragment and irregularly shaped red blood cells

Question 22

When do you give methergine?

Answer 22

0.2mg administered IM or IV is recommended to prevent or control bleeding following birth.

Question 23

What side effects can be seen after magnesium sulfate administrion

Answer 23

Flushing of skin, diaphoresis, nausea, vomiting and drowsiness. A decrease in FHR variability may be observed.

Question 24

What is given to prevent hemolytic disease of newborn

Answer 24

Rho(D)

Question 25

Frequency of contractions is defined as

Answer 25

begnning of one contraction to the begnning of another

Question 26

The Duration of contractions is defined as

Answer 26

beginning of one contraction to the end

Question 27

How do you measure fundal height

Answer 27

From top of bupic bone to top of the uterus

Question 28

Fundal height just above the umbilicus is how many weeks

Answer 28

20-24 Weeks

Question 29

Where do most ectopic pregnancies occur

Answer 29

Fallopian tubes

Question 30

What medications can decrease or stop uterine activity

Answer 30

Terbutaline, mag, nsaid's

Question 31

What med can help decrease the chance an infant will have respiratory distress syndrome

Answer 31

Betamethasone (Celestone)

Question 32

A small amount of fluid is spread on a sline and allowed to dry, a frond crystallization pattern of dried amnionitic flud will be seen under microscopic exam, what is this called

Answer 32

Postivie Ferning

Question 33

Nitrazine paper will turn what color in presence of amniotic fluid

Answer 33

Blue

Question 34

What are contraindications for Magnesium sulfate administration

Answer 34

Myasthenia gravis and renal failure

Question 35

What is Macrosomia

Answer 35

Newborns with excessive birth weight

Question 36

When can Uterine inversion occur

Answer 36

excessive cord traction, fundal pressure, uterine atony rate mecial emergency where uterus turns inside out and protrudes into the vagina. treatment is immediate manual reduction by pushing up on the fundus is returned to its normal position

Question 37

What is the most common cause of preterm labor

Answer 37

Infection

Question 38

Define Placental abruption

Answer 38

premature detachment of a normally implanted placenta from uterine wall

Question 39

Diasotlic BP goal when managing pregnancy induced hypertension is

Answer 39

90-100

Question 40

What method should be used to monitor an OB patient with suspected concealed bleeding

Answer 40

marking and determining fundal height frequently

Question 41

EFM strip is V-shaped or W-shaped and what does it indicate

Answer 41

Variable deceleration Cord compression

Question 42

Normal FHR

Answer 42

110-160

Question 43

Fetal Bradycardia

Answer 43

<100 bpm

Question 44

Fetal tachycardia

Answer 44

>160

Question 45

What is the most common cause of postpartum hemorrhage

Answer 45

uterine atony Loss of tone in the uterine musculature 75-80% of postpartum hemorrhage is due to uterine atony

Question 46

Leopolds Maneuver is

Answer 46

Common and systematic way to determine the position of a fetus inside the uterus.

Question 47

Physiologic changes to mother during pregnancy

Answer 47

Increase blood volume increase CO increased minute ventilation ABG cahnges to compensated rep alkalosis

Question 48

Preterm labor patient is identified as

Answer 48

24-36 weeks

Question 49

What medication should the pre term labor mother recieve

Answer 49

Tocolytic agent, Terbutaline 0.25 mg or Mag 4G infuse

Question 50

What presents with fetal parts palpated inthe abdomen

Answer 50

Uteine rupture, likley caused by trauma

Question 51

Pregnancy HTN meds

Answer 51

Mag 4g in 100ml over 20 min Labetolol 10 mg SIVP with stacked dosing (10,20,40) Hydralazine (alpresoline) Nifedipine (procardia) CCB that targets the arteries

Question 52

Magnesium toxicity presents with what and what is given to reverse the effects

Answer 52

reduced DTR, CNS depression, Hypotension, Give galcium as a reversal agent

Question 53

A EFM where heart rate deceleration occurs completly after the contaction is complete

Answer 53

Late Decel

Question 54

A EFM where heart rate deceleration occurs at the same time as contaction

Answer 54

Early Decel

Question 55

A EFM where heart rate deceleration occurs in a V shape or sharp decline

Answer 55

Variable decel

Question 56

A EFM where heart rate acceleration occurs with contraction

Answer 56

Normal

Question 57

What do you do if the OB patient develops uterine tetany

Answer 57

discontinue infusion