Intrapartum Care

Question 1

Before placement of epidural

What CBC labs are specifically looked into?

Answer 1

Platelets

(low platelets; risk for hemorrhage)

Question 2

before placement of epidural

Vital signs must be checked because it can cause what?

Answer 2

Epidurals can cause a hypotensive reaction.

Question 3

before placement of epidural

What can decrease risk of hypotension?

Answer 3

IV access and bolus

Reduce risk of hypotension

Question 4

after placement of epidural

what instrument must be in place?

(Not IV, since this is AFTER epidural placement)

Answer 4

Urinary Catheter

Patient is no longer able to get up and move around.

Question 5

When should APGAR be assessed?

Answer 5

1 and 5 minute of birth

Question 6

Describe the APGAR assessment

Answer 6

• Appearance = Color
• Pulse Rate = HR
• Grimace = cries w/ stimulation
• Activity = Flexion and resist extension
• Respiratory effort = Strong cry observed

Question 7

What APGAR score would require a further evaluation?

Answer 7

If < 7 on five minute assessment

Question 8

What is the primary goal of external fetal heartrate monitoring?

What is it to prevent?

Answer 8

To continually assess fetal oxygenation

fetal acidemia and minimizing unncessary interventions

Question 9

What are the contraindications for internal FHR monitoring?

Answer 9

Chorioamnionitis, active genital herpes, GBS+, HIV, placenta previa

Chorioamnionitis is infection of amniotic fluid and tissue

Question 10

Which type type of FHR monitoring allows for objective measures of uterine contractions (mmHg)

Answer 10

Internal fetal heart monitoring

Question 11

What does collecting umbilical cord help determine?
What does the blood from the vein and artery represent?

Answer 11

• severity of hypoxia during labor
• Vein assess oxygen supply and artery assess amount of oxygen used by fetus.

Question 12

What is normal fetal heart rate?

Answer 12

110 to 160 bpm

Question 13

what is fetal tachycardia baseline?

Answer 13

> 160 bpm for at least 10 min

Question 14

what is fetal bradycardia baseline?

Answer 14

< 110 bpm for at least 10 min

Question 15

How is normal FHR baseline assessed
Does it include accelerations and decelerations?

Answer 15

FHR is rounded to 5 bpm in 10-minute window of time, excludes accelerations and decelerations.

Question 16

What is the following called?

Fluctuations from baseline FHR that are irregular in amplitude and frequency (excludes accelerations and decelerations)

Answer 16

Baseline variability

Fetal Heart Monitioring graph

Question 17

Describe absent variability

Answer 17

Amplitutde range is undetectable

Question 18

Describe minimal variability

Answer 18

amplitude range is ≤ 5 bpm

Question 19

Which type of variability is normal?

Answer 19

Moderate variability

Question 20

Describe moderate variability

Answer 20

amplitude from peak to trough is 6-25 bpm.

Question 21

Describe marked variability

Answer 21

amplitutde > 25 bpm

Question 22

What is an FH acceleration?

Answer 22

visually abrubt increase in FHR above baseline
≥ 15 bpm lasting for 15 sec but < 2 min

Question 23

Baseline variability represents an interaction of what?

Answer 23

sympathetic and parasympathetic fetal system

Question 24

a tear in the pernieum during labor is called what?

Answer 24

Laceration

Question 25

____ is a purposeful incision in the pernieum to provide more space for the presenting part at delivery

Answer 25

Episitomy

Question 26

# What degree laceration is this? tear in perineal skin and vaginal mucous membrane

Answer 26

1st deree laceration

Question 27

# What degree laceration is this? tear in perineal skin & muscle, and vaginal mucous membrane

Answer 27

2nd deree laceration

Question 28

# What degree laceration is this? tear in perineal skin, muscle, vaginal mucous membrane, and just before rectum.

Answer 28

3rd degree laceration

Question 29

# What degree laceration is this? tear in perineal skin, muscle, vaginal mucous membrane, and rectum.

Answer 29

4th degree laceration

Question 30

What is early deceleration?

Answer 30

When mother has a contraction babies HR drops at the SAME time. | (Mirrors Contractions)

Question 31

What is late deceleration?

Answer 31

**After** mothers contractions, babies HR drops. | (U-shaped Fetal HR)

Question 32

What is variable deceleration?

Answer 32

Variability in when the babies HR drops. The graph is non-uniform. | (Causes a V shaped fetal graph)

Question 33

Which fetal HR deceleartion is reassuring?

Answer 33

Early decelerations

Question 34

What causes early deceleration?

Answer 34

Contractions are **causing head compression** against the pelvis or soft tissue. | Just monitor it doesn't drop below 110bpm

Question 35

What causes late deceleration?

Answer 35

Utero-placental insufficiency. Fetus is not getting enough oxygen | (Non-Reassuring - Req intervention)

Question 36

What causes variable deceleration?

Answer 36

**Cord compression** (*e.g., prolapse cord, nuchal cord, etc*) | (Non-Reassuring - Req intervention)

Question 37

What is VEAL CHOP?

Answer 37

**V**ariable = **C**ord compression **E**arly = **H**ead compression **A**cceleration = **O**kay **L**ate = **P**lacental insuffieciency

Question 38

What is a FH category III?

Answer 38

**Absent** variability w/ either: 1. _recurrent_ late or variable declerations 2. bradycardia. or **Sinusoidal pattern**.

Question 39

What is a FHR category III?

Answer 39

**Absent** variability w/ either: 1. _recurrent_ late or variable declerations 2. bradycardia. or **Sinusoidal pattern**. | Abnormal

Question 40

What is a FHR category I What type of variability? Any decelerations?

Answer 40

Normal HR w/ moderate variability. * Early decelerations present or absent * ABSENT late or variable decelerations

Question 41

What is a FHR category II

Answer 41

All FHR tracing that isn't category I or II. (*e.g., tachycardia, bradycardia w/o absent variability, minimal variability, etc. *) | Inderterminate

Question 42

What is the primary goal of external fetal heartrate monitoring? | What is it to prevent?

Answer 42

To continually assess fetal oxygenation | fetal acidemia and minimizing unncessary interventions

Question 43

Describe moderate variability

Answer 43

amplitude from peak to trough is 6-25 bpm.

Question 44

**Uterine activity** is assessed for what three things?

Answer 44

1. Frequency 2. Intensity 3. Duration