Intrapartum Concerns

Question 0

CTX > 2 min, 5 or more/10 min, frequency every 1 minute

Answer 0

Uterine hyperstimulation

Question 1

Any deviation from normal progress of labor

Answer 1

Dystocia

Question 2

Slow progress in the active phase

Answer 2

Hypertonic uterine motility

Question 3

Seen in most android pelvis

Answer 3

Occiput posterior

Question 4

Where is FHT located in posterior occiput?

Answer 4

Located in flank and is slower

Question 5

How do you evaluate for occiput posterior position?

Answer 5

Leopold’s maneuvers, abdominal contour, suture lines

Question 6

Occiput posterior effects on contractions

Answer 6

Diminish in frequency and intensity

Question 7

Where is labor felt in occiput posterior?

Answer 7

Back

Question 8

What happens to dilation and descent with occiput posterior?

Answer 8

Dilation slows and descent is delayed

Question 9

What is prolonged with occiput posterior?

Answer 9

Active labor and second stage

Question 10

What can happen to the fetus if they are occiput posterior?

Answer 10

Asphyxia

Question 11

How do you manage occiput posterior?

Answer 11

Manual rotation, forceps delivery, forceps rotation, may extend episiotomy

Question 12

How often does breech presentation occur?

Answer 12

3-4%

Question 13

When is breech most common?

Answer 13

Preterm deliveries

Question 14

What risks are associated with breech presentation?

Answer 14

Prolapsed cord, fetal asphyxia, intercranial hemorrhage, birth injuries

Question 15

What is preferred for delivery of a breech?

Answer 15

C-section

Question 16

Helps prevent entrapment of fetal head in a breech

Answer 16

Wigand Martin maneuver

Question 17

When can you do external version?

Answer 17

36-37 weeks

Question 18

What do you use to confirm external version?

Answer 18

Ultrasound

Question 19

What is the success rate with external version?

Answer 19

58%

Question 20

Any head to body delivery time greater than 60 seconds

Answer 20

Shoulder dystocia

Question 21

Risk factors for shoulder dystocia

Answer 21

A- advanced age
D- diabetes
O- obese
P- postterm or previously large baby
E- excessive weight gain in pregnancy

Question 22

Physician tries to go in vaginally and rotate shoulder

Answer 22

Wood’s corkscrew

Question 23

Lift the knees toward the head and apply suprapubic pressure for shoulder dystocia

Answer 23

McRobert’s

Question 24

Get on all fours to deliver with shoulder dystocia

Answer 24

Gaskin maneuver

Question 25

Replace the head in the pelvis and deliver via c-section

Answer 25

Zanvanelli maneuver

Question 26

When do you use Zanvanelli maneuver?

Answer 26

After all other efforts are attempted

Question 27

What does the Zanvanelli move require?

Answer 27

Uterine relaxation (terbutaline) and general anesthesia

Question 28

What are cues to shoulder dystocia?

Answer 28

Long transition and long second stage

Question 29

What do you need to document during the labor?

Answer 29

Delivery of the head

Question 30

What management does the nurse do with shoulder dystocia?

Answer 30

Maneuver, postpartum assessment, and notify nursery

Question 31

Damaged or torn nerve due to extreme traction on the infants head

Answer 31

Erb's palsy

Question 32

Cord palpated through intact membranes ahead of the presenting part

Answer 32

Fundic cord prolapse

Question 33

Cord not visible or palpable and cord lies beside the presenting part

Answer 33

Occult cord prolapse

Question 34

Cord is seen or palpated ahead of the presenting part

Answer 34

Complete cord prolapse

Question 35

What are symptoms of cord prolapse?

Answer 35

Severe repetitive variables, bradycardia after SROM or AROM, and prolonged deceleration

Question 36

What can you do to manage cord prolapse?

Answer 36

Disengage presenting part, use gravity, fill bladder, tocolytic, IV fluids, oxygen, anticipate c-section

Question 37

What should you never do with a cord prolapse?

Answer 37

Attempt to push it in and do not cover it with anything wet