L&D and IPP Flashcards
Other Def/Concepts (96 cards)
1
Q
To deliver breech safely at home
A
Frank or complete
Anterior or transverse position
Well-flexed head
Gynecoid pelvis
Average sized baby
2
Q
In a Breech after trunk, legs, and feet are delivered rotate the infants back to:
A
antero-posterior/ sacrum anterior position
3
Q
Birth head in
A
OA position
4
Q
What maneuver can deliver a head in breech
A
Mauriceau smellie veit
5
Q
Signs and RDS in Newborn
A
Cyanosis, tachypnea, grunting, retractions, nasal flaring
6
Q
Cardinal movements
A
Engagement, Descent, Flexion, Internal Rotation, Extension, Resititution, External Rotation, Expulsion
7
Q
Engagement
A
Biparietal diameter (largest diameter) of fetal head passed through pelvic inlet and engages at the ischial spine
8
Q
Descent
A
Happens throughout labor
9
Q
Flexion
A
occurs when the fetal head meets resistance. First cervix then PF
10
Q
Internal Rotation
A
Head rotates with fontanelles running N to S birth of head to navigate pelvis and muscles. Shoulders do not fully rotate
11
Q
Extension
A
Head is born
12
Q
Resititution
A
head rotates 45 degrees to untwist and realign the shoulders
13
Q
External Roataion
A
Head and shoulders rotate
14
Q
Expulsion or lateral flexion
A
Anterior shoulder born by expulsion then posterior shoulder by lateral flexion and is born
15
Q
Prolonged second stage
A
more than 2hrs with urge to push. Boost maternal energy with honey, electrolytes
16
Q
Circumoral Cyanosis
A
blue around lips. Indicates heart, circulatory, intracranial problems
17
Q
Desquamation
A
peeling of the skin
18
Q
low ears
A
kidney issues see ped immediately
19
Q
unequal femoral pulses
A
might be congenital heart problem
20
Q
Midwife should stay PP for how long
A
at least 2 hours and/or until mom’s vitals are stable and WNL for 1 hour
21
Q
How dilated can the cervix get without pressure from the presenting part?
A
6 cm
22
Q
If there is cervical edema at 6 cm
A
malpresentation, presenting part not well applied to cervix
23
Q
Cervical edema at 8 cm
A
change position
24
Q
AROM is best to prevent cord prolapse
A
+4cm, 0 station or lower
25
Most common cause of sustained tachycardia in term fetus
maternal or fetal infection
26
Chorioamnitis
infection or inflammation of amniotic sac, amnion and choiron
27
S/s of chorioamnionits
maternal fever, +100.4, tachycardia, uterine Tenderness, foul smelling amniotic fluid
28
Chorioamnionits can casue
neonatal sepsis, meningitis, pneumonia, cerebral palsy
29
Risk of induction
fetal intolerance to labor, excessive uterine activity, pp uterine atony, increased risk of c-section
30
What is the most common cause of labor dystocia?
Dysfunctional uterine activity
31
Hypertonic Uterus
Dysfunctional uterine activity, uncoordinated forceful ctx, common in active labor and nulliparous women, leads to prolonged labor and exhaustion
32
OP presentation is associated with
prolonged first and second stages, 3x chance of c-section. Perineal tears, birth trauma, 5 min apgar <7. Umbilical artery acidemia
33
Uterine inversion
Maternal shock, manually reposition uterus with hands, transfer with hand in place, discontinue uterotonics
34
Signs of neonatal infection
fever, lethargy, dehydration, jitteriness
35
Endometritis s/s
fever over 101, elevated pulse, pelvic pain and sub involution of the uterus
If gone untreated, can infect pelvic ligaments, connective tissue, vomiting, chills, extreme pain
36
Superficial thrombophlebitis
pain, heat, tenderness, localized redness at site of inflammation
37
Testing for thrombophlebitis
homan’s sign: sit with leg straight out gently push on knee and dorsiflex foot. Pain in calf is +. Elevate leg and contact dr.
38
Deep thrombophlebitis s/s
high fever, severe pain, edema, tenderness along entire leg. Elevate leg and contact dr. DO NOT TOUCH LEG (embolism O2 and ambulance)
39
Natural remedy for nerve/muscle pain
St john wort (homeopathic Hypericum)
40
Events which stimulate the neonate to breathe include all of the following
-Feeling of decreased temperature change
- sensation of gravity
- fetal lung fluid clearing from the mouth and trachea during birth
41
A pt SROMs in labor. Upon rupture, thick meconium-stained amniotic fluid is noted. What is the next best management step?
Prepare for immediate intubation with an endotracheal tube
42
Immediately after birth, the midwife places the newborn skin to skin with the mother and covers them with a light blanket. What kind of heat loss is the midwife preventing?
Evaporation
43
A midwife is educating a client on how to time contractions in labor. She advises the client to:
Measure from the beginning of one contraction to the beginning of the next
44
In second stage labor, you hear FHT that dip into the 70-80 range after the peak of the ctx and 45 seconds beyond the end of the ctx. What is your assessment?
Physiologic head compression in 2nd stage
45
You arrive at a labor and the mother has a feeling of doom, bright red bleeding, and pain that is unrelenting. What do you suspect?
Uterine abruption
46
A grandmultip began her labor with her wts releasing. Find out it is a breech she is complete and +2 station. She feels comfortable to stay at home. What are your instructions to her as regards to the next steps
Encourage her to breathe through the ctx as long as possible and let the baby descend. Only begin pushing when the urge to push is overwhelming
47
A ct calls you saying she is in labor her ctx are 4-5 minutes apart, lasting 45 seconds and she has to stop what she is doing with each one. She has vomited once since breakfast and feels nauseous occasionally. you arrive at her house and upon cervical exam find that she is 5/80/0. What stage of labor is she in?
Stage one, active phase
48
Next, you instruct your student midwife to complete the gestational age assessment. you observer her during the assessment and note that the baby has moderate flexion in the legs and minimal flexion in the arms. based solely on this observation, you determine that the baby is?
Preterm
49
What landmarks are used to assess fetal position during a cervical exam?
Sagittal suture and fontanelles
50
During pushing, you auscultated FHT and note that there is a significant dip as the contraction starts. It is back to baseline before the end of the ctx. your first action would be:
Begin oxygen therapy
51
What instrument is NOT used for suturing
thumb forceps
52
A midwife must know how to deliver a baby in a breech presentation. Situation(s) in which a midwife may be confronted with a breech delivery
- A woman with little or no prenatal care
- A woman who makes an informed decision to have a vaginal delivery
- A women with a second twin in a non-vertex presentation
53
Deep transverse arrest is associated with a pelvis type of
Platypelloid and Android
54
What are s/s of shock
- ringing of the ears
- metallic taste in mouth
- hypotension
55
The correct order of the mechanisms of labor for an LOA baby is
descent, flexion, internal rotatin (N-S), extension, restitution, External Rotation (E-W), Expulsion
56
When is it normal to see frank meconium in labor
When baby is breech
57
Friedman's curve has led to more dx of what?
Failure to progress
58
Your client is in early labor and experience premature rupture of membranes. which is the best way to minimize the risk of infection
take maternal temperature every few hours
59
The most accurate method to identify premature rupture of membranes is
Positive ferning under a microscope
60
Face presentation
when the head is fully extended
61
The first step in performing infant resuscitation is
wrap the baby in warm blankets and cover their head
62
During the immediate newborn exam, you find the infant has a respiration rate of 125. you know you need to transfer the baby for the following conditions
transient tachypnea of the newborn
63
THe best way to differentiate between true labor and false labor
amount of cervical dilation that occurs
64
Active Labor is characterized by cervical dilation of
4cm
65
Placenta abruption can be caused by what conditon/ event
-trauma
- cord entanglement
- hypertension
66
What type of placental abruption refers to separation at the edge of the placenta only
marginal abruption
67
what is the main concern with twin or higher multiple pg during labor?
cord prolapse
68
During the second stage of labor, you are taking FHT and detect early decelerations. You know this is caused likely by what?
head compression
69
which depicts the correct order of cardinal movements in labor
descent, engagement, restitution
70
During the 3rd stage of labor you are attempting to deliver the placenta. when you look down you notice that the uterus is emerging with the placenta still attached. what is your next step?
Push the uterus back in an dcall EMS
71
Your client is pushing and the baby's head is born. there is a nuchal cord present. which of the following is not an appropriate management technique
perform the gaskin maneuver
72
The best way to manage variable decelerations during labor is to
change the birthing persons's position
73
Clinical exhaustion is dx by
ketonuria, elevated temp, elevated pulse
74
Primary apnea
responds to stimulation caused by short mild hypoxia before birth
75
secondary apnea
does not respond to stimulation and requires ppv. caused by longer period of hypoxia before birth
76
when can you get pg after birth?
3-4 weeks
77
Maternal hyperventilation can lead to
fetal metabolic acidosis (slow down breathing)
78
Late decel
utero placental insufficiency drops at peak
79
variable decelerations
cord compression
80
true pelvis
iliac crest and pelvic brim
81
After the delivery of the placenta following a precipitous birth, you notice a trickle bleed. what do you suspect
cervical laceration
82
When dealing with a face presentation, what might you find on a vaginal exam?
lumpy structures as the presenting part
83
To manage a face presentation at delivery, the midwife will do which of the following
Apply counter pressure to the baby's brow on the perineum until the chin is delivered
84
The mother at 38 weeks reports that her baby had been "moving all night" and she felt very large movements. she is feeling kicks in her lower abdomen. what is your first action
to perform an abdominal assessment to check for position
85
why is suprapubic pressure used in breech deliveries
to maintain flexion of the head
86
if the mother has a pendulous abdomen, what would you recommend for increasing the power of her contractions?
standing and lifting her lower belly with contraction
87
You note on your newborn exam that the baby's pupils are slow to respond to light stimulation and they are unequal in size.
Neurological issues
88
Which of the following has been demonstrated to reduce perineal trauma
warm compress
89
you are performing a vaginal exam in labor. you feel the posterior fontanelle at 2 o'clock and the sagittal suture line running diagonal. what position is the baby in?
LOA
90
What is the number one cause of PPH?
uterine atony
91
Which of the following is a sign that true labor has begun>
Cervical dilation
92
Immediately after birth, you have a baby who has an APGAR of 3 for 1 minute, 7 for 5 minutes, and 8 for 10 minutes. the baby transitions slowly and the skin goes from pale to pink with blue fingertips. when you do the newborn exam, you see that the baby's trunk and face is bright red skin tone. What is your assessment?
Possible polycythemia, refer to pediatrician
93
A baby is born after moderate to severe particulate meconium. The baby transitions with stimulation and no suction. Baby is not having retractions, grunting, or rapid breathing. How should you manage this PP period to ensure the baby doesn't get meconium aspiration syndrome?
Monitor closely and ensure that the parents understand how to look for s/s of respiratory distress for the next 48 hours
94
Your client has had LEEP procedure. She has been at 5 cms for more than 6 hours. what is your next action?
Place evening primrose oil on a sterile glove and gently break up adhesions
95
you attend a client's birth who is expecting a breech delivery. Which is part of the proper technique for safely delivering a breech?
Do not touch the baby to assist until the baby is born to the umbilicus
96
