Labor And Birth

Question 1

Sterilization

Answer 1

Destruction of all forms of microbial life

Question 2

Nonreassuring/ominous patterns

Answer 2

Profound bradycardia, recurrent late and variable decelerations, absent variability

Question 3

Nonreassuring patterns

Answer 3

Fetal tachycardia

Bradycardia (80-100 bpm)

Saltatory pattern
Variable decels with slow return to baseline

Late decels with normal variability

Question 4

Ominous patterns

Answer 4

Persistent late decels with minimal variability

Nonreassuring variable decels with minimal variability

Bradycardia <80 bpm for more than 3 minutes,

Sinusodial pattern

Flat tracing with minimal variability

Question 5

Management of non reassuring/ominous patterns

Answer 5

Explain concerns

Change maternal position

Monitor FHR as frequently as possible

Assess ctx pattern

Give 02

Perform vaginal exam

Scalp stim

Call Ems/transport

Iv fluids

Assess vitals

Assess for cord prolapse

Assess bleeding.

Question 6

Bradycardia

Rate?

Causes?

Assessments?

Answer 6

Rate: 100-119 bpm the absence of other non-reassuring patterns is not usually a sign of compromise

Etiologies: maternal hypothermia, cord compression or prolapse, canal stimulation, cardiac abnormalities, occipital posterior or transverse position, serious fetal compromise

Assessments: presence of prolapsed cord, duration of bradycardia, presence or absence of variability, late or prolonged variable decelerations, expected time to delivery.

Question 7

Tachycardia
Rate?

Answer 7

Rate: >160 bpm in the presence of good variability tachycardia is not a sign of fetal distress.

Mild tachycardia 160-180bpm

Severe tachycardia >180bpm

Question 8

Tachycardia etiologies

Answer 8

Continued tachycardia above 180 bpm suggests chorioamnioitis esp when maternal fever is present

Maternal fever, fetal hypoxia, fetal anemia, amnionitis, fetal tachyarrythmia(usually >200-240 bpm), fetal heart failure, drugs, rebound transient tachycardia following a decel accompanied by decreased variability

Question 9

Baseline change

Answer 9

The decrease or increase in heart rate lasts longer than 10 mins

Question 10

Reassuring FHT patterns

Answer 10

Baseline is normal, variability moderate, accelerations present; indicates healthy well oxygenated fetus

Question 11

Baseline FHR

Answer 11

120-160bpm
Baseline excludes periods of marked FHR variability, periodic or episodic changes, and segments of baseline that differ by more than 25 bpm

Minimum baseline is 2 minutes. If minimum baseline duration is <2 min the baseline is indeterminate

Question 12

What sets baseline?

Answer 12

Atrial pacemaker sets baseline, best to best variation influenced by sympathetic and parasympathetic ANS

Baseline FHR gradually decreases as fetus ages

Question 13

describe contractions with a frequency of 3 minutes?

Answer 13

contractions that last for 30 seconds with a 2 1/2 minute rest in between

Question 14

A positive direct Coombs test done on the cord blood indicates the presence of:

Answer 14

antibodies coating the baby’s red blood cells

Question 15

Marked tachycardia in a fetus is defined as:

Answer 15

Heart rate above 180

Question 16

,The relation of the occiput (in a vertex presentation) to the & areas of the pelvic brim is called the fetal:

Answer 16

position

Question 17

The first stage of labor is defined as:

Answer 17

onset of true contractions to full dilation

Question 18

Mechanisms
of labor

What are the 7 cardinal movements (mechanisms) of labor?

Answer 18

1. Engagement – Head enters pelvic inlet
   
   2. Descent – Baby moves down through pelvis
   3. Flexion – Chin tucks to present smallest diameter
   4. Internal Rotation – Head rotates to fit pelvic shape
   5. Extension – Head extends to pass under pubic bone
   6. External Rotation (Restitution) – Head realigns with shoulders
   7. Expulsion – Shoulders and body are born

Question 19

Descent

Answer 19

Descent = downward movement of the fetus through the pelvis
• Occurs throughout labor, especially during contractions
• Influenced by:
• Uterine contractions
• Maternal pushing
• Fetal position and size

Question 20

What is flexion in the mechanisms of labor?

Answer 20

Allows the smallest head diameter (suboccipitobregmatic) to present
• Promoted by resistance from pelvic floor and uterine contractions
• Helps baby navigate the birth canal more easily

Question 21

What is internal rotation in the mechanisms of labor?

Answer 21

• Internal Rotation = fetal head rotates to align with the pelvic diameter
• Typically, the head turns from occiput transverse (sideways) to occiput anterior (facing down)
• Facilitates passage through the pelvic outlet
• Occurs after flexion to fit the pelvis shape

Question 22

What is extension in the mechanisms of labor?

Answer 22

• Extension = fetal head extends to pass under the pubic bone
• Happens as the head moves through the pelvic outlet
• The chin lifts away from the chest, and the head emerges
• Crowning occurs during thi

Question 23

What is external rotation in the mechanisms of labor?

Answer 23

• External Rotation (Restitution) = fetal head rotates back after delivery
• Aligns the head with the shoulders, which are still in the birth canal
• Allows shoulder rotation to help with shoulder delivery
• Occurs immediately after the head is born

Question 24

What is expulsion in the mechanisms of labor?

Answer 24

• Expulsion = delivery of the body after the head and shoulders
• Occurs once the shoulders are delivered and the rest of the body follows
• Facilitated by maternal pushing and the natural pull of gravity
• Final step in the birth process

Question 25

What are the 3 P’s of labor and how do they affect birth?

Answer 25

1. Power – The strength of uterine contractions and maternal pushing • Effective power moves the baby through the birth canal 2. Passenger – The fetus and its characteristics (size, position, presentation) • Fetal position and size influence labor progress 3. Passage – The birth canal (pelvis and cervix) • Pelvic shape and size impact how the baby fits and moves through

Question 26

Brow presentation

Answer 26

Sinciput is the presenting part

Question 28

Restitution

Answer 28

• Restitution = the slight turn the fetal head makes after birth of the head • The head realigns with the shoulders, which are still inside the birth canal • Part of external rotation • Indicates normal shoulder rotation is occurring

Question 29

synclitism

Answer 29

The sagittal suture of the fetal head is felt midway between the symphysis pubis and the sacral promontory. This would indicate:

Question 30

If hypovolemic shock is occurring, the midwife should:

Answer 30

elevate the woman's legs

Question 31

In shock, a person's blood pressure typically:

Answer 31

rises for a short time then falls

Question 32

In shock, a person's pulse:

Answer 32

Rises

Question 33

In shock, a person's respirations:

Answer 33

Rise

Question 34

If a baby entered the pelvis in the LOP position, to be born he must rotate to a:

Answer 34

OA or OP position

Question 35

The midwife is listening during a contraction and hears the fetal heart rate drop following the acme of the contraction. What kind of decelerations are occurring?

Answer 35

Late