labor and delivery

Question 1

preterm delivery is when

Answer 1

before 37 wks gestation

Question 2

most common cause of neonatal deaths not resulting in congenital malformations

Answer 2

preterm delivery

Question 3

low birth wt infants born prematurely often have what (3)

Answer 3

significant developmental delays, Cerebral palsy, lung disease

Question 4

best test to examin the length of the cervix

-normal length?

Answer 4

ultrasonography

4 cm

Question 5

a length of what of the cervix at when increases the risk to deliver prematurely

Answer 5

a length of 2 cm at 24 wks gestation

Question 6

marker for preterm labor

Answer 6

cervicovaginal secretions for fetal fibronectin, a glycoprotein
- absence means a low rik of delivery within 2 weeks

Question 7

if the cervical length and the fetal fibronectin are

• abnormal
• normal

Answer 7

• abnormal: 50% chance of delivery before 34 wks gestation

- normal: 11% chance of delivery before 34 wks gestation

Question 8

2 labs to get for preterm labor

Answer 8

vaginal cultures and UA with culture & sensitivity

Question 9

define preterm labor

Answer 9

regular uterine contractions(>4 to 6 hr) between 20 and 36 weeks with (1 of the following):

• cervical dilation of 2 or greater at presentation
• cervical dilation of 1 cm or greater on serial exams
• cervical effacement of greater than 80%

Question 10

tocolytic (mediated by calcium)

-what to give in toxicity

Answer 10

mag sulfate

give calcium gluconate

Question 11

CCB in pregnancy

- side effects

Answer 11

tocolytic;

- maternal hypotension and tachycardia

Question 12

17 alpha hydroxyprogesterone caproate

Answer 12

weekly injections from 16-36 wks

Question 13

major risk of PROM and PPROM

Answer 13

infection (chorioamnionitis and endometritis)

Question 14

4 tests for rupture of membranes

Answer 14

sterile spectulum, nitrazine paper, fern test,

ultrasonography(check amniotic fluid index)

Question 15

avoid what in PROM

Answer 15

digital exam

Question 16

ropelike, soft, elongated mass

Answer 16

cord prolapse- EMERGENCY. immediate delivery

Question 17

test to check for lung maturity

Answer 17

amniocentesis.

Question 18

dilatation

Answer 18

opening of cervical os (cm)

Question 19

effacement

Answer 19

cervical softening and thinning out (%)

Question 20

station

Answer 20

location of the presenting part(usually head) in relation of ischial spines

Question 21

0 station; + and - means what

Answer 21

0 is level at the ischial spines

• above spines is -
• below spines is +

Question 22

first stage of labor usual length (hours)

Answer 22

• ends at full dilation
  nulliparous: 6-20 hours
  multiparous: 2-14 hours

Question 23

second stage of labor

Answer 23

• full dilation and ends with delivery of infant
  nulliparous: 30 min to 3 hours
  multiparous: 5 to 60 minutes

Question 24

third stage of labor

Answer 24

is the expulsion of the placenta. usually 5 minutes

Question 25

fourth stage of labor

Answer 25

hour after delivery critical in assessing and treating tears lacerations, and hemorrhage

Question 26

order what 3 labs on admission

Answer 26

UA for protein, glucose, and hematocrit

Question 27

cervix has to be dilated to what for an internal fetal monitor

Answer 27

2 cm and membranes ruptured

Question 28

good accelerations is what

Answer 28

15 bpm for 15 seconds above the nml baseline heart rate

Question 29

early decels

Answer 29

woman approaching second stage of labor and considered benign

Question 30

think what with variable decels

Answer 30

cord compression

Question 31

what to do with a non-reassuring fetal heart rate

Answer 31

stop oxytocin, change position, give O2 via mask, measure fetal scalp pH

Question 32

after crowning, what to do to protect the perineal musculature

Answer 32

apply pressure from the coccygeal region upward will extend the head at the proper time

Question 33

signs of placental separation

Answer 33

umbilical cord lengthening fresh show of blood flow fundus rising uterus becoming firm and globular

Question 34

cord contains what vessels

Answer 34

3; two arteries and one vein

Question 35

what to give to reduce blood loss in 3rd stage

Answer 35

oxytocin; stimulates contractions

Question 36

what is dystocia

Answer 36

abnormal labor; when cervix fails to dilate progressively over time and the fetus fails to descend

Question 37

foul smelling lochia, increased bleeding, pain, fever, enlarged and soft uterus

Answer 37

subinvoluted uterus

Question 38

IV ergonovine, methylergonovine, prostaglandins, oxytocin

Answer 38

first line tx for early postpartum hemorrhage

Question 39

subinvoluted uterus tx

Answer 39

oral agents that increase uterine contractions(ergonovine, methylergonovine); antibx

Question 40

endometritis occurs when

Answer 40

after C section or when membranes are ruptured more than 24 hrs before delivery

Question 41

endometritis findings and they occur when

Answer 41

fever higher than 101; uterine tenderness; 2-3 days postpartum

Question 42

adnexal tenderness, peritoneal irritation, and decreased bowel sounds

Answer 42

may occur with endometritis

Question 43

WBC with endometritis

Answer 43

over 20,000

Question 44

common organism with endometritis | -get what test

Answer 44

anaerobic streptococci | -UA

Question 45

endometritis tx

Answer 45

clinda plus gentamycin first line ampicillin added if no response in 24-48 hrs flagyl if sepsis present

Question 46

what reduces incidence of endometritis

Answer 46

single dose of antibiotic at the time of cord clamping

Question 47

puerperium - at 2 days - at 2 weeks

Answer 47

2 days: uterus shrinks or involutes | 2 weeks: descends into the pelvic cavity

Question 48

when is the uterus back to the nml size

Answer 48

6 weeks

Question 49

what is lochia

Answer 49

bleeding that occurs AFTER delivery; lasts 4-5 weeks

Question 50

menses resume when in a non breast feeding mother

Answer 50

6-8 weeks

Question 51

APGAR

Answer 51

activity, pulse, grimace, appearance, respirations

Question 52

activity 0, 1, 2

Answer 52

0: absent 1: arms and legs flexed 2: active movement

Question 53

pulse 0, 1, 2

Answer 53

0: absent 1: < 100 bpm 2: > 100 bpm

Question 54

grimace 0, 1, 2

Answer 54

0: no response 1: grimace 2: sneeze, cough, pull away

Question 55

appearance 0, 1, 2

Answer 55

0: blue-gray pale all over 1: pink except extremities 2: pink all over

Question 56

respirations 0, 1, 2

Answer 56

0: absent 1: slow, irregular 2: good, crying

Question 57

most common cause of C sections

Answer 57

cephalopelvic disproportion

Question 58

primary cause of neonatal morbidity and mortality

Answer 58

preterm labor

Question 59

nitrazine turns blue

Answer 59

alkaline pH of amniotic fluid

Question 60

+ fern test

Answer 60

amniotic fluid dries up

Question 61

turtle sign

Answer 61

recoil of perineum. think shoulder dystocia

Question 62

AFI under 5 and over 25 on u/s

Answer 62

under 5 is oligohydraminos | over 25 is polyhydraminos

Question 63

40 fold increase in perinatal mortality

Answer 63

oligohydraminos

Question 64

musculoskeletal abnormalities such as club foot, facial distortion

Answer 64

think oligohydraminos complications