Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NM 717 Comps > Module 5 Intrapartum Canvas > Flashcards

Module 5 Intrapartum Canvas Flashcards

1
Q

What are the three muscle layers cut by an episiotomy?

A

Bulbocavernosus, pubococcygeus and the superficial (and possibly) the deep transverse perineal muscles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is lightening and when does it occur?

A

the descent of the fetus into the true pelvis

may occur as early as 4 weeks prior to the onset of labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is engagement and some signs and symptoms?

A

movement of the fetus into a lower position in the true pelvis

decrease in fundal height
partial relief of pressure on the diaphragm
greater ease of breathing
decreased reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Do Nulliparous patient efface or dilate first?

A

Typically effacement precedes dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Do Multiparous patient efface or dilate first?

A

Often occurs at the same time and often occurs some before labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why does dilation occur?

A

the force of contractions, coupled with the hydrostatic action of the amniotic fluid creates a force that promotes dilation of the low-resistance cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the hallmark of labor?

A

contractions that occur at regular intervals with increasing frequency, duration, and intensity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the two primary mechanisms that initiate labor?

A
  1. a change from progesterone dominance (uterine quiescence) to Estrogen stimulated uterotropin activation
  2. Placental production of corticotropin-releasing hormone (CRH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What medications can we give to stop preterm labor and how do they work?

A

terbutaline (Brethine): stimulates the B-adrenergic signaling pathway

indomethacin (Indocin): inhibits inflammatory pathways

nifedipine (Procardia): calcium-channel blocker

magnesium sulfate: inhibits the myosin light chain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is lie?

A

the relationship of the long axis of the fetus to the long axis of the pregnant woman

Longitudinal
Transverse
oblique

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is presentation?

A

the presenting part

Cephalic
Breech
Shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the different types of breech?

A

frank (legs extended
full/complete (legs flexed)
footling (single or double)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is attitude?

A

relationship of the fetal parts to one another and the effect on the fetal vertebral column

well flexed
military
extended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is position?

A

uses 3 letters
First: L or R for Left or Right
references the side of the maternal pelvis
Second: O, S, or M for Occiput, Sacrum or Mentum
references the denominator
Third: A, T, or P Anterior, Transverse, Posterior
references where in the maternal pelvis the denominator lies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is station?

A

where the lowermost (the bone!!) part of the fetal presenting part resides relative to an imaginary line drawn between the ischial spines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is synclitism?

A

the sagital suture is located midway between the symphysis pubis and the sacral promontory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is asynclitism?

A

the fetal neck is tilted so that the fetal head leans laterally toward the fetal shoulder somewhat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is anterior asynclistism?

A

when the anterior (Closest to the pubic symphysis) parietal bone becomes the lowermost (or leading part) of the presenting part

AKA the anterior portion of the head is dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is postterior asynclistism?

A

when the POSTERIOR parietal bone (the one closest to the sacral promontory) becomes the lowermost part of the presenting part.

AKA the postterior portion of the head is dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is molding?

A

the soft skull bones overriding one another because they are not yet completely fused

minor degrees of molding are normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is caput?

A

formation of edematous swelling over the most dependent portion of the presenting fetal head

pressure around the presenting part by the cervical opening produces congestion and edema of the portion of the fetal head that presents against the cervical opening

***caput crosses the suture lines

a few millimeters of caput is considered normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the cardinal movements?

A

1) Engagement
2) Descent
3) Flexion
4) Internal Rotation
5) Extension
6) Restitution
7) External Rotation
8) Delivery of the posterior shoulder by lateral flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the first stage of labor?

A

3 phases:
latent-
begins with the onset of regular uterine labor contractions

active
- the rate of cervical dilation increases

deceleration
- labor progress slows between 8-10 cm (By Friedman) and this phase has been debated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the second stage of labor?

A

expulsive stage
begins with 10 cm and ends with the birth of the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the third stage of labor?

A

from the birth of the baby to the delivery of the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When should ABX for GBS prophylaxis begin for someone with prelabor ROM?

A

Immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the classic method for assessing ROM?

A

FERN!!
sterile spec
fluid from posterior vaginal fornix for 10-15 seconds
DO NOT TOUCH THE CERVICAL OS
spread thinly onto a slide
DRY THOROUGHLY for 10 minutes
inspect without a coverslip at 10x power
fern-like pattern (arborization)

Key: avoid digital exams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe latent phase of labor.

A

from the beginning or REGULAR uterine contractions (UCs) to the point when cervical dilation begins to progress rapidly.

Commonly accelerates after 6cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Describe active phase of labor.

A

starts with an increase in the rate of cervical dilation & ends with complete cervical dilation

progressive descent of the presenting part typically occurs in the latter part of the active phase and into the second stage of labor

can only be determined retrospectively based on an assessment of adequate cervical dilation over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is friedmans recommendation on timing for labor?

A

Nulliparas
Latent: <20 hours
Active: 1.2 cm/hr

Multiparas
Latent: <14 hours
Active: 1.5 cm/hr

Arrest Disorder
No progress for 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What 2 things has contemporary labor studies shown us?

A

**1. Many women are presumed to be in active-phase labor and managed as such, before they are actually in active labor
2. guidelines on expected rates of cervical dilation during traditionally defined active-phase labor progress times (1cm/hr) are overly stringent. 0.5 cm/hr is considered adequate per contemporary studies for both nullip and multips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When did Zhang find that active labor started? When did they find labor accelerated for multips?

A

the active phase of labor may not start, on average, until 5cm dilation in multips or even later in nullips.

labor accelerated after 6 cm for multips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What dilation rate per hour did studies show show in low-risk no intervention people?

A

Nullips 0.5cm/hr
Average 1.2 cm per hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What percent of births in the U/S are C/S?

A

30%!!

WHO says a C/S rate of higher than 10% is NOT associated with better outcomes.
higher rates of C/S are related to increased morbidity and mortality without benefit to mother or baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is pre-active labor admission and why is it important to avoid this?

A

early admission (less than 4 cm)

2x more likely to get augmentation with pit
C/S rate is 2x as high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How can we more reliably determine labor?

A

2 adequately spaced cervical exams (2-4hs apart)

-painful contractions
-and complete or near-complete effacement
-and 4-5cm dilated (and that dilation was preceded by progressive cervical change over time)
-OR 6 cm dilated (regardless of previous cervical change)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

If no cervical change is noted on a low risk patient with normal assessment, what can be offered?

A

Discharge home!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Who should receive GBS prophylaxis?

A

Anyone who tests positive, anyone preterm and untested, anyone with a history of a newborn with GBS, anyone with risk factors (I.e. prolonged ROM >18h or maternal fever)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What ABX is recommended for GBS prophylaxis?

A

PCN G

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What ABX is recommended for GBS prophylaxis for those with PCN allergy?

A

Ancef (if low risk for reaction), clindamycin or vancomycin

Ideally, susceptibility testing should be done!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What risks are associated with supine or lithotomy position?

A

risk of aortic/venae cavae compression
maternal hypotension
potential fetal compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Is an IV necessary for every laboring person?

A

No!

Routine prophylactic insertion of IV access is unnecessary in low-risk laboring people*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the current evidence on amniotomy?

A

there is a decrease in labor duration,
BUT, it isn’t clinically relevant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Is amniotomy alone beneficial?

A

NOT BENEFICIAL tx for women with active-phase arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What risk is increased for AROM in a patient without dystocia?

A

increased risk for Cesarean birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is ACOGs recommendation on amniotomy?

A

amniotomy should NOT be performed in women with normally progressing labor
UNLESS required to facilitate monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

When should amniotomy be used?

A

tx of dystocia
for clear indication for induction of labor
when internal monitoring is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the best indicator of adequate contractions?

A

Labor progress!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What montevideo units are considered adequate?

A

200-250 MVUs defines adequate contractions that reliably predict vaginal birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What should be determined with every cx exam?

A

Dilation, effacement, station

AND

Presentation and Position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the normal pH of the vagina?

A

4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the pH of amniotic fluid?

A

7.0-7.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What can cause positives with nitrazine testing?

A

False positives (from other things that are alkaline):
vaginal infections
blood
semen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is a key benefit of continuous fetal monitoring?

A

decrease in stillbirth with continuous EFM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

When do most children with CP aquire brain injury?

A

studies show that most children with CP acquire a brain injury in the PRENATAL or NEONATAL period, so IP interventions like EFM are not likely to prevent this disorder.

56
Q

What is the best indicator of cerebral oxygenation?

A

FHR variability

57
Q

What FHRs are Cat 1?

A

Baseline 110-160 BMP
Moderate Variability
No late or variable decelerations
Early decels OK but not required.
Accels OK but not required.
Is NORMAL

57
Q

What FHR are Cat 2?

A

Is basically anything not categorized as either I or III.

57
Q

What FHR are Cat 3?

A

Absent variability with any of the following:
recurrent late decels
recurrent variable decels
bradycardia
Sinusoidal pattern

Need to intervene immediatly!

58
Q

What FHR is the most associated with fetal acidemia?

A

Minimal or absent variability with late or severe variable decels is the most likely FHR pattern associated with fetal acidemia.

HOWEVER, the positive predictive value is only 10%-30%. These are patterns we need to worry about but the neonate will still have a significant chance of being vigorous and not acidotic.

59
Q

Do studies show EFM or IA is better?

A

Randomized controlled trials comparing EFM with IA did not find that one modality was a better option when considering Apgar scores, cerebral palsy or perinatal mortality rates.

60
Q

What is cat 1 FHR with IA?

A

Baseline between 110-160 bpm with regular rhythm.
no decels
accels either present or absent

61
Q

What is cat 2 FHR with IA?

A

tachycardia (>160 bpm)
bradycardia (<110 bmp)
audible irregular rhythm
presence of decreases from baseline.

62
Q

What is cat 3 FHR with IA?

A

can NOT be assessed using IA because variability is not assessed.

63
Q

When should FSE NOT be used?

A

for routine fetal assessment
active HSV infection
maternal hepatitis infection
maternal HIV infection
if membranes are not ruptured
if cervix is not dilated
if fetus is in face presentation or presentation is unknown
do NOT place over genitalia in breech presentation
do NOT place over a fontanelle in vertex presentation.
placenta previa

64
Q

What is tokophobia?

A

extreme fear of childbearing

65
Q

What is the difference between epidural analgesia and epidural anesthesia?

A

Analgesia: reduces but does not obliterate all sensation

Anesthesia: all sensation and motor ability is inhibited

66
Q

Why are non-opiod agents used for labor pain management?

A

To mitigate nausea and vomiting and to potentiate the opioid effect.

67
Q

If a patient is given phenergan and an opioid, why would Narcan not fully reverse any significant side effects?

A

Phenergan is NOT and opiod and narcan only reverses opioids.

68
Q

Which opioid has the longest half-life?

A

Demerol

high risk of neonatal respiratory depression

69
Q

Which opioid is most often used to treat prolonged latent labor?

A

Morphine

70
Q

Who should NOT recieve stadol or nubain?

A

contraindication for women with a hx of drug abuse or addiction BECAUSE:
the mu-receptor antagonist effect can elicit withdrawal symptoms

71
Q

How does an epidural fever present?

A

38 degrees C and 100.4 F
tends to start immediately after the epidural
the occurrence of fever equal to or higher than 100.4 F is usually after approx 4 hours

72
Q

T/F: Epidurals increase the incidence of cesarean sections.

A

False!

Note: it IS associated with increased risk of operative vaginal delivery.

73
Q

Which opioid is safe to administer in advanced active labor and is not associated with NRD?

A

Fentanyl

74
Q

When does second stage of labor begin/end?

A

Anatomically: beginning with complete dilation of the cervix, 10 cm, ending with the expulsion of the fetus

Physiologically: the onset of the urge to bear down/involuntary pushing, ending with the birth of the infant (typically +1)

75
Q

Per Friedman, what is a normal duration of second stage?

A

1-2 hours

1cm/h in nulliparas and 2cm/hr in miltips

Arrest if no progress for 1 hour

76
Q

What 3 factors most influence the length of the second stage?

A

parity
fetal position
presence or absence of regional analgesia

77
Q

Contemporary research defines prolonged second stage as what?

A

1-2-3 Rule
1 hour for multips
2 hours for multips with an epidural/nullips without
3 hours for nullips with an epidural

78
Q

What fetal adverse outcomes are associated with prolonged pushing?

A

increased risk of 5 min APGAR of less than 4
neonatal sepsis
NICU admission
perinatal mortality

78
Q

What maternal adverse outcomes are associated with prolonged pushing?

A

intra-amniotic infection
PPH
operative birth
3rd and 4th degree lacerations
long-term adverse outcomes in the pelvic floor
higher risk of shoulder dystocia in multips

78
Q

What is failure of descent?

A

If the fetal presenting part makes no descent after 1-2 hours of adequate contractions and maternal pushing effort.

79
Q

What should be the focus of assessment when a patient is pushing?

A

Emphasis should be placed on EVIDENCE OF PROGRESS in rotation and descent of the presenting part in response to maternal pushing efforts, maternal, stamina, and fetal well-being.

80
Q

What should the CNM do for protracted 2nd stage?

A

Consult MD

81
Q

What cardinal movement occurs for an OP baby’s head to be born?

A

Flexion then extension

82
Q

How can a persistent OP presentation be managed?

A

have birthing person labor on hands and knees
digital rotation with examiner’s fingers*
manual rotation with examiner’s hands*
other positional changes
traditional Mexican Rebozo techniques

83
Q

Do studies support hands on or hands off perineal support more?

A

no studies to suggest one as superior

84
Q

WHy are routine episiotomies not recommended?

A

episiotomies are more likely to result in 3rd or 4th-degree lacerations

85
Q

When is the ideal time for the birth of the fetal head?

A

The ideal time for birth of the fetal head is between contractions

86
Q

Describe the ritgen maneuver.

A

clinician applies pressure on the fetal chin with one hand and pressure on the occiput with the other hand. The chin is pulled forward in between contractions and is a controlled facilitation of fetal head/birth of fetal head.

**Forcing extension to occur

87
Q

What are the s/s of lidocaine toxicity?

A

lightheadedness
dizziness
tinnitus
abnormal taste
facial tingling
circumoral numbness
confusion

88
Q

What does the results of an FFN indicate?

A

fFN has a poor POSITIVE predictive value (PPV)
Note: a positive fFN test in symptomatic women has limited clinical utility and should NOT be used alone to determine management!!

fFN has a HIGH NEGATIVE predictability (97.6%) for indicating that a birth WILL NOT occur within 7 days.

89
Q

When is an FFN contraindicated?

A

fFN is CONTRAINDICATED if there is evidence of ROM.

the accuracy of fFN is decreased with lubricants, blood, semen, or cervical manipulation within the last 24 hours.

do not collect fFN if more than 3 cm dilated or 80% effaced

90
Q

What cervical length is associated with increased risk of preterm birth?

A

a CL of 25 mm or less after 16 wks gestation and before 24 weeks gestation is associated with an increased risk of PTB

91
Q

How does the CNM care for a patient in PTL at 34-37w vs. less then 34w?

A

34-37w: collaborate
Less than 34: refer

92
Q

What gestations should receive corticosteroids?

A

24-34w in PTL

improves fetal lung maturity
and decreases other morbidities associated with prematurity

Consider for patients 34-36 0/7 if at risk for PTB

93
Q

Why may the CNM order mag sulfate for someone in PTL?

A

Tocolysis and neuroprophylaxis

MS reduces the risk of cerebral palsy in infants born prior to 32 weeks gestation

94
Q

Per ACOG, when should IOL be recommended based on GA without other risk factors?

A

induction at 42 0/7 and 42 6/7

based on increased risk of perinatal mortality and morbidity at that time.

95
Q

What is PROM?

A

ROM prior to the onset of labor

PRELABOR rupture is more accurate than saying Premature Rupture of Membranes because that gets confused with premature gestational age.

96
Q

What is PPROM?

A

If Prelabor rupture of membranes (PROM) occurs in women who are less than 37 weeks GA, that is known as Premature Prelabor rupture of Membranes (PPROM).

97
Q

How should a patient be treated for suspected chorio?

A

ampicillin or penicillin AND gentamicin (Garamycin)
APAP
Oxytocin as indicated
Placenta to path
Continue IV abx for 24h PP or at least 1 dose

98
Q

What bishop score is considered unfavorable vs favorable?

A

“Favorable” = score of 8 or higher
“unfavorable” = score of 6 or lower

99
Q

What are the intrauterine resuscitation steps?

A

any sign of fetal compromise requires IMMEDIATE d/c of oxytocin infusion
lateral repositioning of the birthing person
a 500 ML IV fluid bolus of LR
administer O2
possibly a dose of terbutaline 0.25 subcutaneously if previous interventions fail to work
consult physician and remain at the bedside until fetal well-being is ensured

100
Q

What herb should not be used for IOL? Why?

A

blue or black cohosh associated with perinatal stroke and acute myocardial infarction

101
Q

Per ACOG and SMFM, before a C/S for nonprogressive labor occurs, what steps should be taken?

A

the woman should be at 6 cm of cervical dilation or more,
have ROM,
and have no cervical change over 4 hours
with adequate uterine activity

OR
no cervical change with
at least 6 hours of oxytocin
with inadequate uterine activity

102
Q

Which medication used for IOL is contraindicated for a TOLAC?

A

Misoprostoland cervidil
E1 and E2

103
Q

Why do people with pregestational diabetes or GDM have an increased risk of shoulder dystocia?

A

increased risk of macrosomia
larger shoulder diameter
prediction of macrosomia via ultrasound or palpation is inexact**
Induction of labor is NOT recommended for suspected macrosomia
The option of Cesarean birth is offered to women with diabetes who have a fetus with an Estimated Fetal Weight of 4500 g (9.92 lbs) or more

104
Q

Why must we monitor fluid I/O carefully on those with HTN/PreE?

A

People with PreE have intravascular volume depletion but are at risk for pulmonary edema s/t the need for IV fluids in the presence of impaired kidney function

105
Q

When should mag levels be checked for someone on mag sulfate?

A

A client has a seizure while on mag
Creatinine >1.1 mg/dL
If s/s of mag toxicity

**If over >9.6 mg/dL, d/c mag

106
Q

What percent of maternal deaths are preventable?

A

40-50%

107
Q

What are the differential Dx for IP hemorrhage?

A

placenta previa
placental abruption
uterine rupture
vasa previa

108
Q

What is a key complaint common with placenta previa?

A

initial episode of painless vaginal bleeding

109
Q

What are key maternal risk factors for placental abruption?

A

AMA, cocaine use, smoking, HTN, fall/injury, ECV

110
Q

When is an AFE most likely to occur?

A

from the onset of an apparently uncomplicated labor to waiting 30 minutes of placental expulsion.

111
Q

Define shoulder dystocia.

A

a birth requiring extra OB maneuvers after gentle downward traction on the fetal head has failed to release the shoulders

Caused by: impaction of the fetal anterior shoulder on the symphysis pubis or less commonly, the fetal posterior shoulder on the sacral promontory

112
Q

At what EFW should a C/S be offered?

A

4500g for GDM/DM or 5000g for non DM

113
Q

WHat are signs of an impending shoulder?

A

“turtle sign”: the infant’s head slowly extends and emerges over the perineum-instead of fully extending, the vertex partially retracts back in to the vagina

Restitution and external rotation DO NOT occur

114
Q

What is the ideal twin type and presentation for a vaginal birth?

A

vertex-vertex, with diamniotic twins

115
Q

What is the presenting part/diameter in a vertex OA?

A

Suboccipitobregmatic= 9.5 cm

116
Q

Which presentation is the largest fetal head diameter?

A

Brow: vertico-mental

117
Q

Which type of face presentation can be delivered vaginally? Why?

A

MA-the head is able to flex to negotiate the curve of carus

118
Q

What type of breech births have improved outcomes?

A

u/s Estimated Fetal Weight of between 2500 and 400 g
frank or complete breach
no fetal anomalies
adequate maternal pelvis
adequate amniotic fluid
flexion of the fetal head- documented by u/s

119
Q

What is a compound presentation?

A

an extremity prolapses alongside the presenting part, and both present simultaneously in the pelvis

120
Q

What factors may improve the success of a vaginal breech birth?

A

Average-size fetus (2500-3800 g with no known anomalies
Proven adequate pelvis
Frank or complete breech
Documentation of fetal head flexion (by ultrasound)
Spontaneous labor with normal progress
Easy spontaneous delivery of the buttocks and thighs

121
Q

How long should the birth take in a breech delivery after the trunk, legs and feet are delivered?

A

The remainder of the birth should occur in 3-5 min

122
Q

What position should you rotate the breech into after delivery of the trunk?

A

RST or LST

123
Q

What head position should be kept after delivery of the breech arms when the neck is visible?

A

KEEP IT OA so you have room for your hands for maneuvers

124
Q

How is mauriceau-smellie-veit perfomred?

A

The index and middle fingers are placed on either side of the nose on the maxilla & downward pressure is applied to maintain flexion of the head.

An assistant should be directed to perform suprapubic pressure to maintain flexion of the head

125
Q

When is a placenta considered retained?

A

longer than 30 minutes without placental expulsion (from time of birth) with active management and longer than 60 with physiologic management

126
Q

What are the signs of placental separation?

A

Gush of blood, lengthening cord, rise of uterus, uterus becomes firm and round

127
Q

What is the most effective treatment for prevention of PPH?

A

Prophylactic uterotonic after the shoulder or birth of infant

128
Q

What is first choice uterotonic?

A

Pitocin 10U IM or IV

129
Q

What are the risks of excessive cord traction?

A

uterine inversion or umbilical cord avulsion

130
Q

When is fundal massage NOT recommended in third stage and why?

A

NOT recommended prior to placental separation

may cause incomplete separation of the placenta, resulting in hemorrhage

131
Q

How is PPH defined?

A

1,000 mL or more of blood loss accompanied by s/s of hypovolemia

132
Q

What are the S/S of a hematoma?

A

severe pain in birthing person without epidural
rectal pressure in a birthing person with epidural
s/s of blood loss like hypotension or tachycardia

NM 717 Comps (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions