Powerpoints Test 2 module 3

Question 1

stages of labor

Stage 1:

Answer 1

0-10 cm dilation

Phase 1-3= latent , active, and transition dilation

Question 2

Stage 2 of labor

Answer 2

10 cm dilated (complete) to the delivery of the infant

Question 3

Stage 3 of labor

Answer 3

Delivery of infant to delivery of the placenta

Question 4

Stage 4 of labor

Answer 4

First hour to four hours after placental delivery

Question 5

Phase 1 of delivery

Answer 5

Latent phase - dilation of 0-3 cm

Question 6

Phase 2 of delivery

Answer 6

Active dilation 4 to 7 cm

Question 7

Phase 3 of delivery

Answer 7

Transition phase

Dilation is 8 to 10 cm

Question 8

What are the Ps of labor

Woman/fetus-

Answer 8

Power
Passageway
Passenger
Position
Psyche

Question 9

What are the Ps of labor

for providers support persons

Answer 9

Patients
Persistence
Practice/pain relief
Psyche

Question 10

power-

The uterus is stretched to threshold point leading to what?

Answer 10

Synthesis and release of prostaglandin

Question 11

Pressure on the cervix causes what?

Answer 11

The release of oxytocin

Question 12

Oxytocin stimulation in blood Does what during pregnancy?

Answer 12

Increases

Question 13

Estrogen in progesterone ratio does what during pregnancy?

Answer 13

The ratio changes and estrogen increases

And progesterone decreases

and excites her uterine response

Question 14

Placental aging and deterioration triggers what?

Answer 14

Contractions

Question 15

during pregnancy Fetal cortisol concentration rises and causes the placenta to do what?

Answer 15

Reduce progesterone

Question 16

Prostaglandin is produced by fetal membrane during pregnancy and stimulates what

Answer 16

Contractions

Question 17

Power -contractions move downward over the uterus, which portion is contracted for the longest time ?

Answer 17

Upper part of uterus

Question 18

What is responsible for effacement and dilation of the first stage of labor ?

Answer 18

Myometrial Activity -The myometrium is the middle layer of the uterine wall, consisting mainly of uterine smooth muscle cells (also called uterine myocytes), but also of supporting stromal and vascular tissue.

Its main function is to induce uterine contractions.

Question 19

Myometrial activity increases with what?

Answer 19

Good blood flow to the uterus (walking/activity and relaxation to eliminate fight or flight response)

Question 20

How to assess contractions?

Answer 20

Duration - (length beginning to end)

Frequency- time between start of one contraction to the start of the next )

Intensity - palpate uterus

Resting tone- palpate uterus

Question 21

When manually palpating the uterus, for a contraction assessment, what does

Mild
Moderate
Strong

look/feel like?

Answer 21

Mild- uterine wall is easily indented

Moderate-Uterine wall demonstrates resistance to pressure, some indention

Strong- uterine wall can not be indented

Question 22

What is the external machine monitoring contractions called?

And what does it do?

Risks?

Answer 22

Tocotransducer

It measures increased intraabdominal pressure
(Not intrauterine pressure)

No known risks

Question 23

Internal machine monitoring such as FSE (fetal scalp electrolode)-heart monitor or iucp Intrauterine pressure catheter does what ?

Risks

Answer 23

Direct measurement of intrauterine pressure

Include infection and uterine rupture

Question 24

What do Montevideo units do in a contraction assessment

Answer 24

Measurement and quantify uterine work

Expressed by the number of contractions in 10 minutes multiplied by their intensity

**Measures Intensity of contractions

Question 25

How to measure intensity of contractions in montevideo units ?

Answer 25

Review 10 minutes of the contractions strip Count each contraction peek from baseline, total all contraction peak values in 10 minute period This total peak value equals the MVU

Question 26

What is a normal range of contraction/intensity Montevideo units ?

Answer 26

180-300 = Adequate contractions

Question 27

Passageway- Normal female pelvis Labor progresses good Most common Rounded

Answer 27

Gynecoid

Question 28

Labor progresses poor Flat-oval side to side Uncommon

Answer 28

Platypelloid

Question 29

Male pelvis shape Labor progress is poor Higher among Caucasian women Heart shaped

Answer 29

Android

Question 30

Higher among non-Caucasian women Pelvis that has increased OP delivery Labor progresses good Up and down oval shape

Answer 30

Anthropoid

Question 31

Effacement -(Thinning r shortening of the cervix) how thin? What is Palpable with 100% effacement?

Answer 31

2cm- paper thin A thin edge

Question 32

Nulliparas (a woman who has never given birth) - when does effacement Of cervix begin?

Answer 32

Begins before the onset of labor

Question 33

Multiparas (a women who has given birth to two or more babies) - when does effacement of cervix begin?

Answer 33

May it begin until the onset of labor

Question 34

Opening of the external OS

Answer 34

Dilation

Question 35

Dilation of the cervix is caused by what

Answer 35

Pressure of presenting part Contraction and retraction of uterine muscles

Question 36

Diameter of cervix increases to how many cm during labor? When is it not palpable?

Answer 36

10cm At 10cm dilated

Question 37

During labor, the cervix of who remains thicker?

Answer 37

Multipara women remain thicker than women who have never birthed before

Question 38

What to asses for in the passenger (baby)

Answer 38

``` Fetal lie - transverse, longitude Fetal altitude , neck flexion Presentation- brow, breech etc Station - out of pelvis - 0, +1 Position- loa ```

Question 39

Longitudinal position of baby vs transverse

Answer 39

Longitudinal- baby’s head in down by cervix Transverse- head and butt are side to side angling head angling down to cervix

Question 40

Relationship of fetal parts to each other and degree of flexion or extension of the fetal head

Answer 40

Attitude

Question 41

What is normal attitude?

Answer 41

Moderate flexion with chin flexed

Question 42

Presentation determines what?

Answer 42

How the baby is presented to come out of the cervix first Brow, breech , etc

Question 43

Cephalic presentation

Answer 43

Head first - most common - 95%

Question 44

Breech presentation

Answer 44

Pelvis first - 3% term deliveries

Question 45

Shoulder presentation

Answer 45

Shoulder first - 2%

Question 46

Relationship of presenting part to ischial spines of moms pelvis How far the baby is out of pelvis -3 to +4 What number is at ischial spine Ballotable head moves when gentle pushed against

Answer 46

passenger station- 0

Question 47

Relationship between the fetal presenting part and four quadrants of the mothers pelvis

Answer 47

Fetal position | Posterior fontanel,Anterior fontanel, sagittal suture, lamboid suture, coronal suture, Parietal

Question 48

What is the most common and Best birth position for the fetus

Answer 48

LOA

Question 49

False labor s/s

Answer 49

Regular contractions ? Decrease in frequency and intensity Disappear with sleep No change in cervix Sedation decreases or stops contractions Show usually not present

Question 50

True labor s/s

Answer 50

Regular contractions Increase in frequency and intensity Discomfort begins in back and radiates to abdomen Activities such as walking increases contractions and continues with rest Cervix dilate and effaces Sedation does not stop contractions Show is present

Question 51

Labor assessment information

Answer 51

Labor symptoms Pregnancy hx Allergies Cultural needs Support persons Medications Smoking drugs alcohol Last meal and time Group b strep status Vitals Frequency and duration of uterine contractions Well being Urinary protein Cervical dilation Fetal presentation and station Status of membranes Date and time of arrival and notification of provider

Question 52

Latent stage of labor duration

Answer 52

Multi gravida - 5.3 hours Primigravida- 8.6 hours

Question 53

Contraction frequency in latent stage of labor

Answer 53

every 3-30 minutes , may be irregular

Question 54

Contraction duration in latent Stage of labor

Answer 54

30 to 40 seconds

Question 55

Contraction intensity and latent stage of labor

Answer 55

Mild to palpation, 25 to 40mmhg

Question 56

What do you contractions attempt to do to the cervix?

Answer 56

Soften, efface, dialate

Question 57

What’s involved in psyche: labor support

Answer 57

Emotional support Physical support Advocacy Support of partner

Question 58

The physical presence of someone during labor as well as offering words of encouragement

Answer 58

Emotional support

Question 59

Comfort measures in pain relief, hygiene, reassurance touch, application of heat or cold, calm environment, information and advice during labor

Answer 59

Physical support

Question 60

Ways one can assess the fetus

Answer 60

Leopold’s Auscultation Vaginal exam Ultrasound

Question 61

FHR are incomplete without what? The clinician should recognize and respond to both palpated and electronically obtained what?

Answer 61

Uterine activity assessment Uterine activity data

Question 62

Requires attention to audible characteristics of fetal heart rate

Answer 62

Auscultation

Question 63

Methods of auscultation of FHR

Answer 63

Fetoscope and Doppler Intermittent auscultation IA

Question 64

Advantages of external FHM

Answer 64

``` Continuous information Noninvasive Antepartum and during labor Permanent record Assess LTV Can assess contractions Can detect some variable and periodic change ```

Question 65

Disadvantages of FHR monitoring

Answer 65

``` Expensive equipment Subject to artifact Cannot assess STV Variability Belts can be uncomfortable Subject to double or half count Less than 70 bpm double count Greater than 180 bpm half count ```

Question 66

Internal FHR monitoring advantages

Answer 66

Accurate continuous information Information not subject to artifact

Question 67

Internal FHR monitoring disadvantages

Answer 67

Expensive Need to have ROM and 2-3 cm Slight risk of infection to mom and baby

Question 68

Transfer of oxygen and carbon dioxide between the maternal and fetal circulation

Answer 68

Utero placenta unit

Question 69

Primarily mediated by the Vagus nerve innervating the SA and the AV node’s in the heart Decreases the heart rate ** Develops around 28-30 weeks of gestation

Answer 69

Parasympathetic nervous system

Question 70

Stimulation increases the FHR Stimulation of nerves is responsible for long term baseline variability Action occurs through the release of norepinephrine May be stimulated during periods of fetal hypoxemia

Answer 70

Sympathetic nervous system

Question 71

Stretch receptors present in the aortic arch and the carotid arch Detect pressure changes * Maintains homeostasis - regulate the heart rate

Answer 71

Baroreceptors

Question 72

Located in the aortic arch and the CNS Respond to changes in fetal O2 CO2 and ph levels

Answer 72

Chemoreceptors

Question 73

How to determine the FHR baseline rate?

Answer 73

Best straight line image Need at least 10 min monitor strip to determine baseline rate FHR between patterns and contractions

Question 74

Causes of tachycardia in pregnancy

Answer 74

``` Maternal fever Prematurity Fetal infection Fetal and maternal anemia Early fetal hypoxia Maternal dehydration Tocolytic therapy Maternal anxiety Excessive fetal activity ```

Question 75

Management of tachycardia in pregnancy

Answer 75

``` R/o maternal fever or drug effect Hydrate Decreased maternal anxiety O2 8-10L R/O Underlying medical history Notify Dr. and team Determine if associated with late or variable decelerations and anticipate interventions ```

Question 76

Causes of bradycardia in pregnancy

Answer 76

``` Fetal hypoxia Fetal asphyxia Fetal arrhythmia Drugs Maternal hypotension Prolong compression of cord Maternal hypothermia Mild bradycardia May be associated with post term infant ```

Question 77

Presence of variability suggests what in a monitor strip?

Answer 77

good central nervous system control over FHR

Question 78

An irregular FHR baseline on strip demonstrates what?

Answer 78

Normal healthy fetus

Question 79

If baseline is flat on external monitor, how will it look on the internal monitor?

Answer 79

Even flatter

Question 80

Defined range, fluctuations, oscillations in a fetal monitor strip Rate change in heart rate over many seconds to minutes - 2-6 changes per minute Amplitude up /down from baseline Increases with fetal movement Decreases when fetus is asleep

Answer 80

Variability

Question 81

Amplitude greater than 25 per min 6-25 bpm Less than 5 bpm Amplitude range undetectable

Answer 81

Marked Moderate Minimal Absent

Question 82

Causes of decreased variability

Answer 82

Congenital Tachycardia Deep sleep Drugs Prematurity

Question 83

Increases in FHR above baseline

Answer 83

Accelerations

Question 84

Clauses of accelerations

Answer 84

Fetal movement Stimulation Contractions Can be periodic or episodic If everySingle contraction has an acceleration maybe breech presentation

Question 85

Different decelerations Veal Chop:

Answer 85

Veal chop : Variable decelerations Early decelerations Accelerations Late accelerations Cord compression Head compression Okay Placental insufficiency

Question 86

Nadir means ?

Answer 86

The lowest point

Question 87

Gradual vs abrupt ?

Answer 87

Ask what is the shape

Question 88

Abrupt decreases in fetal heart rate may occur with or without What? They may also vary in?

Answer 88

Contractions shape, depth, duration, and timing with contractions

Question 89

Most common cause of variable decelerations How long does the deceleration have to last to be considered variable? If less than 15 seconds long what is it?

Answer 89

Occlusion of the umbilical blood flow

Question 90

These decelerations are believed to represent a vagal response to a cerebral re distribution of blood flow caused by compression of the fetal head When contractions occur the fetal heart is subjected to pressure which stimulates the Vagus nerve Mirror the contraction causing them Can be present in the normal FHR pattern. Benign

Answer 90

Early decelerations

Question 91

This deceleration reaches its lowest point (nadir) after the peak of contraction Typically symmetrical and returns to baseline once contraction resolves If moderate - adequately oxygenated If they reoccur with absent or minimal variability they may represent what?

Answer 91

Late decelerations Heart hypoxic depression and risk of acidemia/acidosis

Question 92

Blood cord gases in the newborn Why is it taken?

Answer 92

Determines their metabolic condition at birth Recommended I’m high risk deliveries such as fever, cesarean section compromise , Growth restriction , abnormal FHR , apgar score less than 7 , multifetal gestation

Question 93

Target new born cord blood gas ranges PH Pco2 Bicarb Po2 BE

Answer 93

7.10 or greater 60 or less 22 or higher 20 Or greater -12 or greater

Question 94

Interval between full cervical dilation and delivery of the infant Bloody show Maternal desire to bear down with each contraction Onset nausea and vomiting Increased maternal shaking

Answer 94

Second stage of labor

Question 95

Operative vaginal birth should be considered to who?

Answer 95

First time birth women - when there is lack of progress for 3 hours with regional anesthesia or for 2 hours with out anesthesia Multiparous women after lack of continuous progress for 2 hours with regional anesthesia or for 1 hour without anesthesia

Question 96

Stage of laceration/episiotomy: involves the perineal skin and vagina mucus membrane

Answer 96

First degree

Question 97

Stage of laceration/episiotomy: Involve the skin, mucus membrane and fascia (superficial) of the perineal body

Answer 97

2nd degree

Question 98

Stage of laceration/episiotomy: Involve the skin, mucus membrane and muscle of the perineal body and extend to the rectal sphincter

Answer 98

Third degree

Question 99

Stage of laceration/episiotomy: Extends into the rectal mucosa and expose the lumen of the rectum

Answer 99

Fourth degree

Question 100

Delivery of the baby to the separation of expulsion of the placenta Mild uterine contractions and fullness in vagina as placenta is released -mom feels relief

Answer 100

Third stage of labor

Question 101

Duration of third stage of labor

Answer 101

5-30 minutes

Question 102

Physical findings in third stage of labor

Answer 102

Gush of blood cord lengthens Fundus rises Uterine shape changes from flat to firm and globular

Question 103

Nursing interventions for third stage of labor

Answer 103

If further assessment, stimulation, or resuscitations are needed after birth explain procedure and infant status as needed Early infant contact - skin to skin until first feeding is completed - encourage touching infant - initiate breastfeeding if possible

Question 104

Fourth stage of labor - encourage what? - how often fundal checks and vitals? - assess what? And where?

Answer 104

Close observation of maternal and newborn for 2-3 hours Continue to encourage bonding Maternal vs and fundal checks every 15 minutes for the first hour and then Every 30 minutes during the 2nd hour Newborn vs- at 30 minutes, 1 hour, 1.5 hours, 2hours of age Assessment of bladder function, palpate above symphysis pubis

Question 105

Education about pain is necessary. Educate on what?

Answer 105

Contractions Vaginal exams Labor progress Comfort measures Plan of Care Help then support person feel comfortable Your role as the nurse

Question 106

Maternal response to pain Physical factors- Pathology- Psychological- Cascade of events-

Answer 106

Speed, OP position, fatigue Endorphins are opioids Fear and anxiety Labor outcome

Question 107

How to provide basic nursing psychology comfort

Answer 107

Apply cool wash cloths Back rubs Body massage Keep patient dry and clean Lip balm Keep linens dry and clean

Question 108

Psychology test and relaxation Nursing interventions

Answer 108

provide Calming stimuli - because it affects the thalamus in the brain and controls emotional response And increases pain tolerance and decreases anxiety Decreases catecholamines and muscle tension

Question 109

Physical movement - Patient should be able to move around unless what? Avoid what? How to support joints? Experiment with what during contractions Change what frequently

Answer 109

Unless continuous electronic fetal monitoring Avoid laying flat on back Use pillows to support joints Experiment with walking, rocking back and forth, or swaying during contractions. Change positions frequently

Question 110

What aids in release of endorphins This decreases hyperventilation-

Answer 110

Moaning - encourage Decreases in carbon dioxide

Question 111

Psychological- Visualization and affirmation nursing interventions

Answer 111

Guided imagery- Visualize creating mental images of the body letting go, the cervix thinning an opening, the baby moving down in the pelvis Encourage the patient to talk to their body as part of the visualization and talk to the baby. Use familiar pictures of openings such as a flower or butterfly emerging from a cocoon Imagine the baby smell, touch, noises

Question 112

Effleurage

Answer 112

Gentle massage used during or between contractions

Question 113

Use of prana (breath) the body’s energy fields the body’s energy fields

Answer 113

Therapeutic touch Healing energy

Question 114

consists of steady, strong force applied to one spot on the lower back during contractions using the heel of the hand, or pressure on the side of each hip using both hands. helps alleviate back pain during labor, especially in women experiencing “back labor.”

Answer 114

Counter pressure

Question 115

A warm bath, Jacuzzi or shower is comforting This does not increase chances of infection A sponge bath maybe soothing in bed or soaking your feet

Answer 115

Hydrotherapy

Question 116

Soothing scents of essential oils

Answer 116

Aromatherapy

Question 117

Ice pack to lower back or heat pack on lower abdomen - May alternate - don’t apply heat to skin covered in what? Why?

Answer 117

Heat and cold packs Lotion or ointment - it might burn

Question 118

The inability to feel pain while still conscious

Answer 118

Analgesia

Question 119

Total or partial loss of sensation, especially tactile sensibility, induced by disease, injury, acupuncture, or anesthetic, such as chloroform or nitrous oxide

Answer 119

Anesthesia

Question 120

Parental analgesia meds?

Answer 120

Fenanyl Morphine Stadol Nubain

Question 121

Local anesthetic

Answer 121

Lidocaine

Question 122

Regional analgesia techniques

Answer 122

``` Epidural Intra spinal narcotic Spinal Combined spinal epidural Pudendal block ```

Question 123

Does not eliminate pain- blunting effect Should not be given until labor is well established Exception is made with morphine to allow an early laboring patient to sleep in preparation for active labor Administration- peak of a contraction

Answer 123

Parental analgesia

Question 124

Parenteral Analgesia: Side Effects What should be available for resp depression?

Answer 124

Maternal Sedation Maternal respiratory depression Transient decreased fetal heart rate variability or psuedosinusiodal pattern Fetal respiratory depression Neonatal sedation, decreased tone, altered suck reflex Naloxone hydrochloride (Narcan) should be available to treat respiratory depression, but should not be used on infants whose mothers are addicted or suspected of being addicted to narcotics or who are in a methadone treatment program.

Question 125

Regional Analgesia Techniques

Answer 125

Pudendal Lumbar Epidural Spinal Intraspinal Narcotic (ISN)

Question 126

Lidocaine can be injected into the perineum and posterior vagina before an episiotomy is performed and after delivery of the placenta for perineal repair. Duration of action is approximately 20-40 minutes.

Answer 126

Pudendal nerve block

Question 127

Great potential to provide pain relief in 1st and 2nd stage of labor Test Dose: local anesthetic mixed with epinephrine may be injected to determine proper placement. ◦Vein placement causes? ◦Subarachnoid placement causes ? Loading Dose: local anesthetic, ropivicaine

Answer 127

Epidural tachycardia, palpitations, increased BP, numbness of tongue and mouth, metallic oral taste, slurred speech, tinnitus immediate upper thoracic sensory loss, initiates severe lower extremity motor blockade, and potentially causes respiratory arrest.

Question 128

Epidural advantages

Answer 128

Superior pain relief throughout delivery Placement of epidural catheter means that emergency c-section delivery can occur more quickly Entire pelvis and lower extremities are affected so that the client perceives touch but not pain

Question 129

Epidural disadvantages

Answer 129

Increased chances of Maternal fever Increased need for episiotomy, forceps and/or vacuum extraction Increases need for oxytocin Decreases bear down reflex Increases first and second stage of labor Increases your ability, inconsolable, uncoordinated suck and decreased responsiveness, interfering with the newborns response to breast-feed

Question 130

Epidural Nursing Care | Pre-procedure:

Answer 130

``` ◦Lactated Ringers Bolus ◦Patient empty bladder ◦Obtain baseline vital signs ◦Resuscitative equipment in room ◦Emergency equipment ◦Collect appropriate paper work ```

Question 131

Epidural Nursing Care | Procedure-

Answer 131

◦Position patient with head and hips flexed and shoulders and hips squared to facilitate the insertion of the epidural needle ◦Provide ongoing emotional support and information. ◦Support person to take a seated position ◦Continuous pulse oximeter if needed

Question 132

Epidural Nursing Care | Post Procedure:

Answer 132

◦Continue to monitor Vital Signs q 5 minutes x3, q 15 minutes x 4, q 1 hr x 4, q2 hrs x2, q4 hrs x duration of epidural ◦Fetal heart tones every 15 minutes for remainder of labor ◦Check Derms with every VS assessment. ◦Monitor lower extremities ◦Foley catheter insertion ◦Monitor Temperature

Question 133

Fentanyl (6 hour pain relief), essential for longer duration. Bupivicaine Morphine

Answer 133

Intraspinal Narcotic (Intrathecal)

Question 134

Used for Cesarean Delivery Combination of Bupivicaine and Morphine Local injection of lidocaine followed by needle placement with administration of medications.

Answer 134

Spinal

Question 135

regional anesthesia side effects

Answer 135

Hypotension, change in FHT, nausea, vomiting, puritis with opiates added, urinary retention, poster all headache, maternal temperature elevation, epidural hematoma, intravascular injection of local anesthetic agents

Question 136

Regional Anesthesia: Contraindications

Answer 136

Coagulation disorders Local infection at the site of injection Maternal hypotension and shock Non-reassuring FHT pattern requiring immediate birth Maternal inability to cooperate Allergy to local anesthetics Last dose of low-molecular-weight heparin within 12 hours.

Question 137

DYSFUNCTIONAL LABOR PATTERNS

Answer 137

``` Hypertonic Labor (tachysystole) ◦Fetus malposition ◦CPD ◦BMI ◦Oxytocin Hypertonic Labor (2-3 cx/10 minutes) ```

Question 138

Precipitous Labor and Birth

Answer 138

``` 3 hours around…. Think of vital supplies Stay Calm Call for assistance Notify provider or other provider who may be in house ```

Question 139

is a method in which isotonic fluid is instilled into the uterine cavity. It is primarily used as a treatment in order to correct fetal heart rate changes caused by umbilical cord compression, indicated by variable decelerations seen on cardiotocography.

Answer 139

Amniofusion

Question 140

artificial rupture of membranes (AROM) and by the lay description "breaking the water," is the intentional rupture of the amniotic sac by an obstetrical provider.

Answer 140

Amniotomy

Question 141

Indications for Induction

Answer 141

``` Postterm pregnancy • Maternal medical conditions • Gestational hypertension • Fetal demise • Chorioamnionitis • Premature rupture of membranes • Fetal compromise • Preeclampsia, eclampsia ```

Question 142

pre-labor scoring system to assist in predicting whether induction of labor will be required. It has also been used to assess the likelihood of spontaneous preterm delivery. Scores dilation, length , consistency, position, head station

Answer 142

Bishop score

Question 143

Cervical ripening refers to the softening of the cervix that typically begins prior to the onset of labor contractions and is necessary for cervical dilation and the passage of the fetus What to use to help this occur?

Answer 143

MISOPROSTOL (Cytotec) Foley Bulb ~ Mechanical DINOPROSTOL (Cervidil) Laminaria Tents

Question 144

Pituitary hormone Intravenous Oxytocin used for induction Requirements for induction Elective induction before 39 weeks

Answer 144

Oxytocin

Question 145

Assisted operative vaginal delivery What they use ?

Answer 145

Forceps Vacuum extraction

Question 146

Clinician externally or internally rotates a breach or transverse plane fetus to a vertex position

Answer 146

Internal/external version

Question 147

Delivery in which the anterior shoulder of the baby is impacted against the maternal symphysis pubis

Answer 147

Shoulder dystocia

Question 148

Dangers of Shoulder dystocia to child? Risk factors In mother ?

Answer 148

Entrapment of cord Inability of child’s chest to expand properly Severe brain damage or death if not delivered in minutes Risks : ``` Diabetes Prolonged gestation Prior shoulder dystocia Macrosomnia of fetus Maternal obesity Instrument assisted in delivery Precipitous delivery ```

Question 149

Prevention of Shoulder dystocia

Answer 149

Maintenance of good glycemic control in diabetic patients helps decrease fetal macrosomia C-section for any hx of it or diabetes

Question 150

Shoulder dystocia tx HELPERR

Answer 150

``` Call for help Evaluate for episiotomy Legs mcroberts maneuver- what is this? External pressure - suprapubic ?? Enter: rotational maneuvers Remove the posterior arm Roll the patient to her hands and knees ```

Question 151

SD treatment Internal Maneuvers First line tx? Last respite maneuvers ?

Answer 151

Internal Maneuvers ◦Rotate anterior shoulder –Rubin’s Apply pressure to the posterior aspect of the shoulder ◦Wood’s screw maneuver Apply pressure to the anterior aspect of the posterior shoulder while trying to rotate the anterior shoulder also ◦Reverse Wood’s screw maneuver Delivery of posterior arm-Now being encourage as first line treatment Gaskin maneuver ◦Moving patient to hands/knees position Last resort measures ◦Fracture clavicle ◦Zavanelli maneuver ◦Symphysiotomy

Question 152

when your baby has their umbilical cord wrapped around their neck

Answer 152

Nuchal cord

Question 153

the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery. Causes what on fetal strip? Tx?

Answer 153

Cord prolapse Variable and prolonged decelerations Alpha- c-section

Question 154

Placental abnormalities

Answer 154

Battedore -normal Succent uriate lobe - small price separates from the main disc of placenta Vasa previa -blood vessels lie across the opening of cervix

Question 155

Abnormal implantation definitions 1.Firm attachment to the myometrium ◦Found in 4% of previas ◦2.Invasion of myometrium ◦3.Invades through myometrium ◦Can invade into bladder/bowel

Answer 155

Placenta accreta Placenta increta ◦Placenta percreta

Question 156

Now Known as: Anaphylactiod Syndrome of Pregnancy Typically seen in labor or just after delivery Difficult to determine incidence 2-6 per 100,000 Mortality rate exceeds 60% ◦If sustained cardiac arrest survival rate is less than 10%

Answer 156

Amniotic Fluid Embolism

Question 157

Amniotic Fluid Embolism | S/s?

Answer 157

``` ◦Hypotension ◦Dyspnea ◦Cyanosis ◦Frothing from mouth ◦Fetal heart rate abnormalities ◦Loss of consciousness ◦Cardiac arrest ◦Bleeding from uterus, incisions, or IV sites ◦Uterine atony ◦Seizure-like activity ```

Question 158

If you have had a cesarean delivery (also called a C-section) before, you may be able to deliver your next baby vaginally. This is called vaginal birth after cesarean, or VBAC. Most women, whether they deliver vaginally or by C-section, don't have serious problems from childbirth. Risks?

Answer 158

VBAC Uterine rupture

Question 159

What is cord prolapse related to?

Answer 159

Amntiotomy High fetal station Polyhydramnios