PROBLEMS OF THE PASSENGER PART 1

Question 1

refers to a position other than an
occipitoanterior position

Answer 1

fetal malposition

Question 2

3 types of fetal malposition

Answer 2

• occipitoposterior
• occipitotransverse
• oblique or asynclyptic

Question 3

s/sx of fetal malposition

Answer 3

• intense back pain
• dysfunctional labor pattern
• prolonged active phase
• secondary arrest

Question 4

physical manifestations of fetal malposition

Answer 4

• depression above the symphysis
• FHT heard far laterally on abd
• wide diamond shaped fontanelle can be felt on the anterior pelvis

Question 5

maternal positions to facilitate fetal position change

Answer 5

• side lying
• knee chest
• hand and knees
• pelvic rocking
• support person may perform firm stroking motions on abd

Question 6

other things one could do to facilitate fetal position change

Answer 6

• sit on the toilet
• walk around the room
• pelvis rock beside bed
• rest in jacuzzi / lie on her side on the bed

Question 7

maternal risks for fetal malposition:

Mother may suffer a ___-degree ___ or extension of ___ during the second stage of labor

Answer 7

third-fourth degree perineal laceration;
midline episiotomy

Question 8

if CPD is assessed, ___ is done

Answer 8

cesarean section

Question 9

rotation of an abnormally positioned fetus by means of forceps with subsequent reapplication of forceps for delivery

Answer 9

scanzoni’s maneuver

Question 10

• Seen in women with
  hypotonic labor
• Diminished
  anteroposterior pelvic
  diameter (as seen in
  platypelloid pelvis) or
• Diminished transverse
  diameter (in the android
  pelvis)

Answer 10

occipitotransverse

Question 11

maternal risks for occipitotransverse

Answer 11

• soft tissue damage
• fistulas (from tissue anoxia)
• postpartal hemorrhage

Question 12

fetal risks of occipitotransverse

Answer 12

cerebral damage (undetected CPD)

Question 13

• In the presence of hypotonic labor pattern & (-) CPD, Diluted ___ may be administered

Answer 13

oxytocin

Question 14

When rotation, uterine cavity, & CPD are absent, Birth is often accomplished by ___, ____, or ____

Answer 14

midforceps, manual rotation, vacuum extraction

Question 15

• If deep transverse arrest exists, ___ may be applied as long as excessive force is avoided.

Answer 15

forceps

Question 16

Refers to a fetal presenting part which includes the vertex as
in brow, face & sinciput, the breech,
like frank, complete, footling, transverse, & compound presentation

Answer 16

fetal malpresentation

Question 17

3 abnormal presentations

Answer 17

sinciput (military)
brow
face

Question 18

• Rarest of the presentations
• Occurs when the area between the anterior fontanelle & the fetal eyes descend first

Answer 18

brow presentation

Question 19

true or false: brow presentation occurs more in nullipara than multipara

Answer 19

false - occurs more in multipara than nullipara

Question 20

brow presentation is due to?

Answer 20

lax abdominal and pelvic musculature

Question 21

• A fetal head presentation at a different angle than expected is termed ____

Answer 21

asynclytism

Question 22

___ presentation is rare, but when it does occur, the head diameter the fetus presents to the pelvis is often too large for birth to proceed

Answer 22

face (chin / mentum)

Question 23

maternal risks for fetal malpresentation

Answer 23

• perineal lacerations
• CPD
• prolonged labor

Question 24

fetal risks for fetal malpresentation

Answer 24

• fetal mortality
• trauma (tentorial tears, cerebral and neck compression, trachea and larynx damage)

Question 25

nursing assessment of fetal malpresentation using leopold's maneuver

Answer 25

- head feels more prominent than normal - head and back on the same side - back is difficult to outline (concave) - FHT heard where arms and feet are palpated

Question 26

(+)labor problems but (-) CPD, a ___ may be attempted

Answer 26

manual conversion

Question 27

Some medical experts advocate, midforceps-assisted birth (+) of ___ & ___

Answer 27

complete dilatation; fetal position at +2

Question 28

If (-)CPD, the chin (mentum) is anterior, & labor pattern is effective = ____

Answer 28

vaginal birth

Question 29

occurs when the fetal buttocks, legs or feet or combinations of these parts present first into the maternal pelvis

Answer 29

breech presentation

Question 30

types of breech presentation

Answer 30

complete frank footling

Question 31

in breech presentation, FHR can be heard where?

Answer 31

lower quadrant or umbilicus

Question 32

criteria for vaginal birth in breech presentation

Answer 32

- adequate pelvis - frank breech (weight <3500) - spontaneous labor - clinician skilled in breech birth

Question 33

A breech presentation, therefore, may be caused by anything that interferes with this mechanism of adaptation:

Answer 33

- ges age < 40 weeks - abnormal fetus - hydramnios - midseptum uterus - mass in uterus - pendulous abd - multiple gestation

Question 34

breech complications

Answer 34

- morbitdity - LBW - anoxia - head injury - spine/arm fracture - PROM - dysfunctional labor - p. previa - multiple fetus

Question 35

maternal risks of breech presentation

Answer 35

- prolonged labor - prolapsed cord - head entrapment - perinatal mortality

Question 36

types of version to perform

Answer 36

external internal

Question 37

when a baby is delivered vaginally without any manipulation, other than supporting the baby

Answer 37

Spontaneous breech delivery

Question 38

a vaginal delivery where the fetus descends spontaneously to the umbilicus, and then the lower part of the body is extracted with assistance

Answer 38

Partial breech delivery

Question 39

The fetal feet are grasped, and the entire fetus is extracted

Answer 39

Total breech delivery

Question 40

presentation that is also called as transverse lie

Answer 40

shoulder

Question 41

shoulder presentation occurs in ___ in 300 term births

Answer 41

1

Question 42

landmark of shoulder presentation

Answer 42

acromion process of scapula

Question 43

conditions associated with shoulder presentation

Answer 43

- grand multiparity w relaxed uterine muscles - preterm fetus - abnormal uterus - polyhydramnios - placenta previa - contracted pelvis

Question 44

One in which there are two presenting parts, such as the occiput & fetal hand

Answer 44

compound presentation

Question 45

___ is often successful if attempted in early labor

Answer 45

intrapartum ECV (external cephalic version)

Question 46

true or false - Most compound presentation resolve themselves spontaneously, but others require additional manipulation at birth

Answer 46

true

Question 47

If prolapsed part is the ___, the birth is generally not difficult.

Answer 47

hand