PROBLEMS WITH PASSAGE Flashcards

Question

INLET CONTRACTION: what ifs

Answer 1

- If there is no engagement in primigravidas, then either a fetal abnormality or a pelvic abnormality should be suspected. - If the membranes rupture, then the risk of cord prolapse increases greatly.

Answer 2

- narrowing of the transverse diameter at the outlet to less than 11 cm. - distance between the ischial tuberosities, a measurement that is easy to make during a prenatal visit, so the narrow diameter can be anticipated before labor starts - can also be assessed easily during labor

Answer 3

1. Clinical pelvimetry 2. IMAGING pelvimetry

Answer 4

Assessment of the pelvic diameters and capacity done at 38 to 39 weeks

Answer 5

1. Internal Pelvimetry - inlet, cavity, and outlet. 2. External pelvimetry - for inlet and outlet

Answer 6

- Palpation of the Fore Pelvis: index and middle fingers are moved along the pelvic brim. Note: whether it is round or angulated, causing the fingers to dip into a V-shaped depression behind the symphysis. - Diagonal conjugate: Try to palpate the sacral promontory to measure the diagonal conjugate. Normally, it is 12.5 cm and cannot be reached. If it is felt the pelvis is considered contracted and the true conjugate can be calculated by subtracting 1.5 cm from the diagonal conjugate.

Answer 7

- height, thickness, and indication of symphysis - shape and inclination of the sacrum - side walls - Ischial Spines - Interspinous Diameter - Sacrosciatic Notch

Answer 8

determine whether it is straight, convergent, or divergent, starting from the pelvic brim down to the base of the ischial spines in the direction of the base of the ischial tuberosity. Then relation between the index and middle finger of the base of ischial spines and the thumb of the other hand on the ischial tuberosity is detected. If the thumb is medial, the side wall is convergent, and if lateral, it is divergent.

Answer 9

- Whether it is blunt (difficult to identify at all), prominent (easily felt but not large),or very prominent (large and encroaching on the mid-plane). - ischialspines can be located by following the sacrospinousligament to its lateral end. - ISCHIAL TUBERSITY diameter – the transverse diameter of the outflow. Diameter should be at 11cm

Answer 10

using the 2 examining fingers,if both spinescanbe touched simultaneously, the interspinous diameter is 9.5cmi.e. inadequate for an average-sized baby.

Answer 11

sacrospinous ligament is two and half fingers, the sacrosciatic notch is considered adequate

Answer 12

- Subpubic angle:Normally,it admits 2 fingers. - Mobility of the coccyx: by pressing firmly on it while an external hand is on it can determine its mobility. - Anteroposterior diameter of the outlet: from the tip of the sacrum to the inferior edge of the symphysis

Answer 13

- Interspinous diameter (25cm): between the anterior superior iliac spines. - Intercrestal diameter (28 cm): between the most far pointson the outer borders of the iliac crests. - External conjugate(20cm) - Bituberous diameter (11cm)

Answer 14

Lateral view: ❖ The patient stands with the X-raytube on one side and the film cassette on the opposite side. ❖ it shows the anteroposterior diameters of the pelvis, angle of inclination of the brim, width of sacrosciatic notch, curvature of the sacrumand cephalo-pelvic relationship. Inlet view: Thepatient sitson the film cassette and leans backward sothat the plane of the pelvic brim becomesparallel to thefilm. Outlet view: The patients its on the film cassette and leans forward

Answer 15

- safe, accurate, and easy method - can detect: the biparietal diameter (BPD), the occipito-frontal diameter, and the circumference of the head

Answer 16

Done to detect inlet if the head is not engaged in the last 3-4 weeks in a primigravida

Answer 17

- more valuable in detection of the degree of disproportion. - patient evacuates her bladder and rectum. - patient is placed in the dorsal position. - left hand pushes the head into the pelvis and vaginal examination is done by the right hand while its thumb is placed over the symphysis to detect disproportion.

Answer 18

- Minor disproportion: anterior surface of the head is in line with the posterior surface of the symphysis. vaginal delivery can be achieved - Moderate disproportion (1st degree disproportion): anterior surface of the head is in line with the anterior surface of the symphysis. Vaginal delivery may or may not occur - Marked disproportion (2nd degree disproportion): head overrides the anterior surface of the symphysis. Vaginal delivery cannot occur.

Answer 19

1. Minor degree - true conjugate is 9 to 10 cm - spontaneous delivery is possible 2. Moderate degree - true conjugate is 8-9 cm - Can deliver vaginally but complication may arise 3. Severe degree - true conjugate is 6-8 cm - CS is indicated - marked disproportion 4. Extreme degree - true conjugate is less than 6 cm - Vaginal delivery is impossible - Absolutecontracted pelvis. - CS is indicated

Answer 20

- MINOR →VAGINAL DELIVERY - MODERATE → TRIAL LABOR, IF FAILED CS - SEVERE → CAESAREAN SECTION

Answer 21

- clinical test for the factors that cannot be determined before start of labor - determination of the progress of labor in a woman who has borderline inlet measurement with a good fetal lie and position - may continue as long as the descent of the presenting part and dilatation of the cervix continue to occur

Answer 22

- Efficiency of uterine contractions - Molding of the head - Yielding of the pelvis and soft tissues

Answer 23

1. Young primigravida of good health. 2. Moderate disproportion. 3. Vertex presentation. 4. No contracted outlet 5. Average-sized baby. 6. Vertex presentation

Answer 24

- Facilities for C.S is available. - Adequate analgesia. - Nothing by mouth. - Avoid premature rupture of membranes - The patient is left for 2 hours in the 2nd stage with good uterine contractions under close supervision to the mother and fetus.

Answer 25

1. rest in bed, 2. avoid high enema, 3. minimize vaginal examinations.

Answer 26

1. mother's knees are maximally flexed towards her chest. This helps to straighten the sacrum and increase the pelvic outlet. 2. Gentle, upward pressure is applied to the mother's suprapubic area (just above the pubic bone). This aims to lift the anterior shoulder of the baby, facilitating its passage. 3. Gentle downward traction on the baby's head is applied to assist in the delivery.

Answer 27

- VAGINAL DELIVERY: either spontaneously or by forceps if the head is engaged. - CAESARIAN SECTION if: failed trial of labor i.e. the head did not engage or complications occur during trial such as fetal distress or prolapsed pulsating cord beforefull cervical dilatation

Answer 28

- Instruct the woman to void every 2 hours to aid in fetal descent. - After the rupture of membranes, assess the FHR closely; if the fetal head is still high, there is an increased danger of prolapsed cord and anoxia in the fetus. - Cesarean birth would be necessary if there is no progress in labor after 6 to 12 hours. - If trial labor fails and cesarean birth is scheduled, explain why cesarean birth is the best birth method. - Women undergoing trial labor need to be reassured, as well as her support person, that cesarean birth is only an alternative, not an inferior, method of birth because the labor is not progressing. - Monitor fetal heart sounds and uterine contractions continuously

Answer 29

1. Moderate disproportion if trial of labor is contraindicated or failed. 2. Marked disproportion. 3. Extreme disproportion whether the fetus is living or dead. 4. Contracted outlet. 5. elderly primigravida 6. malpresentations, 7. placenta previa

Answer 30

- LACK OF ENGAGEMENT AT THE BEGINNING OF LABOR - PROLONGED FIRST STAGE OF LABOR - POOR DESCENT OF FETAL HEAD

Answer 31

- Retroverted gravid uterus - Malpresentations - Pendulous abdomen - Nonengagement - Pyelonephritis due to compression of the ureter

Answer 32

- Slow cervical dilatation and prolonged labor - PROM and cord prolapse - Obstructed labor and rupture uterus - Injury to pelvic joints or nerves from difficult forceps delivery - Postpartum hemorrhage

Answer 33

- Intracranial hemorrhage - Asphyxia - Fracture skull - Nerve injuries - Intra-amniotic infection

Answer 34

1.Encourage frequent position changes and ambulation to promote optimal fetal positioning and facilitate progress through the birth canal. 2.Assist the woman in assuming positions such as hands and knees, side-lying, or upright positions to alleviate pressure on the pelvis and promote effective uterine contractions.

Answer 35

1.Provide comfort measures such as relaxation techniques, massage, heat therapy, and hydrotherapy to relieve maternal discomfort and promote relaxation during labor. 2.Administer analgesia or anesthesia as prescribed by the healthcare provider to manage pain effectively and improve maternal comfort and coping.

Answer 36

1.Initiate intravenous (IV) access and administer fluids as prescribed to maintain hydration, electrolyte balance, and maternal blood pressure during labor. 2.Offer clear fluids and light snacks as tolerated to maintain maternal energy levels and prevent dehydration during prolonged labor.

Answer 37

1.Collaborate with the obstetric team to facilitate assisted delivery techniques, such as forceps or vacuum extraction, when indicated to expedite delivery and reduce maternal and fetal risks associated with prolonged labor. 2.Prepare the woman for instrumental delivery, providing education, support, and informed consent, and ensuring adequate anesthesia or analgesia for pain management.

Answer 38

1. Provide emotional support, reassurance, and encouragement to the woman and her support system, addressing fears, concerns, and anxieties related to obstructed labor. 2. Foster a calm and supportive environment, ensuring privacy, dignity, and respect for the woman’s preferences and cultural beliefs during labor and childbirth

Answer 39

1. Continuously monitor fetal heart rate (FHR) patterns using electronic fetal monitoring (EFM) to assess fetal well-being and detect signs of fetal distress or hypoxia. 2. Document FHR patterns, uterine contractions, and maternal vital signs regularly, reporting any abnormalities or non-reassuring findings promptly to the healthcare provider.

Answer 40

1. Anticipate and prepare for potential complications, such as uterine rupture, fetal distress, or postpartum hemorrhage, by assembling emergency equipment and ensuring readiness for prompt intervention. 2. Educate the woman and her support system about the signs and symptoms of obstetric emergencies, emphasizing the importance of timely reporting and seeking medical attention if concerns arise.

Answer 41

1.Provide postpartum support and monitoring for the woman and her newborn, assessing for signs of maternal or neonatal complications and facilitating early detection and intervention as needed. 2.Offer breastfeeding support, newborn care education

Answer 42

- turning of a fetus from a breech to a cephalic position before birth. - can be done but usual time is 37 to 38 weeks of pregnancy. - Record FHR and ultrasound continuously during the procedure. - uterus should relax , so administration of a tocolytic agent is done. - External cephalic version can decrease the number of cesarean births necessary from breech presentations. - The feeling of pressure may be uncomfortable for the woman. - Women who are Rh negative should receive Rh immunoglobulin after the procedure in case bleeding occurs.

Answer 43

multiple gestation, severe oligohydramnios , vaginal birth, cord coil , and unexplained third trimester bleeding which could be placenta previa

Answer 44

Obstetrical forceps - steel instruments constructed of two blades that slide together at their shaft to form a handle. One blade is - form the handle. The primary care provider then applies pressure on the handle to manually extract the fetus from the birth canal.

Answer 45

1. A woman is unable to push with contractions in the pelvic division of labor such as might happen with a woman who received regional anesthesia or who has a spinal cord injury 2. Cessation of descent in the second stage of labor 3. A fetus is in abnormal position 4. A fetus is in distress from a complication such as a prolapsed cord

Answer 46

1. Membranes must be ruptured. 2. CPD must not be present. 3. The cervix must be fully dilated. 4. The woman’s bladder must be empty.

Answer 47

1. Record the FHR before and immediately after application there is a danger that the cord could be compressed between the forceps blade and the fetal head 2. Assess the woman’s cervix to be certain no lacerations have occurred 3. Record the amount and time of first voiding to rule out bladder injury 4. Assess the newborn to be certain no facial palsy exists from pressure

Answer 48

- transient erythematous mark on the newborn’s cheek - this will fade in 1 to 2 days with no long term effects - Caused by forceps

Answer 49

With the fetal head at the perineum, a soft, disk shaped cup is pressed against the fetal scalp and 2 cm anterior to the posterior fontanelle

Answer 50

Advantage over forceps birth: little anesthesia is necessary less respiratory depression at birth

Answer 51

1. More perineal lacerations may occur 2. A marked caput may be noticeable as long as 7 days after birth 3. Tentorial tears 4. Not indicated for preterm

Answer 52

1. Fetal scalp blood sampling was used 2. Preterm infants

PROBLEMS WITH PASSAGE Flashcards

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