Week 10 pt 1 highlights

Question 1

Define category 3 tracings

Answer 1

Absent FHR variability
AND
Recurrent late decelerations
Recurrent variable decelerations
Sustained Bradycardia
OR
Sinusoidal Pattern (>20min)

Question 2

What includes Everything not in category 1 or 3 tracings?

Answer 2

Category 2 tracings

Question 3

What is Predictive of abnormal fetal acid-base status at time of observation?

Answer 3

Category 3 tracings

Question 4

What determines fetal acid/base status during labor?

Answer 4

Fetal Scalp Blood Sampling

Question 5

What are the requirements for Fetal Scalp Blood Sampling?

Answer 5

Membranes must (already) be ruptured, and cervix dilated 2-3cm to perform

Question 6

Normal scalp pH is what?

Answer 6

7.25-7.35

Question 7

Define false labor

Answer 7

Uterine contractions (regular or irregular) that DO NOT cause dilation and effacement of the cervix
(aka Braxton Hicks contractions)

Question 8

T/F: Braxton hicks contractions are are normal during 3rd trimester of pregnancy

Answer 8

True

Question 9

What 3 things generally cause braxton hicks contractions to resolve?

Answer 9

Ambulation, hydration or analgesia

Question 10

Factors that Contribute to Normal Labor include what 3 things?

Answer 10

1) Power (uterine contractions)
2) Passenger
3) Passage

Question 11

Power: Each uterine contraction must generate >_____mmHg of peak pressure and at least ___ contractions in a 10min interval.

Answer 11

25mmgHg; 3

Question 12

Montevideo units must be at least _______ MVU for adequate labor progression during the active phase.

Answer 12

200

Question 13

Passenger:
1) If fetus’ weight > 4,000-4,500g, there’s an increased risk of what 2 things?
2) What presentation requires a c-section?

Answer 13

1) Shoulder dystocia and fetopelvic disproportion
2) Face presentation (or breech)

Question 14

Give an example of passage

Answer 14

Cephalopelvic disproportion (CPD)

Question 15

How do you inspect effacement?

Answer 15

Digital vaginal exam

Question 16

List 3 terms that describe the position of the fetal head

Answer 16

1) Position
2) Engagement
3) Station

Question 17

Engagement [of the fetal head] occurs when the biparietal diameter is at or below the inlet of the _______ pelvis.

Answer 17

true

Question 18

List 3 terms that assess position

Answer 18

1) Attitude
2) Lie
3) Presentation

Question 19

The normal fetal attitude when labor begins is with all joints in __________

Answer 19

flexion

Question 20

The initial examination of the patient’s abdomen may be accomplished using ____________ maneuvers

Answer 20

Leopold

Question 21

Leopold maneuvers: A series of four palpations of the uterus and fetus through the abdominal wall that helps accurately determine what 3 things?

Answer 21

fetal lie, presentation, and position.

Question 22

Define the 4 main parts of Leopold’s maneuvers

Answer 22

1. Determining what occupies the fundus.
2. Determining location of small parts.
3. Identifying descent of the presenting part.
4. Identifying the cephalic prominence.

Question 23

What 3 things does the cervix do in true labor?

Answer 23

1) Soften: Tip of nose > softest part of cheek
2) Thin: 2-3cm > paper-thin
May cause “bloody show”
3) Dilate: Closed > 10 cm

Question 24

Patients should be instructed to contact their health care provider and/or go to L&D for any of what 4 reasons?

Answer 24

1) If their contractions occur approximately every 5 minutes for at least 1 hour
2) If there is a sudden gush of fluid or a constant leakage of vaginal fluid
3) If there is any significant vaginal bleeding
4) If there is significant decrease in fetal movement.

Question 25

1) Define the first stage of labor 2) Define the second stage of labor

Answer 25

1) Onset of true contractions through complete dilation and effacement of the cervix. 2) Onset with complete dilation and effacement and ends with delivery of baby

Question 26

1) Define the third stage of labor 2) Define the fourth stage of labor

Answer 26

1) Begins with birth of baby and ends with delivery of the placenta -give Pitocin (Oxytocin) 2) The 2hrs immediately following the delivery of the placenta. -high risk for mom

Question 27

Which stages of labor are highest risk for mom?

Answer 27

Third and fourth

Question 28

What is the highest risk stage of labor for mom?

Answer 28

Fourth stage

Question 29

When are 3 different situations in which rupture of membranes (ROM) may occur?

Answer 29

1) Prelabor/premature Rupture of Membranes (PROM) 2) Preterm Prelabor/premature Rupture of Membranes (PPROM) 3) OR may occur as part of the labor process

Question 30

Define amniotomy

Answer 30

Amniotic sac deliberately ruptured to cause a release of amniotic fluid (amniotomy/artificial ROM)

Question 31

When is amniotomy contraindicated?

Answer 31

Contraindicated unless fetal head is engaged

Question 32

What is more likely if presenting part not engaged, malpresentation, if polyhydramnios present, and multiparity?

Answer 32

Umbilical Cord Prolapse

Question 33

What is the Tx for umbilical cord prolapse?

Answer 33

Prompt delivery by C/S Pressure must be kept off cord

Question 34

What are the 3 kinds of breech?

Answer 34

Frank Complete Incomplete (footling)

Question 35

Name 1 thing breech is associated with

Answer 35

prematurity

Question 36

Breech presentation: What are the 2 treatments?

Answer 36

1) External cephalic version 2) C-section

Question 37

1) Define Meconium Staining of the Fluid 2) How common is it? 3) What are 2 causes? 4) What is needed before first breath?

Answer 37

1) Baby has moved its bowels in utero 2) 12% of live births 3) Post-dates gestation or fetal response to stress before or during labor 4) Aggressive suctioning

Question 38

Give 4 examples of invasive pain mgmt in labor

Answer 38

1) Epidural (infusion of local anesthetic through a catheter in the epidural space) 2) Spinal (single injection, lasts ~2hrs) 3) Local block (ie pudendal block) 4) General anesthesia

Question 39

1) What occurs when the biparietal diameter is at or below the pelvic inlet? 2) What allows for the smaller diameters of the fetal head to present?

Answer 39

1) Engagement 2) Flexion of the head

Question 40

When does engagement occur days to weeks prior to labor?

Answer 40

1st child

Question 41

As the fetal head engages and descends, it assumes an occiput _____________ position

Answer 41

transverse

Question 42

When is the greatest rate of descent?

Answer 42

Latter portions of the first stage of labor and during the second stage

Question 43

With further descent, after transverse orientation. the occiput rotates anteriorly, and the fetal head assumes an ___________ orientation.

Answer 43

oblique

Question 44

The curve of the hollow of the sacrum favors ____________ of the fetal head as further descent occurs.

Answer 44

extension q

Question 45

Define restitution

Answer 45

When the fetal head returns to its transverse position

Question 46

1) What occurs rapidly after restitution? 2) What maneuver?

Answer 46

1) Delivery of the body (expulsion) 2) Modified Ritgen maneuver

Question 47

___________ is performed to enlarge the birth outlet and facilitate delivery of the fetus. 

Answer 47

Episiotomy

Question 48

True or false: There is NO evidence-based indication for routine episiotomy.

Answer 48

True

Question 49

Episiotomies are “neater” and easier to repair, but ___________ heal better

Answer 49

lacerations

Question 50

True or false: Immediately after the baby’s delivery, the cervix and vagina must be inspected for lacerations requiring surgical repair

Answer 50

True

Question 51

True or false: Episiotomies must be repaired.

Answer 51

True

Question 52

Delivery Of The Placenta generally, delivers within ______ minutes with no intervention

Answer 52

15

Question 53

What should you not do during stage 3 of labor?

Answer 53

Do not pull on the cord; gentle traction ideal.

Question 54

What should you do to prevent uterine atony during stage 3 of labor?

Answer 54

IV oxytocin

Question 55

Why should you inspect the placenta?

Answer 55

To make sure that it is all there; can cause life-threatening hemorrhage if piece left

Question 56

Stage 4 of labor: 1) Once the placenta has been expelled, you must assess what? 2) Why? 3) What must you do after you assess?

Answer 56

1) Uterine tone. 2) Uterus MUST contract or patient will bleed to death due to post-partum hemorrhage. 3) Fundal massage + oxytocin

Question 57

Primary cause of postpartum uterine atony (immediate or delayed) is what?

Answer 57

Bladder distention

Question 58

Dystocia (difficult labor) is characterized by what?

Answer 58

Abnormally slow progress in labor

Question 59

What is the Most common cause of C/S in US?

Answer 59

Dystocia (difficult labor)

Question 60

Dystocia (difficult labor) may occur because of what 3 things?

Answer 60

Issues with power, passenger, or passage

Question 61

1) Give 2 maternal causes for shoulder dystocia 2) Give 1 fetal causes

Answer 61

1) Gestational diabetes; previous shoulder dystocia, 2) Increased birth weight

Question 62

McRoberts maneuver is for what?

Answer 62

Hyperflexion of legs to mother's abdomen (can cause shoulder dystocia)

Question 63

Brachial plexus palsy (Erb’s Palsy) is a potential complication of what?

Answer 63

Shoulder dystocia

Question 64

1) Arrest Patterns in Labor are possibly associated with what? What should you do if diagnosed? 2) What do arrest patterns signal?

Answer 64

1) Cephalopelvic disproportion (CPD); c-section 2) The likelihood that a bony impediment exists.

Question 65

Prolonged active phase and prolonged second stage are associated with _______________, which is associated with Erb's palsy

Answer 65

shoulder dystocia

Question 66

What are 2 labor disorders of the first stage of labor?

Answer 66

1) Prolonged latent phase 2) Prolonged active phase

Question 67

Protraction disorder may occur in what stage of labor?

Answer 67

Stage 2

Question 68

_____________ is used for all protraction and arrest disorders (per ACOG) (amniotomy is also an option)

Answer 68

Oxytocin

Question 69

If contractions are weak or irregular, use _____________ augmentation

Answer 69

Oxytocin (Pitocin)

Question 70

List 6 important contraindications to oxytocin

Answer 70

1) Significant cephalopelvic disproportion 2) Unfavorable fetal positions or presentations 3) Obstetric emergencies that favor surgery 4) Fetal distress where delivery is not imminent 5) Partial/complete placenta previa 6) Prematurity

Question 71

Arrest of Labor: What is a crucial question to ask before you Dx?

Answer 71

Is she having an arrest of labor or has she never been IN labor?

Question 72

Prior to diagnosing an arrest of labor, uterine contraction pattern should exceed ______ Montevideo units >2 hrs without _________ change

Answer 72

200; cervical

Question 73

What is the most common cause of shoulder dystocia?

Answer 73

Vacuum/ forceps use

Question 74

C-sections are nearly always done with a __________ uterine incision to minimize future risk of uterine rupture

Answer 74

low transverse

Question 75

What is the anesthesia of choice for c-sections?

Answer 75

Epidural

Question 76

What are the criteria for VBAC?

Answer 76

1) Only one previous low-transverse cesarean delivery 2) Presence of a clinically adequate pelvis 3) No other uterine scars or previous rupture 4) Physician immediately available 5) Continuous electronic fetal heart rate monitoring 6) Availability of anesthesia and personnel for emergency cesarean delivery. 7) Availability of a 24-hour blood bank and capability for massive transfusion

Question 76

T/F: VBAC has an increased neonatal morbidity and mortality

Answer 76

True