Ip Management Varney

Front 1

What is the defination of the First Stage of labor by Varney?

Back 1

Define as the beginning with true labor cxtrs as evidenced by progressive cervical change, and ending with the cervix completely dilated (10cms).
THE STAGE OF CERVICAL DILATATION.
(Varney4-737)

Front 2

Has a Midwife you should be able to Name the S&S of impending labor.
SO WHAT ARE THEY?

Back 2

Lightening
Cervical changes
False Labor
Premature Rupture of Membranes
Bloody show
Energy Spurt
GI upset(Varney4-737)

Front 3

G.G. who is 37wks gestation
G1P0 stated, "I woke-up this morning and found that I could breath much better and my stomach has shifted down"
Why is that? WHAT HAS OCCUR TO GG AND WHY?

Back 3

Because lighting occurs 2wks before labor, GG has experience "LIGHTENING" and since she is a primigravida it usually occurs prior to labor. This GG is a normal body change for you.Usually results of Braxton Hicks in a primgravida.
(Varney4-737)

Front 4

Ripeness indicates a readiness of the cervix for labor (TRUE/FALSE)

Back 4

TRUE
(varney4-738)

Front 5

What do you know about False Labor?

Back 5

False labor consist of painful uterine cxtrs. that have no measurable progressive effect on the cervix.
(Varney4-736)

Front 6

When would you expect the membranes to rupture in a laboring women who has not fallen off the labor curve? At what stage in the process of birth?

Back 6

Normally the membranes rupture by the End of the First Stage of Labor.
(Varney4-738)

Front 7

What serves has a protective barrier and closes the cervical canal throughout pregnancy?

Back 7

Mucus Plug;
(Varney4-738)

Front 8

GG stated that lately she has the energy to clean house and prepare for the up and coming birth. What is GG experiencing?

Back 8

GG is experince an energy spurt. Many women experience this approximately 24 to 48 hours before the onset of labor.
(Varney4-739)

Front 9

How long should contractions of active labor last?

Back 9

45 to 90 seconds with the averge of 60 seconds
(Varney4-740)

Front 10

The beginning of one contraction to the beginning of the next contractions.
WHAT IS THIS DESCRIBING?

Back 10

The frequency of a contraction
(Varney4-740)

Front 11

What pattern is essential to dilatation of the cervix?

Back 11

The Normal Gradient Pattern
Which is synchronous activity of the uterine muscle that causes a contraction to be stronger and longer in the fundal portion of the uterus, decreasing in the midportion, and minimal to nonexistent toward the cervix.
(Varney4-740)

Front 12

What is facilitated by the cleftlike arrangement of the endocervix, which in effect unfolds like an accordion as it is stretched and taken up to become part of the lower uterine segment.

Back 12

Effacement
(Varney4-741)

Front 13

________ is the enlargement of the external cervical os from an orifice of a few millimeters in diameter to an opening large enough for the ____ to pass through.

Back 13

Dilatation
Baby
(Varney4-741)

Front 14

JJ is a G1P0, 38wks gestation
in the office for a prenatal vist.
No really complaints voiced, just stated that she has had a backache all night but it is really nothing". Upon examing JJ cervix you found it to be
1/90% effaced.
WHAT ARE YOUR THOUGHTS AS HER PROVIDER?

Back 14

Progressive cervical change in a primigravida in labor is generally sequential, then simultaneous, with 50 to 100% effacement occuring first, followed by a combination of any remaining effacement and dilatation. JJ is a primigravida with a paper-thin cervix who is on the verge of active labor.
(Varney4-742)

Front 15

Who enters into labor with little or no effacement?
Primigravida or Multigravida

Back 15

The cervix of the Multigravida entering labor is frequently 1 to 2 cm dilated(or more, depending o parity) with little or no effacement.
(Varney4-742)

Front 16

Engagment;
How would you define it?

Back 16

It is when the widest diameter of the presenting part has passed through the PLEVIC INLET!
(VARNEY3-743)

Front 17

J.G.is a G2P1 who gives a hx of suggestive ROM at 37weeks and she is not in active labor, and feels no pain.
WHAT IS YOUR MANAGEMENT PLAN FOR JG?

Back 17

First do a SSE, which is indicated to observe the cervix for escaping aminotic fluid.
If no fluid seen, Obtain a specimen for a slide to see if there is any ferning
Also may tap a little of the specimen on some nitrazine paper(but this does not make a definitive diagnosis of rupture)
(Varney4-743)

Front 18

Diagnosis is definitive for ROM when what has occur?

Back 18

When you see amniotic fluid escaping from the cervical os and pooled in the vaginal vault during speculum exam or
When you cannot feel the membranes over the presenting part at the cervial orifice (Varney4-744)

Front 19

Latent Phase covers what period of time to what?

Back 19

The latent phase covers the period of time from the beginning of labor to the point when dilatation begins to progress actively.
(Varney4-746)

Front 20

What is the average length of the Latent Phase for a Primigravida?
Multipara?

Back 20

Takes a primigravida at least 8 to 20 hrs to get to the active phase from the latent phase on average

On average for the multipara it takes about 5 to 14 hrs.
(Oxoran, p 121)

Front 21

When do Braxton-Hicks began?

Back 21

30 to 35 weeks
(Oxorn 660) this is wrong Varney says 6 weeks

Front 22

Approximately 80% of near-term women with Premature rupture of membranes begin labor spontaneously within 24hrs.
TRUE OR FALSE

Back 22

True;
Rupture before the onset of labor is called Premature rupture of membranes and it occurs in about 12% of women.
(Varney4-738)

Front 23

What is the name of the Phase that ends the first stage of labor and is near and prepares the mom for the second stage of labor (Hit: they can vomit, have diarrhea etc.)

Back 23

Transitional Phase
(Varney4-746)

Front 24

As a Midwife what is the defination for LIE and what is the 3 possible LIES?

Back 24

Long axis of the fetus to the long axis of the mom.

3 possible LIES are;
longitudinal, transverse,and oblique
(Varney4-747)

Front 25

Has a Midwife, when you hear the word Presentation, what does this mean? and what is the 3 possible Presentation that the fetus can enter into the pelvic inlet?

Back 25

Presentation is determined by the presenting part, which is the first portion of the fetus to enter the pelvic inlet.
The 3 possible presentations:
Cephalic, Breech, and Shoulder
(Varney4-747)

Hint 25

FYI:
Cephalic and Breech presentations are further subdivided. A cephalic presentation can be either Vertex, Sincipital,Brow,or Face.
A Breech presentation can be either Frank, full/complete, or Footling(single or double.
(Varney4-747)

Front 26

What all the Presentations associated with a longitudinal lie, the most common is the WHAT?

Back 26

Most common is the vertex cephalic presentation.
It has an incidence of approximately 95%
(Varney4-748)

Front 27

What is the Most common position at the onset of labor in relations to the fetus and the pelvis?

Back 27

Because the head usually enters the inlet with the occiput directed to the transverse portion of the mother's pelvis, the most common position at the onset of labor is LOT.
(Varney4-748)

Front 28

True or False:
2/3s of the Presentations associated with a Longitudinal lie will be positioned with the Occiput in the left side of the mother's pelvis.

Back 28

True:
Two-thirds will be positioned in LOA LOT or LOP
(Varney4-748)

Front 29

Asynclitism indicates that the sagittal suture is directed either toward the symphysis pubis or toward the sacral promontory
(True or False)

Back 29

True
(Varney4-749)

Front 30

You are doing an exam on your client and feel that the sagittal suture is more toward the sacral promontory
What postion are you suspecting?

Back 30

Anterior Asyncitism
(Varney4-750)

Front 31

What do you know about caput succedaneum for sure?

Back 31

Caput Succedaneum crosses the suture line
(Varney4-751)
Cephalhomatoma, which is bleeding beneath the periosteum, may occur over more than one cranial bone but is limited to each individual bone and Does not cross any sutures.

Front 32

What do you know about cephalhomatomas?

Back 32

Cephalhomatomas do not Cross the suture lines.
(Varney4-751)

Front 33

So when you as a midwife suspect UTI, you should do What?

Back 33

Take a careful history(any fever, chills, Nausea, vomitng, urgency, lower back pain, suprapubic pain)
Conduct a PE(VS, Lymph nodes, CVA tenderness, SSE) and collect a urine specimen for rte analysis, culture,and sensitivity
(Varney4-754)

Front 34

Client is walking around and there is no intensity in her cxtr and the cxtr are still short in duration and walking stops the ctxr.
What will be your management?

Back 34

True labor is r/o in the absence of cerivcal change and false labor is r/o in the absence of irregular uterine contractions that are relieved by walking.
If this client has no cervical change, allow her to go home
(Varney4-754)

Front 35

If the fetal positon is ROP the woman should be on her right or left side,if the fetal positon is LOP the woman should be on her left or right side.

Back 35

ROP-calls for left side
LOP-calls for right side
(varney4-763)

Front 36

For the normal intrapartal woman there are 5 times when a vaginal exam is indicated, NAME THEM.

Back 36

On admission
Before Medication
Verify complete dilation
After SROM
To check for prolapsed cord when FHR decelerates
(Varney4-777)

Front 37

As a Midwife when would you AROM your patient and Why?

Back 37

To attach an IFM if there is questions about the fetal heart rate.
If the baby is about to be born with the membranes intact at the time of birth
If the client is in a hypotonic uterine dysfunction pattern and there is a need to stimulate labor
To facilitate fetal descent and reduce the possibility that the force of the pushing contractions will lead to sudden and vigorous ROM that will cause the cord to prolapse.
(Varney4-778)

Front 38

Your client has a complete history with no complications and would like to walk. She is 6/c/+1(BOWI) WHAT IS THE MANAGEMENT FOR HER and WHY?

Back 38

Client is low risk/no risk
She may walk but must know that she must return q30mins so that the FHR can be Auscultated and if her bag happens to break she must return immediately so that FHR can be check.
(Varney4-798)

Front 39

Early decels are thought to be cause by Head Compressions.
True or False

Back 39

True;
Early decels is thought to be caused by head compressions. It is associated with cervical dilatation of 4 to 7 cm and is thought to be initiated by the pressure of the dilating cervix across the posterior fontanel in a nomal presentation.
(Varney4-803)

Front 40

What kind of decelerations are thought to be caused by umbilical cord compression.

Back 40

Variable Deceleration:

They have been described has V-shape U-shape, and W-shape
(Varney4-803)

Front 41

TC G1P0 is 2/90/-1 , having cxtr's every 7 to 10mins lasting 20 to 40secs. TC is sleepy and extremely tried, and is becoming frustrated. FHR is 130s with no decels.
WHAT WILL BE YOUR MANAGEMENT FOR TC? Admit to the hospital or send her home with a sedative

Back 41

TC will be send home with a sedative and encourage to rest.(Varney3-391-392)

Front 42

Which of th following is not a term used to describe the lie of the fetus?
Longitudianal
Transverse
Oblique
Vertex

Back 42

Lie is define has the relationship of the long axis of the fetus to the long axis of the mother( Oxorn-53)
Vertex is not a term used to describe the LIE of the fetus(Varney3-398-399)

Front 43

Name the most common position, lie, presentation and variety of the fetus at the onset of labor

Back 43

LOT (Varney3-399)

Front 44

Anterior fontanel of the fetal skull is formed by the meeting of ____,_____, and _____ Sutures.

Back 44

Frontal, Sagittal and Coronal sutures.
(Varney 3-401)

Front 45

Braxton Hicks contractions Start at about 6 weeks gestational age. (True or False)

Back 45

True:
Varney4-738)

Front 46

CC is a G1P0 40wks gestaion, her exam in the office is 1/C/-1. No LOF
BOWI with positive FM.
What is happing to CC?

Back 46

CC cervix is getting ready for True labor.
(Varney3-385)

Front 47

The upper zone of the uterus shorten and thickens, while the lower zone lengthens and thins. WHAT IS THIS DESCRIBING?

Back 47

How the uterine contractions differentiate the uterus into two segments
(Varney4-741)

Front 48

Can you define ENGAGEMENT?

Back 48

The point when the widest diameter of the fetal presenting part has passed THROUGH the pelvic inlet.
(Varney4-743)

Front 49

What is the normal fetal baseline heart rate?

Back 49

120 to 160 beats a minute
(Varney3-402)

Front 50

True of False
In normal labor the fetal head ususally enters the pelvic inlet with a moderate degree of Posterior asynclitism before the mechanism of internal rotation takes places.

Back 50

True
(Varney4-750)

Front 51

Start listening midway between two ctxrs' and continue listening through the next cxtr to the midpoint between it and the following cxtr. WHAT IS THE MIDWIFE DOING?

Back 51

Intermittently listening to fetal heart tones during labor.
(Varney 3-403)

Front 52

What position is most helpful in facilitating the Long ARC rotation of a fetus in ROP?

Back 52

Right Lateral position
(Varney3-412)

Front 53

External rotation accomplishes what in a birth with cephalic presentation?

Back 53

Brings the bisacromial diameter of the fetus into alignment with the anteroposterior diameter of the pelvic outlet
(Varney3-437)

Front 54

Internal rotation accomplish in a birth with cephalic presentation?

Back 54

Brings the anteroposterior diameter of the fetal head into alignment with the anteroposterior diameter of the maternal pelvis
(Varney3-436)

Front 55

WHAT IS KNOWN AS THE STAGE OF EXPULSION?

Back 55

Complete dilation of the cervix to the birth of the baby -The second stage of labor--Known as the stage of expulsion
(Varney4-821)

Front 56

If second stage is lasting longer than 2hrs for a Primigravida or longer than 1 hr for a mulitigravida it is considered abnormal by Friedman -But what could hold them up ?

Back 56

Anesthesia
Varney4-821)

Front 57

What are the 8 basic positional movements that take place when the fetus is in a cephalic vertex presentation?

Back 57

Engagment
Descent (Through out)
Flexion (must have to further descent)
Internal Rotation (brings the anteriorposterior diameter of the head into alignment with the anteriorposterior alignment of the maternal pelvis-IS ESSENTIAL FOR VAGINAL BIRTH TO OCCUR except for premies/abnormally small babies)
Extension (Birth of the Head)
Restitution (Head rotates 45 degrees -left or right, untwists the neck and brings the head so it is again at a right angle with the shoulders-sagittal suture should be in one of the oblique diameters of the pelvis and the bisacromil diameter of the fetus is in the other oblifque diameter of the pelvis)
THIS IS WHAT MAKES
External Rotation happen: because the shoulders rotate 45degrees,this makes the head rotate externally 45degrees into the LOT or ROT position depending on the direction of restitution(Varney4-825)

Front 58

Upon examing CC, you felt the sagittal suture in the right oblique area. What positions could her baby's head be in(out of 2 possibilities)?

Back 58

If the triangle is to the mom's left its LOA, if the triangle is to the mom's right its ROP
But if you can not feel the Triangel then you know its either LOA or ROP.
(Varney4-826)

Front 59

OK! you do an exam and feel the sagittal suture in an obligue LIE. more toward the maternal left. What position could this fetus head be in ?
(Hit; try to find the triangle)

Back 59

If the triangle is in the right then its ROA but if you feel the triangle on the maternal lower left then its LOP
(Varney4-826)

Front 60

JJ BP is 110/70 but when she beings her second stage of labor you note that her blood pressure is now 130/80.
HAS A MIDWIFE WHAT DO YOU KNOW ABOUT BP AND SECOND STAGE.

Back 60

Rises during contractions with the systolic rising an average of 15(10 to 20)mm Hg and the diastolic rising an average of 5-10mm Hg. This average rise that JJ is having is Normal at this time.
(Varney4-752 &827)

Front 61

A pudental block anesthetizes what areas?

Back 61

Perineum
Vulva including the clitoris, labia majora, labia minora, perineal body, and rectal area.
(Varney4-833)

Front 62

_________should have occurred during the active phase of the first stage of labor in the Nullipara and by the onset of the Second stage in the Multipara.

Back 62

ENGAGMENT: failure of engagment to have occurred by entry into the second stage of labor is a signal of a potential problem.
(Varney4-836)

Front 63

What is the criteria to do a fFN?

Back 63

BOWI
No earlier then 24wks
No later then 34wks
Nothing in the vagin in the past 24hrs
Less than 3 cm dilated
(Varney4-858)

Front 64

Painful menstrual like cramps
Dull low backache
Suprapubic pain or pressure
Sensation of pelvic pressure or heaviness
Change in character or amount of vaginal disc.
Diarrhea
Unpalpated Uterine cxtrs(painful or painless)felt more often than every10mins in an hour or more and not relieve by lying down
Premature Rupture of Membranes
IF YOUR CLIENT IS 20 TO 24WKS AND HAVING THESE SYMPTOMS (WHAT ARE YOU THINKING?)

Back 64

THE CLIENT NEEDS TO BE WORKED UP FOR PRETERM LABOR
(Varney4-858)

Front 65

Maternal Fever
Maternal Tachycardia
Fetal Tachycardia
Tender Uterus
Vaginal Walls unusually warm(hot) to touch
Foul-smelling, purulent amniotic fluid
Elevated white blood cell count
ARE ALL SIGNS AND SYMPTOSMS OF WHAT?

Back 65

Amnionitis and Chorioamnionitis
(Varney4-867)

Front 66

JT G1P0, at 37 wks had SROM, JT also reported that when her bag broke the fluid was clear but had a foul odor.JT VS: 100.4 pulse 110 and resp22. Upon Lepold you note that her fundus is tendrer.
FHTs 170s
What will be your management for JT and WHY?

Back 66

Primary goal is to birth the baby and treat JT with antibiotics for Chorioamnionitis by collaborating and consulting the MD.
(Varney4-868)

Front 67

TJ is a G2P1 Her first pregnancy hx showed that she was GBS Positive, ---- should she receive IP antibiotic prophylaxis with this pregnancy? YES or NO
and WHY?

Back 67

Answer is NO-because
A previous pregnancy with a positive GBS culture does not automatically mean that a woman should receive IP antibiotics prophylaxis with this pregnancy unless she again has a positive screening test.
(Varney4-868)

Front 68

All pregnant women should be screened for GBS at 35 to 37 weeks> YES OR NO

Back 68

YES;
Varney4-869

Front 69

GG is a G2P1, in taking her hx you find out that her first born child had GBS disease, has her Provider what do you know for sure?

Back 69

A woman who had a previous baby with GBS disease shoud, however, automatically receive IP antibiotic prophylaxis with this pregnancy and DOES NOT need to be screened at 35 to 37 wks
(Varney4-869)
HAS HER MIDWIFE, YOU KNOW FOR SURE THAT SHE WILL BE GETTING ANTIBIOTICS IP PROPHYLAXIS.

Front 70

Has a Provider, you are looking over your lab results and notice that a client has a positive GBS bacteriuria and she is presently 20 wks pregnant. WHAT DO YOU KNOW FOR SURE ABOUT THIS CLIENT?

Back 70

She will need IP prophylaxis and she does not need a GBS screen done at 35 to 37 wks.
Varney4-869
A woman with GBS bacteriuria during this pregnancy should receive IP antibiotic prophylaxis. She does not need to be screened at 35 to 37 wks gestation.

Front 71

What do you know for SURE with the following:
Unk GBS status (culture not done,incomplete,or results unk)
Delivery at< 37 wks
Amniotic membrane Ruptured >18hrs
Intrapartum Temp.>100.4 F(>38.0 C)

Back 71

All will receive Intrapartum prophylaxis
(Varney4-869)

Front 72

A woman comes in who is scheduled for a cesarean delivery ,but you find that she has SROM(her records showed that she was tested and was positive for GBS.
AS HER PROVIDER,WHO NEEDS TO KNOW THIS FOR SURE?

Back 72

The Neonatal Team needs to know that her GBS status was positive and that she came in with SROM-clear.
(Varney4-869)

Front 73

What is the drug of choice for GBS and what is the dosage?

Back 73

Penicillan G 5 mu load then Penicillan G 2.5 mu every 4 hrs IV
Alternative is Ampicillan 2g IV then 1g every 4 hrs.
(Varney4-871)

Front 74

Prolapsed Cord:
WHAT DO YOU KNOW FOR SURE ABOUT YOUR HAND?

Back 74

Do not under any circumstances remove your hand from the woman's vagina or from the presenting part until the baby is delivered(probably by cesarean section
(Varney4-871)

Front 75

Can you name and give defination for the 2 types of prolapse cords?
Which one can occur without threatening life and why?

Back 75

Frank Cord-prolapse the cord slips through the cervix.
Frank cord can occur without threatening life when there is a tranverse lie or footling breech, because there is no compression of the cord.

Occult Cord- prolapse the cord slips down alongside the presenting part but does not protrude through the cervix.
(Varney4-870)

Front 76

What pelvic types are associated with Deeep Transverse Arrest?
(hit: EGG on its side and heart)

Back 76

Platypelloid
Android
(Varney4-873)

Front 77

Name the signs and symptoms of a Uterine Rupture

Back 77

Symptoms: sharp shooting pain in lower abdomen at the height of a severe contraction
States" I feel that something tore"
Might have vaginal bleeding a slight amount or hemorrhage
Signs:
Presenting part is moveable above the pelvic inlet
Fetal movement might become violent and then none
A round firm uterus may be felt beside the fetus(felt out side of the uterus)
(Varney4-877)

Front 78

What is McRoberts maneuver doing to the pelvis?

Back 78

The procedure causes straightening of the sacrum relative to the lumbar vertebrae, rotation of the symphysis pubis toward the maternal head, and a decrease in the angle of the pelvic inclination
IT DOES NOTE INCREASE PELVIC DIMENSIONS
(Wms22-515)

Front 79

What face presentation CAN NOT delivery vaginal?

Back 79

Mentum Posterior
(RMP, LMP )

Front 80

What face presentation CAN delivery vaginal?

Back 80

Mentum Anterior
(RMA, LMA)
Ma's can
VARNEY4 891

Front 81

Sudden gush of blood
Lengthening of the cord
Change in the shape of the uterus from discord to globular as the uterus now contracts on itself
Change in the position of the uterus
WHAT IS HAPPING HERE?

Back 81

THE PLACENTA IS SEPARATING
(Varney4-906)

Front 82

The placenta separation is centrally- What type of placenta is this?
Duncan or Schultz

Back 82

SCHULTZ- shinny side
fetal side
(Varney4-906)

Front 83

Separation first takes place at the margin or periphery of the placenta. WHAT TYPE OF PLACENTA IS THIS?

Back 83

Duncan side
Maternal side-dirty Duncan
(Varney4-906)

Front 84

How long should a Provider wait before thinking Retained Placenta?
20 or 30 mins

Back 84

Most MWs will wait half an hour for the placenta to deliver before saying it is retained
(Varney4-913)

Front 85

What are the steps for third stage hemorrhage? (placenta is parital seperated)

Back 85

Notify the consultingMD
Thoroughly massage uterus
Have someone start an IV (16g)
Type and Cross
Make sure bladder is empty
If the placenta is not yet deliveried Make sure the MD is on his way and that Pitocin is going
(Varney4-914)

Front 86

Uterine Inversion- Has a Midwife what do you know for sure?

Back 86

Must repositon the uterus with the placenta still attached
(Varney4-915)

Front 87

Never apply fundal pressure with a hand on an uncontracted utterus-Why?
Never have the mother pushed to help expel the placenta without first checking to see that the uterus is contracted-WHY?
Never exert cord traction prior to placental separation-WHY?
Never pull on the placenta during manual removal prior to total placental separation-WHY?

Back 87

Because Uterine Inversion is more apt to occur, and all are an act of mismanagement
(Varney4-915)

Front 88

______ _______ is the major cause if immediate postpartum hemorrhage.

Back 88

Uterine Atony
(Varney4-918)

Front 89

What is the first management step for PPH and WHY?

Back 89

Check the consistency fo the uterus.This step is first, since 80 to 90 % of immediate PPH is due to uterine atony
(Varney4-928)

Front 90

CJ deliveried and the placenta deliveried shortly after the baby. But she began to bleed.
Her uterus was check for consistency(found to be atonic) Upon massage did not contract so Bimanual compression was started..
The uterus was found to be empty and well contracted but bleeding continues-WHAT IS THE NEXT STEP

Back 90

Examine CJs for lacerations:
cervical, vaginal, and perineal since these maybe the cause of hemorrhage.
CJ had a cervical laceration.
(Varney4-928)