Mtb - A Midwife's Handbook - Chapter 5

Front 1

Percentage of occurance of Postpartum Hemorrhage?

Back 1

4% pg 205

Front 2

Advantages of mobility and ambulation during labor?

Back 2

Stronger contractions, shorter labor, less need for augmentation, less need for pain control, fewer operative deliveries and lessened signs of fetal distress (according to one study; another study showed no benefits or disadvantages. pg 124.

Front 3

Studies _________ the consumption of food and drink during labor.

Back 3

Support. pg 124-125.

Front 4

A doula is:

Back 4

an experienced laywoman who provides continuous support to the woman and her partner during labor and delivery. Less incidence of PPD, improved self-esteem, exclusive breastfeeding and increased sensitivity of the mother to her baby - when a doula was present. pg 126.

Front 5

Friedman's curve for a Primigravida:

• Latent Phase

Back 5

Mean: 6.4h; Limit: 20.1h; pg 127

Front 6

Friedman's curve for a Primigravida:

• Active Phase

Back 6

Mean: 4.6h; Limit: 11.7h; pg 127

Front 7

Friedman's curve for a Primigravida:

• Decelerations

Back 7

Mean: .84h; Limit: 2.7h; pg 127

Front 8

Friedman's curve definitely applies to all ethnic groups accurately.

Back 8

False. pg 126

Front 9

Friedman's curve for a Primigravida:

• Maximum Slope

Back 9

Mean: 3.0cm/h; Limit: 1.2cm/h; pg 127

Front 10

Friedman's curve for a Primigravida:

• Second stage

Back 10

Mean: 1.1h; Limit: 2.9h; pg 127

Front 11

Friedman's curve for a Multigravida:

• Latent phase

Back 11

Mean: 4.8h; Limit: 13.6h; pg 127

Front 12

Friedman's curve for a Multigravida:

• Active phase

Back 12

Mean: 2.4h; Limit: 5.2h; pg 127

Front 13

Friedman's curve for a Multigravida:

• Deceleration

Back 13

Mean: .36 h; Limit: .86h; pg 127

Front 14

Friedman's curve for a Multigravida:

• Maximum Slope

Back 14

Mean: 5.7cm/h; Limit: 1.5cm/h; pg 127

Front 15

Friedman's curve for a Multigravida:

• Second Stage

Back 15

Mean: 0.39/h; Limit: 1.1h; pg 127

Front 16

What two factor's seem to invalidate the Friedman's curve?

Back 16

Oxytocin-augmentation; Epidural anesthesia. pg 127

Front 17

Name which types of anesthesia are typically used in the US:

Back 17

epidural, intrathecal, general, spinal, paracervical block, pudendal block and local. pg 131

Front 18

Intrathecal anesthesia is also known as:

Back 18

Walking epidural pg 136

Front 19

Posterior presentation (Occiput Posterior)

Back 19

Persists in 6-10% of labors. pg 140

Front 20

Occiput Posterior is diagnosed by:

Back 20

Fetal skull landmarks on vaginal exam. Leopolds manuevers. depression near maternal umbilicus that may appear to be full bladder (needs to be differentiated), premature urge to push. pg 140

Front 21

With occiput posterior presentation __________ may prevent the fetus from rotating.

Back 21

Amniotomy. pg 141

Front 22

Comfort measures for back labor include:

Back 22

counterpressure; double hip squeeze; knee press; whirlpool bath or shower; TENS unit; Sterile water papules. pg 142

Front 23

Premature Rupture of Membranes (PROM)

Back 23

rupture beginning 1 hour before the onset of labor. 8% of all term pregnancies. 95% of these women deliver within 28 hours. At term, 75% will go into labor spontaneously by 24 hours. Birth is likely to occur within 1 week regardless of gestational age. pg 143

Front 24

Predictors of neonatal infection

Back 24

chorioamnionitis, 16% infected; GBS 4-11%; > 7 or 8 digital vaginal examinations. time from rupture to active labor is >24h. pg 144

Front 25

PROM highest risk:

Back 25

chorioamnionitis.

Front 26

Possible factors for induction at term:

Back 26

abnormal fetal testing; diabetes; IUGR; Postdates; PROM; chorioamnionitis; fetal abnormality; maternal heart disease; preeclampsia; Rh incompatibility. pg 144

Front 27

Contraindications for induction:

Back 27

active herpes lesion; invasive cervical carcinoma; transverse fetal lie; history of classical cesarean section; placenta previa; vasa previa. pg 144

Front 28

Relative contraindications to induction:

Back 28

abnormal fetal position; history of uterine surgery, especially that involving complete transection of the uterus (myomectomy or reconstruction; overdistended uterus. pg 144

Front 29

Proceed with induction with caution:

Back 29

maternal cardiac disease; multiple gestation; nonreassuring FHR tracing not presently requiring emergency delivery; polyhydramnios; presenting part is above the pelvic inlet. pg 144

Front 30

Complications of induction:

Back 30

doubles the risk of cesarean birth, particularly in nullparous or older women. pg 145

Front 31

The bishop score:

Back 31

evaluates cervical readiness.

Front 32

Prostaglandin E2 (dinoprostone; prepidil; cervadil)

Back 32

Bishop score of <4 ripens cervix; Bishop score 5-7 may induce labor. pg 146

Front 33

Prostaglandin E1 gel (misoprostol; Cytotec)

Back 33

associated with uterine rupture; ACOG maintains that, if used appropriately it is safe and effective. pg 146-147

Front 34

Stripping of the membranes:

Back 34

releases prostaglandins in proportion to the area of membranes loosened, increasing the likelihood of labor beginning. pg 147

Front 35

Risk of membrane stripping:

Back 35

introduction of infection; bleeding from an unsuspected low-lying placenta; unintentional rupture of the membranes. pg 147

Front 36

If castor oil is going to work, it will work within:

Back 36

2-6 hours. pg 147

Front 37

Amniotomy

Back 37

AROM relaases prostaglandin. uterine activity results within 2-4 hours. Can be done with or without oxytocin. Must be in term, active labor, 4-5 cm dilated, 0 station. pg 147

Front 38

AROM risks:

Back 38

rupture of aberrant blood vessels; prolapse of cord or fetal extremity; compression of the umbilical cord, rapid descent with resultant fetal bradycardia. prolonged labor with resultant fetal and maternal infection.

Front 39

Mechanical dilators:

Back 39

balloon catheters, laminaria, and synthetic osmotic dilators. Bishop score increases as laminaria expand in cervix. pg 148

Front 40

Risks of pitocin:

Back 40

uterine hyperstimulation; uterine ruptures, fetal distress, or water intoxication. pg 148

Front 41

Serial induction:

Back 41

3 day maximum. pg 148

Front 42

Cervadil:

Back 42

vaginal insert, 10 mg at slower rate; hyperstimulation can occur @ 1.5-9.5 hours after placement and resolves within minutes of removal. Removed after 12 hours or at onset of active labor. pg 146

Front 43

Only advantage of stripping membranes:

Back 43

increases the likelihood of labor beginning. pg 147

Front 44

Preterm labor, 20-37 weeks, includes 10% of all deliveries in the US. More than 50% of women who deliver early have no known risk factors.

Back 44

Therefore, all women must be educated on the signs and symptoms of preterm labor. pg 152

Front 45

Dystocia of labor:

Back 45

difficult or abnormal labor or childbirth; caused by malpositioned head, inadequate expulsive forces, fetal size or presentation, a contracted pelvis or an abnormality of the birth canal. pg 158

Front 46

Asynclitism

Back 46

forward-leaning positions, asymmetric positions, duck walking or stair climbing, sitting in a chair with one foot pulled up onto the chair, standing beside a bed with one foot up on the bed about knee height, kneeling with one foot projected laterally resting the sole on the ground (leg alongside arm), leaning forward onto partner, birthing ball, or head of bed with one leg drawn forward, resting the sole on floor or bed. Vaginal manual rotation. keeping waters in tact may help baby to move. anticipatory managment. pg 159-160

Front 47

Prolonged latent phase risks:

Back 47

frequency of labor abnormalities, maternal fever, cesarean delivery, neonatal resuscitation, thick meconium, neonatal intensive care admissions, lengthened hospital stays, and blood loss. pg 162

Front 48

Hands-knees

Back 48

Gaskin maneuver. Opens pelvis, may not be useful in true dystocia; pg 185

Front 49

McRoberts' position

Back 49

flexion of legs into maternal abdomen; flattens sacrum, rotates symphysis pubis to more favorable angle, and lessens the traction needed to deliver. pg 185

Front 50

Suprapubic pressure

Back 50

may dislodge the shoulder from under the suprapubic bone. pg 185

Front 51

Rubin's maneuvers

Back 51

vaginally push behind the anterior shoulder to rotate the shoulders into an oblique pelvic diameter. assistant uses oblique suprapubic pressure (behind anterior shoulder) to decrease the bisacromial diameter of the shoulders. pg 185

Front 52

What must be excluded when it seems there is a shoulder dystocia?

Back 52

short umbilical cord, enlarged abdomen or thorax, locked or conjoined twins, and Bandyl's retraction ring. pg 185

Front 53

Woods screw maneuver

Back 53

rotate the shoulders 180 degrees, by pushing them clockwise so baby faces the opposite direction. Attempt delivery, if unsuccessful, turn the shoulders back counterclockwise, 180 degrees, attempt delivery, repeat 3-4 times if necessary. pg 186

Front 54

Rubin maneuver

Back 54

suprapubically rock the impacted shoulder from side to side. pg 186

Front 55

Hibbard maneuver:

Back 55

flex the jaw or neck toward the mother's rectum while assistant applies fundal pressure. pg 186

Front 56

fracture the clavicle

Back 56

pressing it against the ramus of the pelvis. Risk of pneumothorax. May be difficult to accomplish. pg 186

Front 57

Zavanelli maneuver

Back 57

place the head in occiput anterior or occiput posterior position, depressing the posterior vaginal wall and returning the head into the vagina. Follow with cesarean delivery. Terbutaline or uterine-relaxing anesthesia will increase the likelihood of success. pg 186

Front 58

What should you send off to lab for any difficult delivery?

Back 58

blood gases. pg 186

Front 59

abnormal placenta

Back 59

placental infarcts; meconium staining, odor, paleness or dark redness; large placenta; succenturate lobes; edema, induration or cysts; grossly disrupted placenta may be accreta; extensive blood clots; misshapen placenta; thrombosis; chorioangioma or hemangioma of the placenta; placenta bipartite or bilobed placenta, tripartate or trilobed; placenta duplex; ring-shaped placenta; membranaceous placenta or placenta diffusa, fenestrated placenta, placenta extrachorialis; circumvallate placenta, circummarginate placenta.

Front 60

Whartons Jelly anomalies

Back 60

1-2 cm yellow-green spots in the jelly (candidiasis) false cysts are liquifactions in the whartons jelly. cord is thinner in oligohydramnios when the Whartons jelly has less fluid.r