N303 - Ch 38 Ob

Front 1

What is birth trauma?

Back 1

Physical injury sustained by a neonate during labor and birth

Front 2

What are the uses of ultrasonography?

Back 2

Antepartum diagnosis of macrosomia, hydrocephalus, and unusual presentations

Front 3

What maternal factors predispose an infant to birth injuries?

Back 3

1. Uterine dysfunction that leads to prolonged or precipitate labor
2. Preterm or postterm labor
3. Cephalopelvic disproportion

Front 4

What other factors predispose an infant to birth injuries?

Back 4

1. Dystocia caused my fetal macrosomia
2. Multifetal gestation
3. Abnormal or difficult presentation, not caused by maternal uterine or pelvic ocnditions
4. Congenital abnormalities

Front 5

What intrapartum events can result in scalp injuries?

Back 5

1. Internal monitoring of fetal heart rate (FHR)

2. Collection of fetal scalp blood for acid-base assessment

Front 6

What birthing techniques can cause injuries?

Back 6

1. Forceps birth
2. Vacuum extraction
3. Version and extraction
4. Cesarean birth

Front 7

What techniques can be used to identify infants with injuries requiring immediate care?

Back 7

1. Apgar score
2. Flaccid muscle tone
3. Weak or hoarse cry
4. Pronounced bruising

Front 8

What is a weak or hoarse cry characteristic of?

Back 8

Laryngeal nerve palsy as a result of excessive traction on the neck during birth

Front 9

What may occur with infants in a breech position?

Back 9

Bruising and swelling seen over the buttocks and genitalia

Front 10

What are ecchymoses and petechiae signs of?

Back 10

A more serious disorder, such as thrombocytopenic purpura, if the hemorrhagic areas do not disappear spontaneously in 2 days

Front 11

How are hemorrhagic areas differentiated from skin rashes or other birth marks (i.e. mongolian spots)?

Back 11

Petechiae and ecchymoses do not blanch

Front 12

What types of skull fractures are typically identified in the newborn?

Back 12

1. Linear fractures
2. Depressed fractures

Front 13

Where do linear fractures commonly occur?

Back 13

Parietal bones

Front 14

What are depressed fractures?

Back 14

The soft skull may become indented without laceration of either the skin or the dural membrane

(also called "PING-PONG BALL" indentations)

Front 15

What causes depressed fractures?

Back 15

May occur during difficult births from pressure of the head on the bony pelvis or as a result of injudicious application of forceps

Front 16

How is a depressed fracture managed?

Back 16

May resolve without intervention; but be removed by using a hand breast pump or vacuum extractor (still VERY controversial)

Front 17

Which bone most often fractured during birth?

Back 17

The clavicle

Front 18

What are the risk factors of clavicle fractures?

Back 18

1. Dystocia, particularly shoulder impaction
2. Vacuum extraction
3. Birth weight greater than 4000 grams

Front 19

What are the diagnostic assessments of clavicle fractures?

Back 19

1. Limitation of motion of arm
2. Crepitus over bone
3. Absence of the Moro reflex on the affected side

Front 20

What is dystocia?

Back 20

Difficult or labored breathing r/t obstruction or constriction of birth passage or abnormal size, shape, or position

Front 21

How long do fractures in newborns take to heal?

Back 21

Generally heal rapidly

Front 22

How is immobilization accomplished?

Back 22

With slings, splints, swaddling, or other devices

Front 23

What is the most common type of paralysis associated with difficult births?

Back 23

Erb-Duchenne palsy or brachial plexus injury

Front 24

What is Erb-Duchenne palsy?

Back 24

Brachial paralysis of the upper portion of the arm

Front 25

What increases the risk of Erb-Duchenne palsy?

Back 25

1. Birth weights over 4000 grams
2. Shoulder dystocia
3. Vaginal breech deliveries
4. Forceps-assisted or vacuum-assisted birth
5. Maternal diabetes
6. Prolonged second stage of labor

Front 26

What causes injury to the upper plexus?

Back 26

Stretching or pulling the head away from the shoulder during the difficult birth

Front 27

What are the typical symptoms of upper plexus injury?

Back 27

1. Flaccid arm with the elbow extended and the hand rotated inward
2. Absence of the Moro reflex on the affected side
3. Sensory loss over the lateral aspect of the arm
4. An intact grasp reflex

Front 28

What are the treatments for Erb-Duchenne palsy?

Back 28

1. Intermittent immobilization across the upper abdomen
2. Proper positioning
3. ROM exercises

Front 29

When should ROM exercises be used to treat Erb-Duchenne palsy?

Back 29

Delayed until about the tenth day to prevent additional injury to the brachial plexus

Front 30

How is immobilization accomplished?

Back 30

With a brace or splint or by pinning the infant's sleeve to his or her shirt

Front 31

What is Klumpke palsy?

Back 31

Damage to the lower plexus (this is less common)

Front 32

What are the clinical manifestations of Klumpke palsy?

Back 32

1. Lower arm paralysis
2. Flaccid wrist and hand
3. Absence of grasp reflex
4. Presence of deep tendon reflex
5. Dependent edema
6. Cyanosis may be apparent

Front 33

What is the expected % of infants achieving full recovery from skeletal injuries during birth?

Back 33

88% to 92%

Front 34

What generally causes facial paralysis (palsy)?

Back 34

Pressure on the facial nerve during birth

Front 35

What are the risk factors of facial palsy?

Back 35

1. Prolonged second stage of labor
2. Forceps-assisted birth

Front 36

What are the clinical manifestations of facial palsy?

Back 36

1. Affected side of face is flattened and unresponsive to the grimace that accompanies crying or stimulation

2. Eye on affected side remains open during crying

3. Forehead will not wrinkle

Front 37

How long does facial palsy last?

Back 37

Often the condition is transitory, resolving within hours or days of birth

(permanent paralysis is rare)

Front 38

What nerve controls the diaphragm?

Back 38

Phrenic nerve

Front 39

What is required in the presence of persistent respiratory distress?

Back 39

Diaphragmatic pacing or surgical correction

Front 40

What are the risk factors of intracranial hemorrhage (ICH)?

Back 40

1.Termed, LGA infants (increased fetal size)
2. Vacuum extraction or forceps births
3. Precipitous or prolonged second stage of labor

Front 41

What are subdural hemorrhages?

Back 41

Hematomas = a collection of blood in the subdural space, most often produced by the stretching and tearing of the large veins on the tentorium of the cerebellum

Front 42

What is the tentorium?

Back 42

The dural membrane that separates the cerebrum from the cerebellum

Front 43

What are commonly associated with subdural hemorrhages?

Back 43

1. Nulliparous mother
2. Difficult birth involving high forceps or mid-forceps application
3. LGA infant

Front 44

What is a nulliparous mother?

Back 44

A pregnant woman with the total labor and birth occurring in less than 2 or 3 hours

Front 45

What is the most common type of intracranial hemorrhage (ICH)?

Back 45

Subarachnoid hemorrhage

Front 46

What is subarachnoid hemorrhage?

Back 46

The most common type of ICH that occurs in term infants as a result of trauma and in preterm infants as a result of hypoxia

Front 47

What are the signs of hemorrhage in infants?

Back 47

Usually signs are absent, and hemorrhaging is diagnosed only because of ABNORMAL findings on the lumbar puncture (i.e. RBCs in the CSF)

Front 48

What are the nursing care provided to an infant with ICH?

Back 48

Supportive and includes monitoring of ventilatory and IV therapy, observation and management of seizures, and prevention of increased ICP. Minimal handling to promote rest and reduce stress should guide nursing care.

Front 49

What are the predisposing factors of spinal cord injuries?

Back 49

1. Brow and face presentations
2. Dystocia
3. Preterm birth
4. Maternal nulliparity
5. Precipitate birth
6. Stretching of the spinal cord

Front 50

What is the most common mechanism of spinal cord injuries?

Back 50

Stretching of the spinal cord, usually by forceful longitudinal traction on the trunk while the head is still firmly engaged in the pelvis

Front 51

What are the clinical manifestations of spinal cord injuries?

Back 51

1. High cervical cord injuries are more likely to cause stillbirths or rapid death of the neonate

2. Lower lesions cause an acute spinal cord syndrome

3. Spinal shock

Front 52

What are the common signs of spinal shock?

Back 52

1. Flaccid extremities
2. Diaphragmatic breathing
3. Paralyzed abdominal movements
4. Atonic anal sphincter
5. Distended bladder

Front 53

What are the complications associated with maternal diabetes?

Back 53

1. Twice the risk of stillbirth

2. Two and a half to five times the risk of perinatal mortality

3. 35% of infants will weigh more than 4000 grams (LGA)

Front 54

What % of infants of diabetic mothers (IDMs) may require neonatal intensive care unit (NICU) admission?

Back 54

Up to 40%; this is due to hypoglycemia or respiratory distress

Front 55

What problems occur in IDMs?

Back 55

1. Congenital anomalies
2. Macrosomia
3. Birth trauma and perinatal asphyxia
4. Respiratory distress syndrome (RDS)
5. Hypoglycemia
6. Hypocalcemia
7. Hypomagnesia
8. Cardiomyopathy
9. Hyperbilirubinemia
10. Polycythemia

Front 56

How can the rate of diabetic complications be reduced?

Back 56

Careful control of maternal blood sugars

Front 57

What are the most common congenital anomalies?

Back 57

1. Cardiac anomalies
2. Renal anomalies
3. Musculoskeletal anomalies
4. Central nervous system anomalies

Front 58

What is associated with diabetic pregnancies in most defects?

Back 58

The structural abnormality occurs before the 8th week after conception

Front 59

What are the types of CNS anomalies?

Back 59

1. Anencephaly
2. Encephalocele
3. Meningomyelocele
4. Hydrocephalus

Front 60

What is the neonatal small left colon syndrome?

Back 60

Transient condition in which the neonate fails to pass the meconium, and presents with abdominal distention and bile-stained vomitus

(also called LAZY COLON SYNDROME)

Front 61

What is macrosomia?

Back 61

Large body size as seen in neonates of diabetic or prediabetic mothers (even though the infants are premature)

Front 62

What are the typical characteristics of an LGA infant?

Back 62

1. Round, cherubic (tomato or "cushingoid") face, a chubby body, and a plethoric or flushed complexion

2. The infant has enlarged internal organs (hepatosplenomegaly, splanchnomegaly, cardiomegaly)

3. The placenta and the umbilical cord are larger than average

4. The BRAIN is normal size because insulin does not cross the BBB

Front 63

What is the LGA infant-of-diabetic-mother most at risk for?

Back 63

1. Neonatal complications of hypoglycemia, hypocalcemia, hyperviscosity, and hyperbilirubinemia

2. Four to six times more likely to develop RDS

Front 64

What happens in fetuses exposed to high levels of maternal glucose?

Back 64

1. Synthesis of surfactant may be delayed because of high fetal serum levels of insulin and/or glucose

2. Possible fetal lung immaturity

Front 65

What is the main component of surfactant?

Back 65

Phosphatidylglycerol

Front 66

What is hypoglycemia?

Back 66

Blood glucose levels less than 40mg/dl in term infants

Front 67

What are the signs of hypoglycemia?

Back 67

1. Jitterness
2. Apnea or tachypnea
3. Cyanosis

Front 68

What worsens hypoglycemia?

Back 68

Hypothermia or respiratory distress

Front 69

What causes hypomagnesemia?

Back 69

Maternal renal losses that occur in diabetes

Front 70

What is hypomagnesemia associated with?

Back 70

Preterm birth, birth trauma, and perinatal asphyxia

Front 71

What are the signs of hypomagnesemia?

Back 71

Similar to those of hypoglycemia, EXCEPT they occur between 24 to 36 hours of age

Front 72

What are the chracteristics of hypertrophic cardiomyopathy (HCM)?

Back 72

1. A hypercontractile and thickened myocardium

2. Ventricular walls are thickened, as in the septum, which in severe cases results in outflow tract obstructions

3. The mitral valve is poorly functioning

Front 73

What are the chracteristics of non-hypertrophic cardiomyopathy (non-HCM)?

Back 73

1. Myocardium is poorly contractile and overstretched

2. Ventricles are increased in size, and no outflow obstruction is found

Front 74

How is HCM treated?

Back 74

A beta-adrenergic blocker (such as propranolol) to decrease contractility and heart rate

Front 75

How is non-HCM treated?

Back 75

A cardiotonic agent (such as digoxin) is used to increase contractility and decrease heart rate

Front 76

What are the most common problems of IDMs that require interventions?

Back 76

1. Birth trauma and perinatal asphyxia
2. RDS
3. Difficult metabolic transition (including hypoglycemia and hypocalcemia)
4. Congenital anomalies

Front 77

Do maternal immunoglobulins cross the placenta?

Back 77

NO

Front 78

What is septicemia?

Back 78

A generalized infection on the bloodstream

Front 79

What is the most common form of neonatal infection?

Back 79

Pneumonia

Front 80

What is one of the leading causes of perinatal death?

Back 80

Pneumonia

Front 81

What is the prevalence of bacterial meningitis?

Back 81

1 in 2500 live-born infants

Front 82

What is the prevalence of sepsis among male and female infants?

Back 82

2:1 (male:female)

Front 83

What is the neonate assessed for if sepsis is suspected?

Back 83

1. Respiratory distress
2. Skin abscesses
3. Rashes
4. Other indications of infection - fever, warmth, redness, swelling, etc.

Front 84

What are the early signs of sepsis?

Back 84

1. Lethargy
2. Poor feeding
3. Poor weight gain
4. Irritability

Front 85

What lab tests are done if sepsis is suspected?

Back 85

1. CBC
2. WBC
3. C-reactive protein (CRP)

Front 86

What is the effectiveness of antibiotic therapy?

Back 86

13% to 45%, depending on the causative agent

Front 87

What are the signs of sepsis?

Back 87

1. Apnea, bradycardia
2. Tachypnea
3. Grunting, nasal flaring, retractions
4. Decreased O2 sat
5. Acidosis
6. Decreased cardiac output
7. Tachycardia
8. Hypotension
9. Decreased perfusion
10. Temperature instability
11. Lethargy
12. Hypotonia
13. Irritability, seizures
14. Feeding intolerance
15. Abdominal distention
16. Vomiting, diarrhea
17. Jaundice
18. Pallor
19. Petechiae

Front 88

What offers protection against infection in the gastrointestinal tract?

Back 88

Immunoglobulin A (IgA), found in colostrum

Front 89

What does human milk contain?

Back 89

Iron-binding protein that exerts a bacteriostatic effect on E. coli

Front 90

What is snuffles?

Back 90

A copious clear mucous discharge from the nose

Front 91

What maternal habits are hazardous to the fetus?

Back 91

Drug addiction, smoking, and alcohol abuse

Front 92

What is the result of opoid use during pregnancy?

Back 92

LBW infants who are not necessarily preterm

Front 93

What is alcohol?

Back 93

Teratogen = a nongenetic factor that causes malformations and disorders in utero

Front 94

What complications can arise from maternal ethanol abuse during gestation?

Back 94

1. Fetal alcohol syndrome (FAS)
2. Alcohol-related neurodevelopmental disorders
3. Alcohol-related birth defects

Front 95

What are the adverse effects of exposure of the fetus to drugs in utero?

Back 95

Transient behavioral changes such as alterations in fetal breathing movements or irreversible effects such as fetal death, IUGR, structural malformations, or mental retardation

Front 96

What maternal conditions further compound the difficulty in identifying the presence or consequences of intrauterine drug exposure?

Back 96

1. Poverty
2. Malnutrition
3. Comorbid conditions such as STIs

Front 97

What are the criteria of signs for fetal alcohol syndrom (FAS)?

Back 97

1. Prenatal and postnatal growth restrictions
2. CNS malfunctions, including mental retardation
3. Craniofacial features such as microcephaly, small eyes or short palpebral features, thin upper lip, flat midface, and an indistinct philtrum

Front 98

What craniofacial features are characteristic of fetal alcohol syndrome (FAS)?

Back 98

1. Microcephaly
2. Small eyes or short palpebral features
3. Thin upper lip
4. Flat midface
5. An indistinct philtrum

Front 99

What neurologic problems are associated with fetal alcohol syndrome (FAS)?

Back 99

1. Some degree of intelligence quotient (IQ) deficit
2. Attention-deficit disorder (ADD or ADHD)
3. Diminished fine motor skills
4. Poor speech
5. Lack of inhibition
6. No stranger anxiety
7. Lack of appropriate judgment skills

Front 100

What pattern of growth deficiencies are associated with fetal alcohol syndrome (FAS)?

Back 100

1. Deficient linear growth rate
2. Deficient rate of weight gain
3. Deficient growth of head circumference
4. Ocular structural anomalies
5. Limb anomalies
6. Cardiocirculatory anomalies, especially ventricular septal defects
7. Mental retardation (IQ = or < 79)
8. Hyperactivity
9. Fine motor dysfunction (poor hand-to-mouth coordination, weak grasp)

Front 101

What are some of the medical diagnoses of fetal alcohol syndrome (FAS)?

Back 101

1. Respiratory distress
2. Neurologic damage
3. "Floppy" epiglottis and small trachea, which may cause cardiopulmonary arrest
4. Recurrent otitis media and hearing loss

Front 102

What long-term effects are caused by fetal alcohol syndrome (FAS)?

Back 102

1. Feeding difficulties
2. Poor sucking ability
3. Possible cleft palate
4. Brain dysfunction
5. Microcephaly
6. Grand mal seizures
7. Impaired visuomotor perception and performance
8. Lowered IQ scores
9. Delayed receptive and expressive language
10. Reduced capacity to process and store factual data

Front 103

How are infants with fetal alcohol syndrome (FAS) cared for in order to improve emotional development and social functioning?

Back 103

Placing infants in a warm, caring environment with understanding caregivers who can handle the infant's hyperirritability

Front 104

What agent is used in pregnancy to treat maternal drug cravings and prevent withdrawals?

Back 104

Methadone

Front 105

What are the signs of withdrawal of infants whose mothers used heroin or methadone during gestation?

Back 105

1. Depression
2. Jitterness and hyperactivity
3. Infant's cry is shrill and persistent
4. Frequent yawning or sneezing
5. Tendon reflexes are increased, but Moro reflex is decreased
6. Poor feeding and sucking
7. Tachypnea
8. Vomiting and diarrhea
9. Hypothermia or hyperthermia
10. Sweating
11. Abnormal sleep cycle, with absence of quiet sleep and disturbance of active sleep

Front 106

What can occur if withdrawal is not treated?

Back 106

Vomiting, diarrhea, dehydration, apnea, and convulsions may develop

Front 107

What is the most common illicit drug used by pregnant women?

Back 107

Marijuana

Front 108

What are the adverse effects of marijuana used during pregnancy?

Back 108

1. Marijuana crosses the placenta, so it may result in a shortened gestation and a higher incidence of IUGR

2. Higher incidence of meconium staining of the amniotic fluid

Front 109

What are the symptoms of marijuana withdrawal in infants?

Back 109

Jitterness, tremors, and impaired sleeping

Front 110

What complications have been associated with maternal cocaine ingestion?

Back 110

1. Fetal brain, kidney, and urogenital system malformations

2. Infarctions to developing organs, resulting in defects such as congenital heart disease, skull defects, ileal atresia, and limb reduction

3. High rate of perinatal morbidity, IUGR, preterm birth, and placental or cerebral infarction

Front 111

What difficulties are experienced by cocaine-exposed infants?

Back 111

1. Limited ability to habituate to stimuli
2. Reduced capacity for verbal reasoning and difficulties maintaining attention
3. Poor visual processing
4. Increased startles

Front 112

What are the adverse effects of maternal use of amphetamines during gestation?

Back 112

1. Higher incidence of cleft lip and palate and cardiac defects
2. Bradycardia or tachycardia
3. Lethargy
4. Frequent infections
5. Poor weight gains

Front 113

What are the treatments for infants with drug toxicity in utero?

Back 113

Swaddling, frequent feedings, and protection from noxious external stimuli

Front 114

How does nicotine and cotinine affect breast milk?

Back 114

These substances can be secreted in breast milk for up to 2 hours after the mother has smoked

Front 115

What are the adverse effects of cigarette smoke on newborns?

Back 115

1. Deficits in growth, in intelligence and emotional development, and in behavior

2. Poor auditory responsiveness, increased fine motor tremors, hypertonicity, and decreased verbal comprehension

Front 116

What is neonatal abstinence syndrome?

Back 116

The group of signs and symptoms associated with drug withdrawals in the neonate

Front 117

What are the signs and symptoms of neonatal abstinence syndrome?

Back 117

1. Poor feeding, vomiting, regurgitation, diarrhea, excessive sucking

2. Irritability, tremors, shrill cry, incessant crying, hyperactivity, little sleep, excoriations on knees and face, convulsions

3. Nasal congestion; tachypnea; sweating; frequent yawning; increased RR > 60 breaths/min; fever > 37.2 degrees C

Front 118

What are the methods used to determine the type of prenatal drug used by the mother?

Back 118

1. Careful history collection (most reliable)

2. Analysis of meconium on day 1 or 2 of life

Front 119

Is total prevention of drug use a realistic goal for mothers?

Back 119

NO, not given the scope of drug abuse problems

Front 120

What are some pharmacological treatments of drug withdrawal in infants?

Back 120

1. Opium (0.4 mg/ml of morphine equivalent)

2. Phenobarbital

3. Paregoric (least commonly used)

Front 121

What are the types of care for infants experiencing withdrawal?

Back 121

1. Place the infant in a side-lying position with the spine and legs flexed

2. Position the infant's hands in the midline with the arms at the side

3. Carry the infant in a flexed position

4. When interacting with the infant, introduce one stimulus at a time when the infant is in a quiet, alert state

5. Watch for time-out or distress signals (gaze aversion, yawning, sneezing, hiccups, arching, mottled color)

6. When the infant is distressed, swaddle in a flexed position and rock in a slow, rhythmic fashion

7. Put the infant in a sitting position with the chin tuck down for feeding

Front 122

What are the distress signals of infants experiencing withdrawal?

Back 122

1. Gaze aversion
2. Yawning
3. Sneezing
4. Hiccups
5. Arching
6. Mottled color

Front 123

What drugs are contraindicated during breastfeeding?

Back 123

1. Amphetamine
2. Cocaine
3. Heroin
4. Marijuana
5. Nicotine (smoking)
6. Phencyclidine

Front 124

What are the reasons for concern of amphetamines?

Back 124

Irritability and poor sleeping pattern

Front 125

What are the reasons for concern of cocaine?

Back 125

Cocaine intoxication

Front 126

What are the reasons for concern of heroin?

Back 126

Tremors, restlessness, vomiting, poor feeding

Front 127

What are the reasons for concern of marijuana?

Back 127

Only one report in literature; no effect mentioned; at risk for inhaling smoke, may reduce protective effects of human milk against infection

Front 128

What are the reasons for concern of nicotine (smoking)?

Back 128

Shock, vomiting, diarrhea, rapid HR, restlessness, decreased milk production

Front 129

What are the reasons for concern of phencyclidine?

Back 129

Potent hallucinogen