Narm Prep--Heart And Hands Chapter 5 Complications In Labor

Front 1

What is Friedman's curve?

Back 1

a scale based on averages which defines normal length and progress for first and subsequent labors.

Front 2

According to Friedman's curve dilation in a first time mom is ___cm per hour; in a subsequent labor _____cm per hour.

Back 2

1 cm per hour for primip
2 cm per hour for multip

Front 3

ketoacidosis define

Back 3

Ketoacidosis occurs when the clinically exhausted mother's blood becomes abnormally acidic and less able to to carry oxygen. Unless this condition is reversed, fetal distress will result.

Front 4

What are the three signs of clinical exhaustion?

Back 4

ketonuria, elevated temperature and elevated pulse

Front 5

What will the midwife feel upon internal exam when the baby is in asynclistism?

Back 5

The sagital suture will be high or low in the cervical opening rather than bisecting it.

Front 6

What are two causes of asynclitism?

Back 6

CPD, polyhdramnios and ROM "as the baby may then descend rapidly and settle in a cocked position."

Front 7

Describe three things the midwife can do for a cervical lip.

Back 7

Try different positions, especially knee-chest, place ice in a finger of a sterile glove and hold it against the cervix, manually reduce the lip during a contraction and have the mom bear done

Front 8

What can cause an arrest of lactive abor? (6)

Back 8

exhaustion, asynclitism, cervical edema, crvical lip, tense membranes/tight forebag, emotional/environmental issues.

Front 9

According to Heart and Hands, why might a midwife want to perform Artificial rupture of the membranes?

Back 9

Because "occasionally, tense membranes or a tight forebag retard descent and cause an arrest in progress, typically at 7 or 8 cm dilation."

Front 10

Describe the steps to performing AROM.

Back 10

Sterile glove with sterile get or betadine on the fingertips, splint an amnihook between them, keeping the tip protected. As the contx ends, with the mother propped upright, insert your fingers and push the hook to the bag, pull down on the handle with your other hand to lift the etip and pull back toward you to snag the membranes. Carefully draw the hook back tween your fingertips and remove hand slowly. Be sure to chart and take heart tones.

Front 11

What is the incidence of true CPD?
What is the definition of true CPD?

Back 11

,1% true CPD: when the head is presenting well but is turly too large for the mother's dimensions.

Front 12

What is relatve CPD?

Back 12

When the head could pass through the pelvis but malpresentation prevents it from doing so.

Front 13

How does inlet disproportion present?

Back 13

Arrest at 6 cm, lack of descent past -3 or -2 station, deflexion or asyclitism the cervix not well applied to the head.

Front 14

How does midpelvic disproportion present?

Back 14

The head may have engaged without trouble, but the second stage is prolonged and descent delayed. This is often due to deep transverse arrest, in which the head is wedged behind thee ischial spines and cannot rotate to the OA or OP position.

Front 15

What is deep transverse arrest?

Back 15

When the head is wedged behind the ischial spines and cannot rotate to the OA or OP position.

Front 16

How does outlet disproportion present?

Back 16

Outlet disproportion also laeds to prolonged second stage but more commonly affects the perineal phase, causing severe early decels or bradycardia, delayed delivery and tears.

Front 17

How would the midwife manually correct asynclitism?

Back 17

Sterile gove, mother in knee chest position, press firmly on the protruding parietal bone and center the sagital suture line.

Front 18

What two activities might the midwife suggest to the mother to try to correct asynclitism?

Back 18

--Duck walking: she walks in a semisquat position, shifting her weight from one foot the other. This helps open the inlet by stretching the sacroiliac and pubic joints at the same time enouraging the baby to reposition itself.--the lunge

Front 19

Describe two rebozo techniques.

Back 19

have mom lie with hips on top of the rebozo on top of pillows arranged as for the breech tilt. jStnd over her, straddling her body at thigh level, pick up both ends and rock her briskly from side to side. or have the mother in hands and knees with rebozo strung across her hips and upper thighs, ends twisted like a candy wrapper and the rock the ips side to side

Front 20

What is chunging?

Back 20

An ancient Chines techniqe that involves two or three people placing their hands on the mother and vigorously shaking her all over (she could be standing and braced for this, in a doorway or leaning against a wall.

Front 21

Describe the pelvic press.

Back 21

Mother may squat. One to two people kneeling behind her, a hand on each iliac crest, press together as firmly as possible or until you feel some movement. Pressure on the iliac creasts flexes the syphysis pubis and sacroiliac joint, opening the midpelvis so the head can rotate and descend.

Front 22

Posterior labors: In general ___________positions make it easier for the baby to rotate.

Back 22

forward leaning positions

Front 23

List techniques/positions mentioned in Heart and Hands to rotate a posterior baby.

Back 23

forward leaning, butterfly, abdominal lift, rebozo, manual rotation, double hip squeeze

Front 24

List three pain relief measures for back labor.

Back 24

hot or cold compresses with firm pressure, double hip squeeze and sterile water injections

Front 25

intermittent monitoring: how often in labor

Back 25

every 30 minutes

Front 26

Describe fetal scalp sampling. What is an acceptable result? What does scalp sampling assess?

Back 26

"A small sample of blood is taken from the baby's head, and the pH is tested to determine whether or not the baby is acidotic, that is, truly hypoxic. Readings at or above 7.26 are considered normal. Fetal scalp sampling more truly identifies fetal distress than does fetal monitoring."

Front 27

How does the midwife do fetal scalp massage? What result are you looking for?

Back 27

"In lieu of fetal scalp sampling, you can use fetal scalp massage. Massage should be performed for about 10 seconds, a 15 point acceleration of the FHT, lasting 15 seconds, is said to indicate a pH of at least 7.26."

Front 28

What may you notice in labor with when there is cord entanglement? (3)

Back 28

descent may be inhibited, variable decelerations and when severe, bradycardia

Front 29

What factors are associated with cord prolapse?

Back 29

polyhydramnios, multiple pregnancy, breech, compound presentation, transverse lie

Front 30

What is occult prolapse?

Back 30

When the cord is low enough in the pelvis to be increasingly compressed by the head as it descends

Front 31

5 steps to deal with a cord prolapse.

Back 31

1. call 911
2. knee chest
3. use your hand to displace the presenting part from the cord
4. place cord gently in side the vagina or wrap it in a washcloth soaked in warm water and covered in a plastic bag
5. O2 at 8 l/min

Front 32

what are the blood pressure ranges listed in Heart and Hands for mild gestational hypertension?

Back 32

between 140/90 and 160/110

Front 33

Hypertension increases the risk of what two complications?

Back 33

placental abruption and fetal distress

Front 34

Checking for proteinuria in labor is unreliable, due to discharges and amniotic fluid giving false positives. How could the midwife screen for preeclampsia in labor?

Back 34

Check for clonus/hyperreflexia and transport at the first sign.

Front 35

Herbal remedies for hypertension. (4)

Back 35

`Hops, Hawthorn, Skullcap and Passionflower

Front 36

What is vasa previa?

Back 36

"An exceedingly rare complication in which placenal or cord vesselts present at the cervical os...with velamentous cord insertion of vessels running toa a succenturiate lobe..if membranes rupture at this location the mother will hemorrhage the baby could die."

Front 37

In order for birth to happen when a baby is presenting with his or her face, the chin must be located where? And where must the occiput be located?

Back 37

mentum (chin) anterior, occiput posterior

Front 38

Face presentation: postpartum what to be alert for in mom(1) and baby (3) complications

Back 38

mom: extensive tearing
baby: bruising, swelling, use arnica and vit k watch for breathing difficulties from tracheal edema

Front 39

List the three deflexed head presentations.

Back 39

face, brow, military

Front 40

Compound presentation (also called nuchal hand or arm). Discuss.

Back 40

high likelihood of perineal tears, unusually large circumference, pinch baby's finger before the head crowns which may cause it to retract it's hands or prepare to extract the arm so the shoulders can be born by grasping the hand and manually restituting the head while bringing the arm across the chest and outward

Front 41

macrosomia

Back 41

large baby; baby's body large relative to head size; common with gestational diabetes

Front 42

Describe the turtle sign.

Back 42

Typically, "an unusually large head passes over the perineum, then pulls back or retracts against it...and there is no restitution. Both these occurrences are due to shoulders too high in the pelvis to allow the head normal freedom of movement."

Front 43

Describe what you can observe about the baby during a shoulder dystocia.(3)

Back 43

turtle sign, no restitution, baby's color rapidly deepens to dark purple

Front 44

Describe the Gaskin maneuver.

Back 44

"Immediately have the mother roll over to her hands and knees. This will often shift the baby and bring the shoulders spontaneously. If not, this position will promote pelvic relaxation and enhance your ability to maneuver."

Front 45

Describe the Rubin-Davis maneuver.

Back 45

"Reaching inside the perineum for the posterior shoulder, placing two fingers in front of it (at the juncture of the chest and the armpit) and pushing the baby backward to the oblique diameter of the pelvis(about 30 degrees) This dislodges the anterior shoulder and the baby is free to birth spontaneously."

Front 46

Describe McRoberts position.

Back 46

"The mother is fully supine with her knees hyperflexed to her shoulders. This lifts the pelvis off the bed or floor, increasing flexibility of the joint sand available room to maneuver."

Front 47

What is Jacquemier's or Barnum's manuever?

Back 47

Another name for delivery of the posterior arm during sholulder dystocia by sweeping it across the chest.

Front 48

How would the midwife do suprapubic pressure?

Back 48

With the "heel of your hand immediately above the pubic bone)...apply in conjunction with your rotation efforts to help dislodge the anterior shoulder. Press inward and at an angle to complement the direction you are turning the shoulders with your other hand."

Front 49

What is a bilateral shoulder dystocia?

Back 49

A rare occurrence: the anterior shoulder is impacted behind the pubic bone and the posterior shoulder is impacted on the sacral promontory.

Front 50

Describe a last ditch procedure the midwife may do in a should dystocia.

Back 50

Break the baby's clavicle to collapse the shoulder girdle and facilitate deliver.

Front 51

What is a negative consequence of shoulder dystocia for the baby?

Back 51

Erb's Palsy

Front 52

Four principles for assisting breech birth.

Back 52

1. warm up the room
2. allow mother to chose position
3. mother should breathe her baby out
4. do not support the the baby's body: let it hang free to promote flexion of the head

Front 53

Risk factors or correlates with Amniotic Fluid Embolism (10)

Back 53

abortion, amniocentesis, amnioinfusion, hyperstimulated utuers, pit, cytotec, women with uterine scarring, preeclampsia, abruption, previa

Front 54

Symptoms of AFE (6)

Back 54

gasping for air, drop in BP, depressed cardiac function, hypoxia, seizures, DIC

Front 55

Intrapartum Bleeding: 4 causes besides bloody show

Back 55

placenta previa and abruption are the principal causes but vasa previa and uterine rupture may involve intrapartum bleeding

Front 56

4 symptoms of placental abruption.

Back 56

1. severe persistent abdominal pain (different from the ebb and flow sensation of contractions) 2. abdominal tenderness (abdomen rock hard to the touch) 3. fetal distress (with FHT pattern indicating hypoxia) 4. bleeding

Front 57

What conditions, obstetric history or risk factors are associated with uterine rupture? (6)

Back 57

1. improper use of uterine stimulant drugs, 2. obstructed labor due to true CPD, transverse lie, fetal anomalies or tumors, 3. grand multiparity with prolonged labor or improper uterine stimulation, 4. uterine abnormalities, 5.pendulous abdomen with resulting malpresentation 6. overdistension from polyhydramnios or multiple pregnancy

Front 58

What are some signs and symptoms of impending rupture? (4)

Back 58

mother is anxious and complains of pain, pulse elevated, lood pressure low, fetal distress

Front 59

What are signs and symptoms that rupture has occurred? (5)

Back 59

mother may cry out that something has torn, rapid shock, thready, erratic pulse, pallor, vaginal bleeding may or may not be present

Front 60

What is Third Stage Hemorrhage and what are 3 causes?

Back 60

Excess of 500cc after the baby is born but before the placenta. Caused by partial separation of the placenta, cervical laceration and vaginal lacerations.

Front 61

Why is "fundal fiddling" a problem?

Back 61

causes partial separation of the placenta. "If left alone, the uterus will clamp down uniformlyh and fully release the placenta in the vast majority of cases. But if it is poked and prodded, only certain areas contract, releasing only these portions of the placenta."

Front 62

There are three degrees of morbidly adherent placenta. What are they called?

Back 62

placenta accreta
placenta increta
or placenta percreta

Front 63

What are three measures the midwife can take for partial separation of the placenta?

Back 63

angelica tincture, nursing or nipple stimulation, administer 10 to 20 IU pitocin

Front 64

Describe the process of manual removal of the plaenta.

Back 64

Sterile glove with antiseptic, insert hand through the os, using your other hand at the fundus, slip hand between uterine wall and placenta using the edge of your hand like a spatula, continue gauarding the uterus and bring out placenta, give pit or methergine and uterine massage

Front 65

Describe active management of the 3rd stage.

Back 65

Mother is given pit following bireth of the head with controlled cord traction

Front 66

Define 4th stage hemorrhage. What is the primary cause?

Back 66

In excess of 500cc blood loss after placenta has delivered but in the 1st 24 hours after birth. Primary cause: uterine atony.

Front 67

What are causes of postpartum hemorrhage? (4) (not risk factors)

Back 67

uterine atony, cervical or vaginal lacerations, full bladder, sequestered clots

Front 68

A bit of raw placenta is a remedy for what condition?

Back 68

uterine atony

Front 69

What are two tinctures you can give to the mom have a slow trickle bleed?

Back 69

Shepherd's Purse and Blue Cohosh

Front 70

Define placenta accreta.

Back 70

The placenta implants abnormally into the endometrium.

Front 71

Cord traction should only be done if________________.

Back 71

You are sure separation has occurred.

Front 72

Inverted uterus is a potential catastrophic side effect of what action by birth attendants?

Back 72

cord traction when the placenta is adhered can cause the uterus to be inverted with the placenta still attached

Front 73

Placenta accreta may be treated what two ways by a physician?

Back 73

D&C or hysterectomy

Front 74

What is placenta increta

Back 74

placenta grows into the myometrium of the muscle layer of the uterus

Front 75

What is placenta percreta?

Back 75

When the placenta invades not only the uterine muscle but adjacent tissues or organs.

Front 76

What is the apex of a tear?

Back 76

the top

Front 77

True or false. Stimulation may help the baby in secondary apnea.

Back 77

False. The baby in secondary apnea will not attempt to breathe on its own again, so waste no time with stimulation

Front 78

Secondary apnea requires

Back 78

positive pressure ventilation and possibly chest compressions

Front 79

Heart and Hands recommends what to help a baby with about an APGAR of six? (6)

Back 79

warmth, possibly suction, stimulation, skin to skin, mother talks to baby and rocking with a seesaw motion (this affects diaphragmatic pressure to stimulate respiration)