| What are the three primary birthing options to consider? | Hospital
Birthing center
Home |
| What percentage of births occur outside of a hospital? | 1.4% |
| What is an LDRP room, or unit? | Labor, delivery, recovery, postpartum room |
| What is the most common reason for hospitalization of a planned home birth? | Failure of the labor to progress |
| What is lightening? | When the fetus settles, or "drops" |
| When does lightening usually occur? | 2 weeks before the onset of labor |
| What kind of paper can distinguish between bodily fluids from the vagina? | Nitrazine paper |
| What color does the nitrazine paper turn if the discharge is amniotic fluid? | Blue |
| At what point does the amniotic sac generally rupture? | After labor has begun |
| Delivery should occur within how many hours of membrane rupture? | 24 hours |
| Prolonged rupture of membranes puts the woman and fetus at risk for _________ | Infection |
| Blood-tinged mucus is called ______ ______. | Bloody show |
| When do Braxton Hicks contractions start? | First trimester |
| What kind of contractions do not dilate the cervix? | Braxton Hicks |
| Regular, rhythmic contractions that cause progressive cervical dilation of the cervix and effacement is _______ ________. | True labor |
| What kind of precautions should be used during birth? | Standard precautions |
| What are the standard precautions applicable to child birth? | Wash hands
Don gloves
Cover gown/ mask with eye protection
Sterile towels to drape woman
Gloves and gown when handling newborn
Teach partner where to stand/what to touch/protective coverings
Use appropriate method of suction for infant's airway |
| What are the 5 P's of labor and delivery? | Passageway
Passenger
Powers
Position
Psyche |
| The true pelvis is divided into 3 segments: | Inlet
Cavity (midpelvis)
Outlet |
| What methods can the practitioner use to evaluate the size of the pelvis? | Palpation
Pelvimetry
Ultrasound |
| Which soft tissues undergo changes to allow passage of the fetus? | Uterine structures
Cervical tissues
Vagina
Perineum |
| The delivery of what part of the body is of highest concern? | The fetal head |
| The reshaping of the skull bones in response to pressure of the maternal pelvis is called _____. | Molding |
| Name the major bones of the skull: | Two frontal bones
Two parietal bones
Two temporal bones
Occiput |
| Where sutures meet are larger membranous areas called _______ | Fontanelles |
| How many bones form the anterior fontanelle, and what shape is it? | Four bones, diamond shaped |
| How many bones form the posterior fontanelle, and what shape is it? | Three bones, triangular |
| The relationship of two fetal body parts is called _________. | Attitude |
| What is the ideal attitude for the fetal body at full term? | Flexion |
| What is fetal lie? | The relationship of the cephalocaudal axis of the fetus to the mother's |
| Describe longitudinal fetal lie | Spine of the fetus is parallel to that of the mother |
| If the spine of the fetus is perpendicular to that of the mother, it is called _______ lie. | Transverse lie |
| Cephalic presentation is divided into 4 types: | Vertex (between fontanelles)
Brow
Face
Mentum (chin) |
| In what percentage of deliveries is the presentation breech? | 3% |
| What is the most common position for delivery? | Left occiput anterior (LOA) |
| What is the second most common position for delivery? | Right occiput anterior (ROA) |
| Fetal position can be determined using which maneuver? | Leopold's maneuver |
| Which position best enables the fetal skull bones to mold as they progress through the maternal pelvis? | Longitudinal lie
Well-flexed attitude
Vertex presentation |
| Prolonged cord compression will result in what kind of damage to the fetus? | Central nervous system damage or death |
| What completes the third stage of labor? | The delivery of the placenta |
| Involuntary uterine contractions are called ________ powers. | Primary powers |
| What is effacement? | Shortening and thinning of the cervix during the first stage of labor |
| What marks the end of the first stage of labor? | Full cervical dilation |
| The maternal urge to bear down is called the _______ reflex | Ferguson's reflex |
| Which position is predominantly used during physician assisted births in the US? | Lithotomy |
| What are primary powers responsible for? | Effacement and dilation of the cervix and descent of the fetus |
| What are secondary powers responsible for? | Expelling the infant after the cervix is dilated fully |
| What are the cardinal movements of labor? | Engagement
Descent
Internal rotation
Extension
External rotation |
| What is the longest stage of delivery? | The first stage |
| The first stage of labor lasts an average of how long in nulliparas? | 10 to 12 hours |
| How long does the first stage of labor generally last in multiparas? | 6 to 8 hours |
| The first stage of labor starts with _____ and ends with _______ | Starts with regular contractions, ends with complete dilation of cervix |
| The first stage of delivery is divided into which 3 phases? | Latent
Active
Transitional |
| Describe contractions in the latent phase of the first stage of delivery | Occur 5 to 8 minutes apart; Last 20 to 35 seconds |
| During which phase of the first stage of delivery are contractions 3 to 5 minutes apart, lasting 40 to 60 secoonds? | Active phase |
| During the latent phase, dilation of the cervix is the size of a _______. | Penny |
| Describe the contractions during the transitional phase of the first stage of delivery | 2 to 3 minutes apart, lasting 90 seconds |
| During the active phase the cervix is at ___ to ___cm dilation | 4 to 7cm |
| 0 to 3cm dilation occurs during which phase of labor? | Latent phase |
| The cervix is 8 to 10cm dilated during which phase of the first stage of labor? | Transitional phase |
| How long does the second stage of labor/delivery generally last for nulliparas? | 30 minutes to 2 hours |
| The second stage of labor/delivery lasts how long in multiparas? | 20 to 90 minutes |
| When is an episiotomy performed? | End of the second stage of labor |
| For which 3 reasons is an episiotomy performed? | Macrosomic infants
Rapid deliveries
Abnormal presentations |
| What is the most common type of episiotomy performed? | Midline, or median |
| What are the complications of an episiotomy? | Infection
Blood loss
Pain
Painful sexual intercourse |
| The second stage of labor/delivery begins with ______ and ends with ______ | Begins with complete dilation, ends with birth of the baby |
| Which stage of labor/delivery begins with the delivery of the infant and ends with the delivery of the placenta? | Third stage |
| How long does the third stage of labor/delivery generally last for both primiparas and multiparas? | 5 to 20 minutes |
| How much blood is normally lost during the third stage of labor/delivery? | 200 to 300mL |
| More than _____mL blood lost during delivery is considered excessive | 500 mL |
| What is responsible for producing oxytocin? | The pituitary gland |
| Which 2 medications are commonly administered during the third phase of labor/delivery to stimulate uterine contractions? | oxytocin (Pitocin)
methylergonovine (Methergine) |
| How often should assessments be performed during the first hour after delivery? | Every 15 minutes |
| An increase or decrease of __bpm of the fetal heart rate may indicate distress. | 30 bpm |
| Why is magnesium sulfate primarily administered? | Seizure prevention in preeclampsia and eclampsia |
| How often should the FHR e auscultated during the first stage of labor? | Every 15 to 30 minutes |
| FHR should be monitored every __ minutes during the second stage of labor | Every 5 minutes |
| What does a tocotransducer monitor? | Uterine activity
Frequency and duration of contractions |
| A tocotransducer cannot assess the intensity of ________. | Contractions |
| What external transducer reflects movement of the fetal heart ventricles ? | Ultrasound transducer |
| Greenish-stained amniotic fluid is the result of ________ | Meconium |
| Greenish-stained amniotic fluid due to the presence of meconium is called _______ _______. | Meconium staining |
| The apgar scoring is done at ____ and ____ minutes off age | 1 and 5 minutes of age |
| The apgar score includes which 5 criteria? | 1. Heart rate
2. Respiratory effort
3. Muscle tone
4. Reflex irritability
5. Skin color |
| What temperature is the environment in utero? | 99 F |
| When should enemas NOT be given? | If vaginal bleeding or premature labor is present
If presenting part is not engaged
If presentation is not vertex |
| How should the woman be positioned if FHR shows late deceleration or if the woman experiences hypotension? | Left side |
| Side-lying positions reduce pressure on the: | Vena cava |
| What does the term doula mean? | "Woman servant" |
| What are 3 therapeutic concepts to convey to the father? | 1. He is of value and competent
2. He can learn to be a partner in the mother's care
3. Childbearing is a partnership |
| What are the most commonly used analgesics during labor? | meperidine hydrochloride (Demerol)
butorphanol tartrate |
| What are the potential major adverse effects of general anesthesia? | Maternal aspiration of gastric contents
Respiratory depression
Uterine relaxation |
| What are the measures used to reduce the risk of maternal aspiration? | 1. Restrict intake to clear fluids or NPO
2. Administer drugs to raise gastric pH
3. Administer drugs to reduce secretions |
| Labor that lasts less than 3 hours from the onset of contractions to the time of birth is called: | Precipitous labor |
| What scoring tool is used to evaluate the readiness of the mother for induction of labor? | Bishop scoring |
| The artificial rupture of the fetal membrane is called an _________. | Amniotomy |
| When do contractions normally begin after instillation of prostaglandin gel to ripen the cervix? | Within one hour |
| What is performed in conjunction with with prostaglandin gel application? | Amniotomy |
| What is uterone inertia? | Absence or weakness of uterine contractions |
| List some maternal indications for induction of labor? | Rupture of membranes greater than 24 hours
Hypertensive disorders
Diabetes
History of stillbirth or fetal demise |
| What are fetal indications for induction of labor? | Intrauterine growth restriction
Nonreassuring fetal status
Oligohydramnios |
| List the major maternal indications for cesarean delivery? | 1. Cephalopelvic disproportion
2. Previous c-section
3. Breech presentation
4. Endangering medical conditions
5. Abnormal conditions of placenta
6. Infections
7. Pelvic abnormalities |
| What are the five fetal indications for cesarean delivery? | 1. Fetal oxygen
2. Prolapse of umbilical cord
3. Breech presentation
4. Malpresentations
5. Congenital abnormalities |
