Theory 2b Flashcards by Klaren Voon

occipitoposterior position

During internal rotation, the fetal head must rotate an arc of approximately how many degrees

135°

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Rotation from a posterior position can be aided by having the patient assume what positions

Hands and knees position
Squatting
Lying on their side
(left side if the fetus is ROP)
(Right side if the fetus is LOP)

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Occipital posterior position

Shifting the weight from right to left or swinging the body from right or left while elevating the left foot on a chair, widens pelvic path and makes fatal rotation easier what is this called?

Lunging
However, it is not evidence based and not proven to be effective

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What type of ball when placed between the legs has been found to open the pelvis and reduce labor time

Peanut ball

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OccipitoPosterior positions tend to occur more in birthing parents with what type of pelvises

Android
Anthropoid
Contracted

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With an occipital posterior position, where is the fetal heart sounds best heard

Lateral sides of the abdomen

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Occipital posterior position
True or false
Posteriorly presenting heads, does not fit the cervix as snuggly as one in an anterior position

True

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Occipital posterior position

Is suggested by dysfunctional labor pattern, such as?

Prolonged active face
Arrest of descent
Fetal heart sounds heard best of the lateral sides of the abdomen

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True or false
During an occipital posterior position increase molding and caput formation are to be expected

True

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Is occipital posterior position usually longer than a labor with anterior position

Yes, occipital poster position will be prolonged because the arc of rotation is greater

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Occipital posterior position

Because the fetal head rotate against the sacrum, causing pain the lower back what can you do to help relieve the pain?

Apply counter pressure on the sacrum by a back rub

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What does occipital posterior increase the risk of?

Umbilical cord prolapse

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During an occipital posterior position, what does the fetal head rotate against and where does the birthing parent experience pressure and pain?

Fetal head rotates against the sacrum

Birthing parent may experience pressure and pain in the lower back because of sacral nerve compression

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Occipital posterior position

What method of massaging the uterus may be helpful when assisting the fetus to rotate in a better position

Rebozo method

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Occipital posterior position

During a long labor of this type be certain that the patient voids approximately how many hours ago

Two hours to keep their bladder empty because a full bladder would further them impede decent of fetus

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Occipital posterior position

Why do you need to be aware of how long since the patient last ate?

They may need an oral sports drink

Or IV glucose solution to replace glucose stores being used in active labor

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Occipital posterior position

Some patients are able to pass a persistent occipital posterior position through their pelvis. The baby is born looking at the ceiling. What is this called?

Sunny side up

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Occipital posterior position

If contractions are not effective or if the fetus is larger than average or not in good flexion rotation through the 135° arc may not be possible the fetal head may arrest on these two positions

Transverse position (transverse arrest)

Persistent, occipitoposterior position

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Occipital posterior position

If forceps are used to help the fetus rotate what do you need to closley the observe on the patient?

Hemorrhage from cervical lacerations

Infection in the postpartum period

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Most fetuses are in this type of presentation in early pregnancy but by week 38, however approximately how many percent of all pregnancies does a fetus turn into cephalic presentation

Most fetuses are in a breech position

97 of all pregnancies are fetus turns to cephalic presentation

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Why do most fetuses end up in a breech presentation in early pregnancy

The buttocks plus the legs of the fetus actually take up more space as the fundus is the largest part of the uterus. This places the bulk parts of the fetus and the fundus

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What are the types of breach presentation?

Complete
Frank
Footling

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Breech Presentation is more hazardous to fetus than a cephalic presentation because there is a higher risk of

Developing dysplasia of the hip
Anoxia from a prolapse cord
Traumatic injury to the after coming ahead
Fracture of the spine or arm
Dysfunctional labor
Early rupture of the membrane
Meconium staining

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What causes meconium staining in breach presentation

Meconium staining occurs because of cervical pressure on the buttock and rectum not because of fetal anoxia

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Breach presentation True or false Meconium staining is not a sign of fetal distress

True, however, meconium excretion can lead the meconium aspiration if the infant inhales amniotic fluid

With a breach presentation, where is the fetal heart sounds usually heard?

High in the abdomen

Breach presentation What usually reveals the presentation

Leopold maneuvers Vaginal exam examination

If the breach presentation is unclear what usually confirms breach presentation

Ultrasound

Breach presentation True or false In a breach presentation the same stages of flexion, descent, internal rotation, expulsion, and external rotation occur as in a vertex birth

True

Breech presentation During a breach birth What should you always monitor frequently because this allows for early detection of fetal distress from a complication such as prolapse cord or arrest of decent

Always monitor FHR and uterine contractions frequently

Breach presentation If the infant will be born vaginally the patient is allowed to push after what is achieved

After full dilation is achieved, and the breach trunk and shoulders are born

What is the most hazardous part of a breach birth?

Birth of the head The pressure of the head against a pelvic brim automatically causes compression on the umbilical cord

What are the dangers of a breach birth? 2

Intracranial hemorrhage Umbilical cord preceeding the head

Breach presentation Why is **umbilical cord** preceding the head dangerous?

Can lead to **cord compression**, restricting blood flow to the baby.

Breach presentation Explain **intracranial hemorrhage**.

Occurs during a breach birth due to rapid pressure changes, potentially causing tentorial tears.

What is the usual method of birth for breach presentations

Planned Cesarean section

An infant was born from a Frank breach position tends to keep their legs extended and at the level of the face for the first, how many days of life

2 to 3 days of life

What do you call when a fetal head is presenting at a different angle?

Asynclitism

Give me examples of asyclitism

Brow and face presentation

During a face presentation, what do you usually feel while doing Leopold maneuver?

A head that feels more prominent than normal with no engagement When the back and head are both felt on the same side of the uterus

Face presentation Where is fetal heart tones usually heard?

On the side of the fetus where the feet and arms can be palpated

How is A face presentation is usually confirmed?

Vagina examination when the nose, mouth and chin can be felt as the presenting part

Face presentation This usually occurs in a birthing parent presenting with?

Contracted pelvis placenta previa Relax uterus of a multipara Prematurity Polyhydramnios Fetal malformation

When a face presentation is suspected what is used to confirm it

Ultrasound

If face presentation is indicated what needs to be measured?

Pelvic diameter

When is it possible for a face presentation to be NSVD?

If the chin is anterior and the pelvic diameters are within normal limits

Face presentation The back is difficult to outline in this presentation because it is__

Concave

In a face presentation when will Caesarian birth be necessary?

If the chin is posterior It would result in a long posterior to anterior rotation to occur, such rotation could result in uterine dysfunction or a transverse arrest

What happens to babies born after a face presentation?

Facial edema from ecchymotic bruising

Face presentation Babies born after face presentation In some infants, lip edema is so severe that they are unable to suck for a day or two how do you feed them?

Gavage feeding may be necessary to allow them to obtain in enough fluid

Face presentation After a baby is born through face presentation, where will they be transferred to for how many hours?

Neonatal intensive care unit for 24 hours

Face presentation True or false After birth, the edema will be transient and will disappear in a few days with no aftermath

True

This is the rarest type of presentation

Brow presentation

When does a brow presentation usually occur?

Multipara Birthing parent with relaxed, abdominal muscle

Brow presentation True or false Unless the presentation spontaneously correct, cesarean birth will be necessary to birth infant

True

Brow presentation It results in obstructed labor, because what part of the baby becomes jammed and the brim of the pelvis

Occipitomental diameter

Brow presentation True or false Brow presentation leaves infants with extreme ecchymotic bruising on the face

True

Brow presentation True or false It is OK to see bruising over the anterior Fontanelle or soft spot

True

Transversely, usually occurs in patient with?

Pendulous abdomen Uterine fibroid tumors Contraction of the pelvic brim Congenital abnormalities of the uterus Polyhydramnios

Transversely may occur infants with?

Hydrocephalus Abnormalty that prevents the head from engaging Prematurity of infant Short umbilical cord Multiple gestation

Why is a transverse lie usually obvious on inspection?

The ovoid of the uterus is more horizontal than vertical

Transverse lie True or false A mature fetus can be born vaginally from this presentation

False A mature fetus cannot be born vaginally from this presentation

Transverse lie When do membranes rupture and why?

Membranes rupture at the start of labor because no firm presenting part is present; the cord or an arm may prolapse or the shoulder may obstruct the cervix.

Macrosomia Size may become a problem in a fetus who is more than how many grams?

4000 to 4500 g (9 to 10 pounds approximately)

Macrosomia Babies of this size most frequently are born to parents who have?

Entered pregnancy with diabetes Developed gestational diabetes Multiparity (each infant born to a person tends to be slightly heavier and larger than the one born just before)

Macrosomia How can an oversized infant cause uterine dysfunction during labor or at birth?

Because of overstretching of the fibers of the myometrium

Macrosomia How can the wide shoulders of the baby cause a problem at birth?

Because they can cause fetal pelvic disproportion or even uterine rupture

Macrosomia Large size of fetus may be missed in what type of patient

Obese patient because the fetal cons are difficult to palpate and obesity does not necessarily indicate larger than usual pelvis

Macrosomia In the postpartum period, why does the birthing parent have an increased risk of hemorrhage?

Due to an overextended uterus that may not contract effectively.

Why is shoulder dystocia increasing an incidence?

Because the weight and therefore the size of newborns is increasing

When does shoulder dystocia occur and why?

It occurs in the second stage of labor When the fetal head is born, but the shoulders are too broad to enter and be born, so the pelvic outlet

Why is shoulder dystocia harmful to the parent?

It can result in vagina or cervical tears

Why is shoulder dystocia harmful to the fetus?

If the cord is compressed between the fetal body and bone pelvis The force of birth can result in a fractured clavicle or brachial plexus injury

Where are shoulder dystocia most common to occur in patients?

Patient with diabetes Multiparas Post date pregnancy Fetus that are large for their gestational age

How can a shoulder dystocia be suspected earlier

If the second stage of labor is prolonged There is arrest of descent Fetal head moves past the perineum at retracts (turtle sign)

What are the two main procedures of shoulder dystocia?

Mcroberts maneuver Suprapubic pressure

Shoulder dystocia What part of the procedure is this? The patient is asked to or assisted deeply to flex their thighs back toward their abdomen, then rotate the laterally to make a wide v this widens the pelvic outlet and may allow the anterior shoulder to be born

McRoberts maneuver

Shoulder dystocia What part of the procedure is this? This is often completed by nursing stuff. The fetal back is identified, and the nurse stands on the side of the patient that is closest to the fetal deck, downward and lateral pressure is applied just above the patient’s pubic bone to dislodge and rotate the fetal shoulder away from the midline.

Suprapubic pressure

Shoulder dystocia Under suprapubic pressure, what type of pressure is applied above the patient’s pubic bone to dislodge and rotate the fatal shoulder away from the midline

Downward and lateral pressure

Inlet contraction is narrowing of the anteroposterior diameter of the pelvis to less than __centimeters or of the transverse diameter to less than __centimeters or less

Anteroposterior diameter of the pelvis less than 11 cm Transverse diameter to less than 12 cm

Inlet contraction is usually caused by?

Rickets in early life Inherited small pelvis

Inlet contraction What is Rickets is caused by?

Lack of vitamin D or calcium

Inlet contraction In primigravida, the fetal had normally engages between what weeks of pregnancy

36 and 38 weeks

Inlet contraction True or false If the fetal had engages before labor begins. It is proved that the pelvic inlet is adequate.

True Because lightning the sinking of the fetal head into the pelvis by definition means the fetal head has moved below the inlet following the general rule what goes in comes out

Inlet contraction If engagement does not occur in Primi gravida then what should be suspected

Fetal abnormality (larger than usual head) Pelvic abnormality (smaller than usual pelvis)

Inlet contraction True or false Engagement does not occur in multiGravidas until labor begins

True for these patients, previous vagina birthd of full term infants without problems, proves their pelvises are adequate

Inlet contraction True or false If CPD exist because the fetus may not engage, but instead remain floating, the possibility of court prolapse is primary concern

False secondary concern

This is the narrowing of transverse diameter, the distance between the tuberosities and the outlet to less than 11 cm

Outlet contraction

Outlet contraction is the narrowing of the transverse diameter the distance between the ischial tuberosities at the outlet to less than how many centimeters

11 cm

Outlet contraction is the narrowing of transfers diameter the distance between the __at the outlet

Ischial tuberosities

What is the normal placenta weight approximately in grams, diameter in centimeters, and thickness in centimeters?

500 g 15 to 20 cm in diameter 1.5 to 3 cm thick

Placental weight is approximately __ that of a fetus

One sixth

A placenta may be unusually enlarged in patients with?

Patient with diabetes

If the uterus scar or a septum, the placenta may be wide in diameter why is that?

Because it was forced to spread out the find implantation space

This is a placenta that has one or more accessory lobes connected to the main placenta by blood vessels

Placenta succenturiata

Placenta succenturiata True or false No fetal abnormality is associated with this type

True

The fetal side of the placenta is covered to some extent with chorion

Placenta circumvallate

Placenta succenturiata Why is it important to recognize when there is Placenta succenturiata?

Because the small lobes may be retained in the uterus leading to severe obstetric hemorrhage

Placenta circumvallata True or false No abnormalities are associated with this type of placenta

True, Although no abnormalities are associated with this type of placenta it’s presence should be noted

The fold of chorion reaches just to the edge of the placenta

Placenta marginata

The cord is inserted marginally, rather than centrally

Battledore placenta This anomaly is rare and has no known clinical significance

Velamentous insertion of the cord This form of cord insertion is most frequently found with what type of patient

Patient with multiple gestation

Velamentous insertion of cord Because the fetal blood supply may not be as generous as usual, this type of placenta is associated with?

Fetal anomalies

Velamentous insertion of cord If avulsion is found in the cord, what do you do?

Avulsion requires a manual removal of the placenta

In this situation, the cord, instead of entering the placenta directly separates into small vessels that reach the placenta by spreading across a fold of amnion

Velamentous insertion of cord

In this situation, the umbilical vessels of a velamentous cord insertion cross the cervical os and therefore deliver before the fetus

Vasa previa

Tearing of vasa previa would result in?

Fetal blood loss

Vasa previa True or false The infant can be born by NSVD

False The infant needs to be born by cesarean section

What is suspected if painless bleeding occurs with the beginning of cervical dilation

Placenta previa Vasa previa

This is an unusually deep attachment of the placenta to the uterine myometrium so deep that the placenta will not loosen end deliver

Placenta accreta

What can be done with a patient with placenta accreta?

Hysterectomy to remove the uterus Methotrexate to destroy the still attached tissue

What is the difference between inlet and outlet contraction?

Inlet contraction is narrowing of the anteroposterior diameter of the pelvis to less than 11 cm or the transverse diameter to less than 12 cm Outlet construction is the narrowing of the transverse diameter to less than 11 cm

A normal cord contains one vein and two arteries. The absence of one of the umbilical arteries is usually associated with?

Congenital heart and kidney anomalies Because the insult that cost the loss of the vessel may also have affected other mesoderm germs layer

When must you inspect the cord to assess how many vessels are present?

Immediately after birth, before the cord begins to dry

What can occur when you have an unusually short umbilical cord

Premature separation of the placenta Abnormal fetal lie

What can occur when you have an unusually long umbilical cord

An unusually long cord may be easily compromise because of its tendency to twist or knot

Unusual cord length True or false When the cord wraps once around the fetal neck, it has no interference on fetal circulation

True

Theory 2b Flashcards

(117 cards)