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Questions and Answers
What is the primary purpose of fetal flexion during labor?
What is the primary purpose of fetal flexion during labor?
When does the anterior fontanelle typically close?
When does the anterior fontanelle typically close?
Which of the following best describes the suboccipitobregmatic diameter?
Which of the following best describes the suboccipitobregmatic diameter?
What characterizes a 'complete breach' presentation?
What characterizes a 'complete breach' presentation?
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What is the significance of the fontanelles in newborns?
What is the significance of the fontanelles in newborns?
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Which fetal lie presents the smaller anteroposterior diameter first?
Which fetal lie presents the smaller anteroposterior diameter first?
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What does a 'military position' in fetal lie describe?
What does a 'military position' in fetal lie describe?
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At what age does the posterior fontanelle typically close?
At what age does the posterior fontanelle typically close?
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What is a common reason for slow passage of stools postpartum?
What is a common reason for slow passage of stools postpartum?
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What is likely to occur with striae gravidarum after childbirth?
What is likely to occur with striae gravidarum after childbirth?
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What change occurs to the hormone HCG postpartum?
What change occurs to the hormone HCG postpartum?
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Which hormone stimulates the milk glands during lactation?
Which hormone stimulates the milk glands during lactation?
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What is a characteristic of diastasis recti observed postpartum?
What is a characteristic of diastasis recti observed postpartum?
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Which method emphasizes the partner's role during pregnancy, labor, and the newborn period?
Which method emphasizes the partner's role during pregnancy, labor, and the newborn period?
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What is one technique used in the Bradley method to reduce pain during labor?
What is one technique used in the Bradley method to reduce pain during labor?
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Which method addresses the psychological aspects of childbirth, specifically through relaxation and breathing techniques?
Which method addresses the psychological aspects of childbirth, specifically through relaxation and breathing techniques?
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According to the Dick-read method, what is the relationship between fear and pain during labor?
According to the Dick-read method, what is the relationship between fear and pain during labor?
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Which option describes a technique included in the Dick-read method for pain reduction?
Which option describes a technique included in the Dick-read method for pain reduction?
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How does the Psychosexual method influence the woman's experience during childbirth?
How does the Psychosexual method influence the woman's experience during childbirth?
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What is a primary focus of the Bradley method during the childbirth process?
What is a primary focus of the Bradley method during the childbirth process?
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What is a common feature of the methods discussed regarding pain management during labor?
What is a common feature of the methods discussed regarding pain management during labor?
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Which pelvis shapes are associated with a good prognosis for vaginal birth?
Which pelvis shapes are associated with a good prognosis for vaginal birth?
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What forms the posterior aspect of the bony ring of the pelvis?
What forms the posterior aspect of the bony ring of the pelvis?
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What is the function of the pelvic cavity during birth?
What is the function of the pelvic cavity during birth?
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What structure bounds the outlet of the pelvis in front?
What structure bounds the outlet of the pelvis in front?
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Which part of the innominate bone forms the upper and lateral position?
Which part of the innominate bone forms the upper and lateral position?
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What is a characteristic feature of the pelvic inlet in terms of diameter?
What is a characteristic feature of the pelvic inlet in terms of diameter?
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What is the significance of the curved nature of the pelvic cavity during labor?
What is the significance of the curved nature of the pelvic cavity during labor?
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Which of the following correctly describes the pelvic outlet?
Which of the following correctly describes the pelvic outlet?
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At what age does the ductus arteriosus typically close permanently?
At what age does the ductus arteriosus typically close permanently?
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What physiological change promotes the closure of the foramen ovale?
What physiological change promotes the closure of the foramen ovale?
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When does the umbilical vein, umbilical arteries, and ductus venosus typically close permanently?
When does the umbilical vein, umbilical arteries, and ductus venosus typically close permanently?
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What is the typical normal range for a newborn's blood volume in ml/kg?
What is the typical normal range for a newborn's blood volume in ml/kg?
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What condition is indicated by acrocyanosis in newborns?
What condition is indicated by acrocyanosis in newborns?
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What blood value can be falsely high due to sluggish peripheral circulation in a newborn?
What blood value can be falsely high due to sluggish peripheral circulation in a newborn?
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At what point after birth are bacteria typically cultured from the intestinal tract of most newborns?
At what point after birth are bacteria typically cultured from the intestinal tract of most newborns?
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What factor contributes to an immature newborn's difficulty in establishing effective residual capacity?
What factor contributes to an immature newborn's difficulty in establishing effective residual capacity?
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Study Notes
Fetal Presentation
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Breech: Fetus’s buttocks or feet present first to the cervix. There are three types:
- Complete: Fetus’s buttocks are present first, with the legs flexed at the hips and knees.
- Frank: Fetus’s buttocks are present first, with the legs extended up towards the head.
- Footling: One or both feet present first.
- Shoulder: Fetal shoulder is presenting.
- Compound: More than one fetal body part is presenting.
Fontanelle
- Lambdoidal suture: The suture line between the occipital bone and the two parietal bones.
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Fontanelle: Membranous spaces between suture lines of the fetal skull.
- Anterior fontanelle (bregma): Larger, diamond-shaped fontanelle located at the intersection of the sagittal, coronal, and frontal sutures. Closes between 12-18 months of age.
- Posterior fontanelle: Smaller, triangular fontanelle located at the intersection of the sagittal and lambdoidal sutures. Closes between 2-3 months of age.
Fetal Skull Diameters
- The skull is shaped wider in anteroposterior (AP) diameter than the transverse diameter.
- Suboccipitobregmatic diameter: The smallest AP diameter that the fetal skull can present at birth. Approximately 9.5 cm, measured from the inferior aspect of the occiput to the center of the anterior fontanelle.
Fetal Lie:
- Fetal lie: The relationship of the long axis of the fetus to the long axis of the mother.
- Longitudinal Lie: Fetus's spine is parallel to the mother's spine (most common).
- Transverse Lie: Fetal spine is perpendicular to the mother's spine.
- Oblique Lie: Diagonal position of fetal spine in relation to mother's spine.
Fetal Attitude:
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Fetal attitude: Degree of flexion the fetus assumes during labor.
- Good flexion (Vertex): Fetal back is convex, arms are flexed and folded on the chest, thighs are flexed toward the abdomen, and chin is touching the chest.
- Moderate flexion: Chin is not touching the chest (Military position).
- Poor flexion: Fetus is extended; this is the most difficult position to deliver vaginally.
Passage:
- The passage refers to the route the fetus must travel from the uterus through the cervix and vagina to the external perineum.
- Pelvis: The bony ring formed by four united bones.
- Inlet: Wider transverse diameter than AP diameter.
- Pelvic Cavity: The space between the inlet and outlet.
- Outlet: Wider AP diameter than transverse diameter.
- Gynecoid pelvis: The most common type of pelvis, with a round inlet and a wide outlet, favorable for vaginal delivery.
- Android pelvis: Shaped like a male pelvis, with a heart-shaped inlet and a narrow outlet that may make vaginal delivery difficult.
Postpartum Reproductive Changes:
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Hormonal System: Pregnancy hormones produced by the placenta are no longer present.
- Human chorionic gonadotropin (HCG) in urine is negligible within 24 hours.
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Integumentary System:
- Striae gravidarum: Stretch marks on the abdomen, breasts, and thighs that may fade but not disappear completely.
- Chloasma: Also known as the "mask of pregnancy," a darkening of the skin around the eyes, nose, and forehead that fades after delivery.
- Linea nigra: A dark line that runs down the center of the abdomen, also fades after delivery.
- Diastasis recti: Overstretching and separation of the abdominal muscles.
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Lactation:
- Estrogen stimulates milk glands.
- Colostrum: Thin, watery pre-lactation secretion.
- Mature milk: Forms within the breast ducts and is produced about three days after delivery.
Postpartum Progressive Changes:
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Cardiovascular System:
- Closure of the ductus arteriosus (permanently closes at 2-3 weeks of age).
- Closure of the foramen ovale (permanently closes at 6 months to 1 year of age).
- Umbilical vein, two umbilical arteries, and ductus venosus close and atrophy (permanently closes at 1-3 months).
- Circulation remains sluggish for the first 24 hours.
- Acrocyanosis: Blue extremities (feet) with a pink body.
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Blood values:
- Blood volume: 80-110 ml/kg body weight or 300 ml.
- Erythrocyte count: 6 million/cubic ml.
- Hematocrit (Hct): Between 45 and 50%.
- Hemoglobin (Hgb): 17-18 mg/dl.
- White blood cell (WBC) count: 15,000-30,000 cells/mm3 (may be as high as 40,000 cells/mm3). - A capillary heel stick can give false high hematocrit or hemoglobin due to sluggish peripheral circulation.
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Gastrointestinal System:
- Usually sterile at birth.
- Bacteria colonize the intestines within 5 hours of birth and in all babies by 24 hours.
Postpartum Assessment:
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Health History:
- Family profile.
- Pregnancy history.
- Labor and birth history: Length of labor, position of the fetus, type of birth, any analgesia or anesthesia used, and problems during labor.
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Infant Data:
- A baby born by cesarean section does not have as much lung fluid expelled at birth and may have more difficulty establishing effective respirations.
- A healthy newborn establishes a good residual volume (amount of air that cannot be expelled) within 10 minutes.
- By 10-12 hours of age, the infant establishes their vital capacity, which is based on their proportions.
- Immature newborns who lack pulmonary surfactant have trouble establishing effective respiratory capacity.
- If the alveoli don’t open well, the cardiac system is compromised because the closure of the foramen ovale and ductus arteriosus depends on free blood flow through the pulmonary artery and good oxygenation of the blood.
Pain Management Methods:
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Bradley (Partner-coached) Method: Stresses the important role of the husband during pregnancy, labor, and the early newborn period.
- Pain is reduced by:
- Abdominal breathing: Controlled deep breathing techniques to manage pain.
- Walking during labor: Encourages movement and helps to manage pain.
- Pain is reduced by:
-
Psychosexual Method: Emphasizes pregnancy, labor, birth, and the early newborn period as significant points in a woman's life cycle.
- Includes:
- Contentious relaxation: Using relaxation techniques to manage pain and anxiety.
- Levels of breathing: Controlled breathing techniques.
- Includes:
-
Dick-Read Method: Relies on the principle that fear leads to tension and pain.
- Uses abdominal breathing during contractions to reduce pain.
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Description
This quiz explores the different types of fetal presentation, including breech variations and shoulder presentation, as well as the anatomy of fontanelles in the fetal skull. Test your knowledge on the definitions, characteristics, and closure timelines of these crucial neonatal features.
