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In which presentation is the fetal head primarily in extension as it enters the pelvis?
What is a characteristic of shoulder presentation during labor?
Which breech presentation involves the fetus's thighs being flexed alongside the body?
What is a defining feature of compound presentation during labor?
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Which type of breech presentation is characterized by one or both knees being flexed?
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What is indicated by a visually apparent abrupt increase in fetal heart rate (FHR) above baseline of at least 15 bpm lasting 15 seconds or more?
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What is the significance of the nadir in relation to uterine contractions during labor?
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What condition is indicated by variable decelerations in fetal heart rate during labor?
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What does the term 'arrest of labor' refer to during the second stage of labor?
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What is a common cause of head compression during labor?
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What is the primary purpose of induction of labor (IOL)?
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Which of the following methods is considered a mechanical cervical preparation?
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What does a Bishop Score of greater than 8 indicate?
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What is a common indication for labor augmentation?
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Which of the following factors is NOT a risk associated with postpartum hemorrhage?
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Which intervention is used to increase contractions during labor?
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What is the greatest risk period for primary postpartum hemorrhage?
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Which condition is associated with an increased risk of labor complications?
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What is the primary hormone responsible for lactation?
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Which hormone has a suppressive effect on lactation during pregnancy?
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What is one of the three conditions that must be fulfilled for the lactational amenorrhea method to be effective?
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During which phase of life is lactogenesis primarily taking place?
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Which of the following is NOT one of the five P's of taking a health history?
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What is the primary cause of respiratory distress syndrome (RDS) in neonates?
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What is the expected time frame for the closure of the ductus arteriosus after birth?
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Which of the following is a sign of patent ductus arteriosus (PDA)?
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Meconium aspiration syndrome is most likely to occur in which group of newborns?
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What typically characterizes breastfeeding jaundice in newborns?
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Which principle of discharge teaching emphasizes the importance of the environment during patient education?
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Which hormone is primarily associated with the process of lactogenesis?
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What nursing action is crucial in managing meconium aspiration syndrome in newborns?
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What does an abrupt increase in fetal heart rate (FHR) suggest when it is at least 15 bpm above baseline for at least 15 seconds?
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Which situation necessitates a period of 30 seconds to reach nadir during a labor scenario for a preterm infant?
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What is a possible cause of variable decelerations in fetal heart rate regarding cervical dilation and membrane status?
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What is indicated by a second stage arrest disorder during labor?
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Which of the following presentations might contribute to complications during labor based on fetal positioning?
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What changes in fetal heart rate (FHR) are typically regarded as a favorable outcome during contractions?
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What is the significance of monitoring the nadir during fetal heart rate assessment?
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Which scenario is characteristic of labor requiring intervention based on patient symptoms?
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Which combination of conditions is required for the lactational amenorrhea method to be effective?
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What is the immediate effect on lactation hormones after the placenta is delivered?
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During which phase of life does lactogenesis primarily take place?
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Which hormone is primarily responsible for suppressing lactation during pregnancy?
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What is one of the five P's concerning taking a health history in women's health?
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Which presentation is characterized by the fetal spine being vertical to the maternal pelvis?
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What distinguishes the brow presentation from the face presentation?
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In which breech presentation are the fetus's thighs flexed alongside the body with feet near the head?
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Which fetal presentation involves one or more extremities accompanying the presenting part?
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What defines a footling breech presentation?
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What is a key purpose of cervical preparation in the process of labor induction?
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What is a risk associated with both shoulder and compound presentations?
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What does a Bishop Score of 6 indicate regarding labor induction?
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Which abnormal fetal position is characterized by the back of the baby’s head being closest to the mother's back?
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Which factor is considered a contraindication for labor augmentation?
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What indicates a higher risk of dysfunctional labor during breech presentations?
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What intervention is typically used to artificially rupture membranes during labor?
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What is one of the complications associated with face presentation during labor?
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What complication can arise from performing an artificial rupture of membranes early in labor?
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Which of the following presentations pose a significant risk of requiring a C-section?
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What does augmentation of labor aim to achieve?
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Which of the following conditions is a significant risk factor for postpartum hemorrhage?
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Which method is classified as pharmacological cervical preparation?
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What is the largest risk associated with blood loss postpartum?
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An insufficient Bishop Score may suggest what concerning labor induction?
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What distinguishes postpartum depression from postpartum blues?
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Which of the following is a significant cause of secondary postpartum hemorrhage?
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What condition results from the body breaking down clots faster than it can form them?
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Which of the following is NOT a symptom indicative of postpartum blues?
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What is a common symptom of respiratory distress syndrome in neonates?
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Which condition is characterized by a 'boggy' fundus in postpartum assessment?
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What is a potential complication that can arise from lower genital tract lacerations?
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What physiological changes occur in the uterus during subinvolution?
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What are the two primary factors that infant health and survival depend on?
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Which condition involves the collection of blood within connective tissues after a ruptured vessel?
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Study Notes
Fetal Dystocia Presentations
- Occiput posterior: Baby's head is positioned towards the mother's back instead of the front, causing potential discomfort and labor difficulties.
- Face presentation: Baby's head is extended instead of flexed, leading to a larger diameter of the head entering the pelvis.
- Brow presentation: Baby's head is in a position between full flexion and extension, presenting a large diameter of the head into the pelvis.
- Shoulder presentation: Baby's spine is vertical to the pelvis, increasing risk of a prolapsed cord. A C-section is typically required.
- Compound presentation: One or more fetal extremities accompany the presenting part. This also creates a higher risk of a prolapsed cord and a C-section is indicated.
Breech Presentations
- Frank breech: Baby's thighs are flexed, and feet are close to the head.
- Complete breech: Baby's knees are flexed.
- Footling breech: One or both feet present before the buttocks.
Breech Presentations Complications
- Breech presentations can lead to dysfunctional labor, fetal injury, increased risk of prolapsed cord, and often necessitate a C-section.
Induction of Labor (IOL)
- IOL deliberately stimulates labor onset before spontaneous labor occurs to facilitate a vaginal birth.
- There must be a medical indication for IOL.
IOL Interventions
-
Cervical preparation: This process involves physically softening, thinning, and dilating the cervix to prepare for labor and birth.
- Mechanical cervical preparation options include using a balloon catheter.
- Pharmacological methods use misoprostol or cervidil to prepare the cervix.
- Oxytocin (Pitocin) is titrated to stimulate contractions and labor.
- Amniotomy (AROM): Artificial rupture of membranes used to induce or augment labor. AROM early in labor increases the risk of a C-section.
Bishop Score
- This score determines how close a woman is to labor.
- A score of 8 or higher indicates a successful induction outcome, similar to spontaneous labor.
- A score of 6 is considered favorable for successful induction.
Labor Augmentation
- Labor augmentation stimulates contractions when labor does not progress after spontaneous labor begins.
- The goal is to strengthen and regulate contractions.
- Indications for Augmentation:
- Blood loss exceeding 1000cc with a 10% drop in hemoglobin or hematocrit.
Postpartum Hemorrhage (PPH)
- PPH is a significant complication with the greatest risk in the first hour after birth.
- Primary PPH: Occurs within 24 hours of birth.
- Secondary (delayed) PPH: Occurs between day 1 and 6 weeks after birth.
- Treatment focuses on identifying the cause and preventing hypovolemic shock.
Postpartum Hemorrhage Risk Factors
- Neonatal Macrosomia (large baby)
- Placenta previa/accreta
- Multiple gestation (twins, triplets, etc.)
- Previous C-sections or uterine surgery
- Polyhydramnios (excess amniotic fluid)
- Prior PPH
- High BMI
- Operative vaginal delivery
- Chorioamnionitis (infection of the amniotic sac)
- Congenital or coagulation defects
Respiratory Distress Syndrome (RDS)
- A life-threatening lung disorder, primarily affecting premature infants due to underdeveloped alveoli and insufficient surfactant levels.
- Signs and symptoms of RDS:
- Tachypnea (rapid breathing)
- Gray or dusky skin
- Lethargy and hypotonia (low muscle tone)
Patent Ductus Arteriosus (PDA)
- Occurs when the ductus arteriosus, a blood vessel connecting the aorta and pulmonary artery, remains open after birth.
- Normally closes within a few hours to 96 hours after birth.
- Signs and symptoms of PDA:
- Tachycardia (rapid heartbeat)
- Tachypnea (rapid breathing)
- Recurrent apnea (temporary cessation of breathing)
- Bounding pulses
Meconium Aspiration Syndrome
- This occurs when meconium fluid, a first stool in the womb, enters the lungs, partially obstructing airflow and causing respiratory failure.
- Increases in post-mature newborns (born after 41 weeks).
- Nursing actions:
- Assess for respiratory distress
- Administer oxygen if indicated
Breastfeeding Jaundice
- Jaundice is a condition where a newborn's skin and eyes appear yellow due to high bilirubin levels.
- Breastfeeding jaundice is associated with ineffective breastfeeding causing early onset jaundice (within the first few days of life).
- Associated with delayed passage of meconium stool.
- Treatment:
- Encourage effective breastfeeding without supplementation.
Five Principles of Discharge Teaching
- Right Time: The ideal time for the information to be given.
- Right Context: An environment should be quiet, free of distractions, private, soothing, or stimulating, depending on the information.
- Right Goal: Patient actively involved in the setting and achieving mutually set goals. Goals should be realistic and valued by the patient.
- Right Content: The information should be clear, concise, and appropriate for the patient's understanding.
- Right Method: The information should be presented in a way that the patient understands and can remember.
Lactogenesis
- Lactogenesis refers to the process of milk production.
- Starts during the second trimester.
- Hormones involved:
- Prolactin: Primary hormone responsible for lactation.
- Estrogen and Progesterone: Suppress lactation during pregnancy.
- After delivery, prolactin levels increase, and estrogen and progesterone levels decrease. Estrogen levels will then re-increase approximately one week after delivery.
- The lactational amenorrhea method uses breastfeeding as a form of birth control.
Women's Health Phases
- Adolescence
- Childbearing Years
- Perimenopause
- Post-Menopause/Geriatric
5 Ps of Women's Health History
- Partners: Current and previous intimate partners
- Practices: Sexual practices, including frequency and type
- Protection from STIs: Methods used to prevent STIs
- Past history of STIs: Previous diagnoses and treatments of STIs
- Pregnancy intention: Future pregnancy plans or intentions.
Long-Acting Reversible Contraception (LARC)
- Currently available in the United States.
- Examples include:
- Intrauterine devices (IUDs)
- Implants
- Hormonal injections
Fetal Presentations that may lead to Dystocia (Malpresentations)
- Occiput posterior: the back of the baby's head is in the posterior portion of the pelvis (closest to your back) instead of the anterior (occiput anterior = back of baby's head is closest to your front)
- Face presentation: Fetal head is in extension rather than flexion as it enters the pelvis
- Brow presentation: Fetal head presents in a position midway between full flexion and extreme extension – largest diameter of the head in the pelvis
- Shoulder presentation: Fetal spine is vertical to the maternal pelvis – higher risk of prolapsed cord, C-section is indicated
- Compound presentation: One or more fetal extremities accompany the presenting part – also higher risk of prolapsed cord and C-section is indicated
Breech Presentations
- Dysfunctional labor, fetal injury, risk of prolapsed cord, C-section
- Frank Breech: Fetus’s thighs are flexed alongside the body, feet are close to the head
- Complete Breech: One or both knees are flexed
- Footling Breech: Either one (single footing) or both (double footing) feet present before the buttocks
Induction of Labor
- Deliberate stimulation of labor onset of spontaneous labor to facilitate a vaginal birth
- Interventions:
- Cervical preparation: the process of physical softening, thinning, and dilating of the cervix in preparation of labor and birth
- Mechanical cervical preparation ➔ balloon catheter
- Pharmacological methods of preparation ➔ misoprostol, cervidil
- Oxytocin (Pitocin) titration used to stimulate contractions and labor
- Amniotomy (AROM): artificial rupture of membranes used to induce or augment labor
- AROM in early labor ➔ increased risk of C-section
- Cervical preparation: the process of physical softening, thinning, and dilating of the cervix in preparation of labor and birth
Bishop Score
- A calculation to predict how close you are to labor
- Bishop score >8: Same likelihood of vaginal delivery with induction of labor as that following spontaneous labor, indicates a successful induction
- Bishop score 6: Favorable for successful induction
Indications and Contraindications of Labor Augmentation
- Augmentation = stimulation of contractions when labor does not progress after the onset of spontaneous labor, goal is to strengthen and regulate contraction
- Indications:
- 1000cc C/S + 10% drop in Hgb/Hct
- How do we assess it? EBL >> QBL (estimated blood loss >> quantitative blood loss)
- Greatest risk is in the first hour after birth!
Postpartum Hemorrhage (PPH)
- Primary PPH → happens within 24 hours of birth
- Secondary (delayed) PPH→ occurs between day 1 to 6 weeks
- Treatment goal→ identify cause and prevent hypovolemic shock
- Other risk factors:
- Neonatal macrosomia
- Placenta previa/accrete
- Multiple gestation
- Previous C/S or uterine surgery
- Polyhydramnios
- Prior PPH
- High BMI
- Operative vaginal delivery
- Chorioamnionitis
- Congenital/coagulation defects
Causes of Postpartum Hemorrhage
- The Four T’s:
- Tone: uterine atony (boggy [meaning soft and tender] fundus), subinvolution (delayed return of the enlarged uterus to normal size and function)
- Tissue: retained placental fragments – common cause of secondary PPH
- Trauma: lower genital tract lacerations – 2nd most common cause of primary PPH
- Hematomas can develop – when blood from a ruptured vessel collects within the connective tissues of the vagina or perineal areas
- Thrombin disorders: disseminated intravascular coagulation (DIC), DVT, PE
- The body breaks down clots faster than it can form them→depleting the body of clotting factors→ leading to hemorrhage and death
Postpartum Blues (Baby Blues) vs. Postpartum Depression
- PPB (Baby Blues) → symptoms disappear without medical intervention, occurs within the first 2 weeks postpartum, able to safely care for self and baby
- PPD → mild to severe depression requires psychiatric interventions, occurs within the first 6-12 months postpartum, unable to safely care for self-and/or baby
- 2 weeks of:
- Loss of interest or pleasure in daily activities
- Insomnia
- Decreased energy/fatigue
- Decreased concentration
- Feelings of worthlessness or guilt
- Weight changes
- 2 weeks of:
Infant Health and Survival
- Length of gestation
- Birth weight
Respiratory Distress Syndrome in the Neonate
- Signs and symptoms:
- Rapid breathing
- Grunting
- Nasal flaring
- Retractions (skin pulling in between ribs or above the collarbone)
- Cyanosis (bluish color of the skin, especially around the mouth)
Lactogenesis
- Begins during the 2nd trimester: milk is produced in the alveolar glands and transported to the nipple through lactiferous ducts
- Hormones associated with lactogenesis:
- Prolactin – primary hormone responsible for lactation
- High levels of estrogen and progesterone SUPPRESS lactation
- Once placenta is delivered ➔ prolactin levels increase, estrogen/progesterone levels decrease→ estrogen will re-increase 1 week PP
- Lactation amenorrhea method
- Ovulation suppressed longer for lactating parent
Women’s Health Phases
- Adolescence ➔ Childbearing years ➔ Perimenopause ➔ post-menopause/geriatric
Five P’s of Taking a Health History
- Partners
- Practices
- Protection from STIs
- Past History of STIs
- Pregnancy Intention
Lactational Amenorrhea Method of Birth Control
- Using breastfeeding as your birth control – breastfeeding temporarily helps prevent pregnancy since breastfeeding hormones may stop your body from releasing eggs
- Must be used correctly for it to work – the three simultaneous conditions that must be fulfilled is:
- The baby is under 6 months
- The mother is still amenorrheic
- The mother practices exclusive or quasi-exclusive breastfeeding on demand
Long-Acting Reversible Contraception in the United States
- Hormonal implants
- Intrauterine devices (IUDs)
- Copper IUD
- Hormonal IUD
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Description
Test your knowledge on fetal dystocia presentations such as occiput posterior, face, brow, shoulder, and compound presentations. Additionally, explore the different types of breech presentations: frank, complete, and footling. This quiz will help you understand the implications of these positions in childbirth.