Passenger: Fetus and Placenta Concepts

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Questions and Answers

What is the management approach for PPROM at less than 32 weeks?

Total bed rest with no interventions

Expectant and conservative management (correct)

Surgical intervention

Immediate induction of labor

Which medication is administered for fetal neuroprotection in the case of preterm PROM?

Magnesium sulfate (correct)

Oxytoxic agents

Broad-spectrum antibiotics

Antenatal glucocorticoids

During which phase of the first stage of labor does the greatest rate of cervical dilation occur?

Latent Phase

Transition Phase

Active Phase (correct)

Second Stage of Labor

What characterizes the Third Stage of Labor?

Birth of the baby to placental delivery Signup and view all the answers

What should be continuously monitored for during SROM/AROM fetal surveillance?

Signs of infections Signup and view all the answers

What occurs in the Fourth Stage of Labor?

First 2 hours after birth with maternal-fetal bonding Signup and view all the answers

What does fetal presentation refer to?

The position of the fetus within the uterus Signup and view all the answers

Which fetal attitude results in the smallest head diameter during birth?

Complete flexion with chin down Signup and view all the answers

What is the significance of the Ferguson reflex during labor?

It induces the urge to bear down Signup and view all the answers

Which pelvis shape is typically referred to as the classic female shape?

Gynecoid Signup and view all the answers

In fetal lie, what does the term 'longitudinal' refer to?

The fetal spine parallel to the mother's spine Signup and view all the answers

What is meant by fetal position in the context of childbirth?

The position of the fetal sacrum in relation to the mother's pelvis Signup and view all the answers

Which of the following best describes primary powers in labor?

Involuntary uterine contractions that efface and dilate the cervix Signup and view all the answers

What does the term 'molding' refer to in the context of fetal head size?

The changing shape of the fetal head during delivery Signup and view all the answers

What is the definition of gestational hypertension?

Onset of hypertension without proteinuria after week 20 of pregnancy Signup and view all the answers

What systolic blood pressure reading is considered normal during pregnancy?

Less than 140 Signup and view all the answers

How is chronic hypertension defined during pregnancy?

Hypertension diagnosed before pregnancy or before week 20 of pregnancy Signup and view all the answers

What is a requirement for diagnosing gestational hypertension?

Two separate readings, at least 4 hours apart, with only one elevated reading Signup and view all the answers

What typically happens to gestational hypertension after giving birth?

It resolves but may take 1-12 months Signup and view all the answers

Which condition can women with chronic hypertension potentially develop during pregnancy?

Preeclampsia or eclampsia Signup and view all the answers

What is the primary goal of antepartum care for women requiring insulin during pregnancy?

To achieve strict blood glucose control Signup and view all the answers

Which of the following describes HELLP syndrome?

A variant of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets Signup and view all the answers

What monitoring is necessary when labor-enhancing drugs are administered?

Close observation for signs of fetal distress Signup and view all the answers

What is an expected change in blood glucose management during the intrapartum period for women with diabetes?

Blood glucose levels are monitored hourly during labor Signup and view all the answers

What is a key consideration when performing Leopolds maneuver?

To estimate fetal size and determine the fetal position Signup and view all the answers

What should women who experienced gestational diabetes mellitus (GDM) do postpartum?

Be assessed for carbohydrate intolerance and screened every 3 years Signup and view all the answers

What is an indication of tachysystole during labor?

More than 5 contractions in 10 minutes Signup and view all the answers

How often should women requiring insulin for blood glucose control have non-stress tests (NSTs) beginning at 32 weeks of gestation?

Twice weekly until delivery Signup and view all the answers

What is the main indication for using tocolytics during labor?

To arrest labor after uterine contractions and cervical change Signup and view all the answers

Which of the following is a common method for augmentation of labor?

Oxytocin infusion Signup and view all the answers

What does a station of +4 or +5 cm indicate during labor?

Birth is imminent Signup and view all the answers

In which situation would you consider lifestyle modifications such as activity restriction and pelvic rest?

When there are risks related to continuing pregnancy Signup and view all the answers

What does the term 'engagement' refer to in the context of labor?

The largest diameter of the presenting part has passed through the pelvic brim Signup and view all the answers

What is one of the goals of aggressive labor management with oxytocin?

To ensure birth occurs within 12 hours of admission Signup and view all the answers

What does external fetal monitoring (EFM) primarily assess during labor?

Fetal heart rate and uterine activity Signup and view all the answers

Which condition is not typically indicated for early intervention during pregnancy?

Pelvic rest order due to low fetal heart rate Signup and view all the answers

Study Notes

Fetus and Placenta

Fetal Head Size: Includes assessments of fontanels and molding during birth.
Fetal Presentation: Identifies the position of the fetus; types include cephalic/vertex, breech, and shoulder.
Fetal Lie: Relationship of the fetal spine to the maternal spine, categorized as longitudinal/vertical or transverse/horizontal/oblique.
Fetal Attitude: Describes the posture of the fetus in utero; head in complete flexion results in a smaller diameter, while extension leads to a wider anteroposterior diameter.
Fetal Position: Defines the relationship of a reference point (occiput, sacrum, mentum, sinciput) on the presenting part to the mother's pelvis quadrants.

Passageway: Birth Canal

Pelvic Shapes: Four basic types, with gynecoid being the typical female shape; actual birthing ability cannot be solely predicted by pelvic shape alone.
Cervical Changes: Maternal soft tissues adapt during childbirth as the cervix effaces and dilates.

Powers: Contractions

Primary Powers: Involuntary uterine contractions initiating labor; described by frequency, duration, and intensity.
Ferguson Reflex: Stretch receptors in the vagina trigger oxytocin release, prompting the maternal urge to push.
Secondary Powers: Voluntary efforts to bear down following cervical dilation.

SROM/AROM and Fetal Surveillance

Management of PROM: Individualized, with expectant management for PPROM under 32 weeks and vigilant monitoring for infection.
Antenatal Glucocorticoids: Administered to those with preterm PROM between 24 and 34 weeks.

Stages of Labor

First Stage: Onset of contractions to full cervical dilation, subdivided into latent (0-6 cm), active (6-10 cm), and transition phases.
Second Stage: From full dilation to birth; includes latent (passive descent) and active pushing phases.
Third Stage: Delivery of the baby to placental delivery.
Fourth Stage: From placental delivery to the first 2 hours postpartum, focusing on monitoring for complications.

Interventions for Labor Management

Risk Factor Prevention: Addressing potential complications through lifestyle modifications and medical interventions.
Suppression of Uterine Activity: Use of tocolytics to halt labor after contractions and cervical changes have started.
Augmentation of Labor: Enhancing contractions with methods like oxytocin infusion when labor does not progress adequately.

Labor Positioning and Monitoring

Back Labor: Occurs with the baby in the occiput posterior position.
Station Measurement: Indicates fetal descent in relation to the ischial spines, with engagement typically at station 0.

External Fetal Monitoring (EFM)

FHR Monitoring: Can be performed via intermittent assessment or electronic monitoring; assists in detecting fetal distress.
Emergency Situations: Immediate C-section may be necessary for conditions such as uterine rupture.

HELLP Syndrome and Diagnostic Techniques

HELLP: A severe variant of preeclampsia involving hemolysis, elevated liver enzymes, and low platelets.
Leopold's Maneuvers: Abdominal palpation technique to assess fetal presentation, position, and lie.

Insulin Management in Pregnancy

Antepartum Care: Focuses on blood glucose control through diet, exercise, self-monitoring, and pharmacologic support.
Intrapartum Care: Continuous monitoring of blood glucose levels during labor; maintenance target is 80-110 mg/dL.

Hypertension in Pregnancy

Normal Blood Pressure: Defined as SBP < 140 mmHg and DBP < 90 mmHg.
Gestational Hypertension: Diagnosed after 20 weeks, characterized by hypertension without proteinuria; usually resolves postpartum.
Chronic Hypertension: Present before pregnancy or identified before 20 weeks; may lead to increased risks for preeclampsia or eclampsia.

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Description

This quiz covers essential concepts related to fetal development, focusing on the size of the fetal head, presentation, lie, and attitude. Understand the important anatomical positions and measurements that impact childbirth. Ideal for students in obstetrics or maternal health courses.