2025 NM 704 FINAL EXAM LATEST
UPDATED 100 QUESTIONS WITH
CORRECT VERIFIED ANSWERS
(EXPERT SOLVED)
1. What do we know about pain meds in second stage of labor?: They prolong
2nd stage labor
Increase the likelihood of operative vaginal deliveries
Studies are unclear whether they increase or do not increase the rate of csection 2.
Which pain med is short acting and has very few side effects compared to
morphine?: Fentanyl
3. Do epidurals increase the length of 3rd stage labor?: no, false
4. Direted or coached pushing is known to decrease the length of 2nd stage
labor by up to an hour compared to spontaneous pushing: False. Coached
oushing can decrease the amount of oxygen for the parent and the child and
make them acidotic
5. What is more likely to occur with prolonged second stage labor?:
MAternal morbidity rises neonatal outcomes are unclear fever, fistulas,
choreoamnionitis
6. When does the fetal ejection reflex (ferguson reflex/urge to push) occur?
What precipitates it?: The stretch receptors on the pelvic floor are activated
, by downward progression of the fetus and signals a positive feedback loop to
continue to push the fetus out
The nerves send a message to the brain, the brain makes more oxytocin, oxytocin
makes contractions stronger which emphasizes increased pressure and stretch. this
occurs until fetus is expelled
7. what are the outcomes of water birth compared to traditional?: outcomes
are similar across both types of births
8. What are the signs of placental separation?: 1. fresh flow of blood from
vagina
2. umbilical cord lengthens outside vagina
3. uterine fundus rises up
4. uterus goes from discoid and becomes firm and globular
9. How do we avoid 3rd stage complications?: do not pull on the cord do
not massage the fundus
10. What is expectant management of 3rd stage labor? (use SDM):
Expectant management of third stage in the context of a physiological labor and
birth is a more recent topic of research. There is a growing body of research
whose findings support expectant management of third stage labor when first
and second stages of labor have been spontaneous and without complication or
intervention. This population of birthing people also has no prenatal or
intrapartum risk factors for PPH. The AMTSL research did not look at this
population.
The current body of evidence has shown the following outcomes for expectant
management of third stage in birthing people at low risk of PPH who experience
a normal labor and birth, as defined above:
, No increase in blood loss compared with AMTSL in a general population
No increased risk of PPH compared with AMTSL in a general population
When labor and birth are normal in a healthy and well person, expectant
management of third stage results in comparable bleeding outcomes as when
AMTSL is implemented with a general population of birthing people at mixed risk
for excessive bleeding.
11. What is ACTIVE management of 3rd stage labor? (use SDM): Three
Components of AMTSL according to the ICM/FIGO Joint Statement (2004) are:
Administration of a uterotonic medication within one minute of the birth of the
baby, after ruling out multiple gestation.
Oxytocin is the preferred medication.
Controlled cord traction to assist with placental expulsion.
Uterine massage immediately after placental expulsion, and then as needed 12.
What are the medications used during uncomplicated 3rd and 4th stage of
labor?: Typically pitocin is used in active management of 3rd stage and for
increased bleeding
Methergen can be used in increased bleeding in the 4th stage if pitocin has
already been administered and pt is not hypertensive (2nd line med). Used with
massage
Methergen produces a sustained strong contraction to stop the bleeding
Hemabate and Transnexamic acid are used in hemmorhage
13. What is the evaluation of the birthing person in the 4th stage?: Varneys
pgs 1437-1440 and appendix 34a (1471-1472)
Basics: VS
UPDATED 100 QUESTIONS WITH
CORRECT VERIFIED ANSWERS
(EXPERT SOLVED)
1. What do we know about pain meds in second stage of labor?: They prolong
2nd stage labor
Increase the likelihood of operative vaginal deliveries
Studies are unclear whether they increase or do not increase the rate of csection 2.
Which pain med is short acting and has very few side effects compared to
morphine?: Fentanyl
3. Do epidurals increase the length of 3rd stage labor?: no, false
4. Direted or coached pushing is known to decrease the length of 2nd stage
labor by up to an hour compared to spontaneous pushing: False. Coached
oushing can decrease the amount of oxygen for the parent and the child and
make them acidotic
5. What is more likely to occur with prolonged second stage labor?:
MAternal morbidity rises neonatal outcomes are unclear fever, fistulas,
choreoamnionitis
6. When does the fetal ejection reflex (ferguson reflex/urge to push) occur?
What precipitates it?: The stretch receptors on the pelvic floor are activated
, by downward progression of the fetus and signals a positive feedback loop to
continue to push the fetus out
The nerves send a message to the brain, the brain makes more oxytocin, oxytocin
makes contractions stronger which emphasizes increased pressure and stretch. this
occurs until fetus is expelled
7. what are the outcomes of water birth compared to traditional?: outcomes
are similar across both types of births
8. What are the signs of placental separation?: 1. fresh flow of blood from
vagina
2. umbilical cord lengthens outside vagina
3. uterine fundus rises up
4. uterus goes from discoid and becomes firm and globular
9. How do we avoid 3rd stage complications?: do not pull on the cord do
not massage the fundus
10. What is expectant management of 3rd stage labor? (use SDM):
Expectant management of third stage in the context of a physiological labor and
birth is a more recent topic of research. There is a growing body of research
whose findings support expectant management of third stage labor when first
and second stages of labor have been spontaneous and without complication or
intervention. This population of birthing people also has no prenatal or
intrapartum risk factors for PPH. The AMTSL research did not look at this
population.
The current body of evidence has shown the following outcomes for expectant
management of third stage in birthing people at low risk of PPH who experience
a normal labor and birth, as defined above:
, No increase in blood loss compared with AMTSL in a general population
No increased risk of PPH compared with AMTSL in a general population
When labor and birth are normal in a healthy and well person, expectant
management of third stage results in comparable bleeding outcomes as when
AMTSL is implemented with a general population of birthing people at mixed risk
for excessive bleeding.
11. What is ACTIVE management of 3rd stage labor? (use SDM): Three
Components of AMTSL according to the ICM/FIGO Joint Statement (2004) are:
Administration of a uterotonic medication within one minute of the birth of the
baby, after ruling out multiple gestation.
Oxytocin is the preferred medication.
Controlled cord traction to assist with placental expulsion.
Uterine massage immediately after placental expulsion, and then as needed 12.
What are the medications used during uncomplicated 3rd and 4th stage of
labor?: Typically pitocin is used in active management of 3rd stage and for
increased bleeding
Methergen can be used in increased bleeding in the 4th stage if pitocin has
already been administered and pt is not hypertensive (2nd line med). Used with
massage
Methergen produces a sustained strong contraction to stop the bleeding
Hemabate and Transnexamic acid are used in hemmorhage
13. What is the evaluation of the birthing person in the 4th stage?: Varneys
pgs 1437-1440 and appendix 34a (1471-1472)
Basics: VS
