NM704 Final Exam - Accurate Solutions For Every
Question
What do we know about pain meds in second stage of labor? Right Ans -
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
Which pain med is short acting and has very few side effects compared to
morphine? Right Ans - Fentanyl
Do epidurals increase the length of 3rd stage labor? Right Ans - no, false
Direted or coached pushing is known to decrease the length of 2nd stage labor
by up to an hour compared to spontaneous pushing Right Ans - False.
Coached oushing can decrease the amount of oxygen for the parent and the
child and make them acidotic
What is more likely to occur with prolonged second stage labor? Right Ans
- MAternal morbidity rises
neonatal outcomes are unclear
fever, fistulas, choreoamnionitis
When does the fetal ejection reflex (ferguson reflex/urge to push) occur?
What precipitates it? Right Ans - 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
what are the outcomes of water birth compared to traditional? Right Ans -
outcomes are similar across both types of births
,What are the signs of placental separation? Right Ans - 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
How do we avoid 3rd stage complications? Right Ans - do not pull on the
cord
do not massage the fundus
What is expectant management of 3rd stage labor? (use SDM) Right Ans -
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.
What is ACTIVE management of 3rd stage labor? (use SDM) Right Ans -
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
What are the medications used during uncomplicated 3rd and 4th stage of
labor? Right Ans - 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
What is the evaluation of the birthing person in the 4th stage? Right Ans -
Varneys pgs 1437-1440 and appendix 34a (1471-1472)
Basics: VS
Brain: psych/emotional response
Breastfeeding
Belly: Fundus and Uterus
Bladder: full?
Bleeding: minimal bright red lochia with walnut sized clots are normal (larger
than a orange is abnormal)
Bottom: evaluate perineum and hemorrhoids
Perineal Lacerations Right Ans - (First degree)-involves the superficial
vaginal mucosa, disruption of perineal skins/eputhelium
(Second degree)-involves the vaginal mucosa perineal skin, posterior
fourchette and musculature of the perineum
(Third degree)-same as second degree, plus involves the anal sphincter
(Fourth degree)-extends through the anal sphincter into the rectal mucosa
Is active managemnt of labor a treatment protcol or prophylactic protocol for
managing excessive bleeding after the baby is born and before the placenta is
expelled? Right Ans - it is a prophylactic protocol
Question
What do we know about pain meds in second stage of labor? Right Ans -
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
Which pain med is short acting and has very few side effects compared to
morphine? Right Ans - Fentanyl
Do epidurals increase the length of 3rd stage labor? Right Ans - no, false
Direted or coached pushing is known to decrease the length of 2nd stage labor
by up to an hour compared to spontaneous pushing Right Ans - False.
Coached oushing can decrease the amount of oxygen for the parent and the
child and make them acidotic
What is more likely to occur with prolonged second stage labor? Right Ans
- MAternal morbidity rises
neonatal outcomes are unclear
fever, fistulas, choreoamnionitis
When does the fetal ejection reflex (ferguson reflex/urge to push) occur?
What precipitates it? Right Ans - 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
what are the outcomes of water birth compared to traditional? Right Ans -
outcomes are similar across both types of births
,What are the signs of placental separation? Right Ans - 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
How do we avoid 3rd stage complications? Right Ans - do not pull on the
cord
do not massage the fundus
What is expectant management of 3rd stage labor? (use SDM) Right Ans -
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.
What is ACTIVE management of 3rd stage labor? (use SDM) Right Ans -
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
What are the medications used during uncomplicated 3rd and 4th stage of
labor? Right Ans - 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
What is the evaluation of the birthing person in the 4th stage? Right Ans -
Varneys pgs 1437-1440 and appendix 34a (1471-1472)
Basics: VS
Brain: psych/emotional response
Breastfeeding
Belly: Fundus and Uterus
Bladder: full?
Bleeding: minimal bright red lochia with walnut sized clots are normal (larger
than a orange is abnormal)
Bottom: evaluate perineum and hemorrhoids
Perineal Lacerations Right Ans - (First degree)-involves the superficial
vaginal mucosa, disruption of perineal skins/eputhelium
(Second degree)-involves the vaginal mucosa perineal skin, posterior
fourchette and musculature of the perineum
(Third degree)-same as second degree, plus involves the anal sphincter
(Fourth degree)-extends through the anal sphincter into the rectal mucosa
Is active managemnt of labor a treatment protcol or prophylactic protocol for
managing excessive bleeding after the baby is born and before the placenta is
expelled? Right Ans - it is a prophylactic protocol
