NM 704 exam 3 questions and answers
Know the components of evaluation of the uterus during the fourth stage
✔✔Every 5 to 15 minutes
Position: usually midline in the middle of the abdomen approx 2/3 to 3/4 of the
way up between the symphysis pubis and the umbilicus
If the uterus is above or deviated from the umbilicus it may be due to the
presence of blood and clots or displacement because of a full bladder
Consider evacuation of the uterus or emptying of bladder
Tone: should be firm to the touch
A soft boggy uterus is not well contracted - fundal massage and assessment og
bleeding is indicated in this case
Know the actions, indications, side effects of, and contraindications for oxytocin
(pitocin) as used prophylactically during third and fourth stage ✔✔Uterotonic; for
postpartum hemorrhage
Contraindications: never give undiluted in a bolus dose
SE: cramping; water intoxication
,Know the actions, indications, side effects of, and contraindications for
methylergonomine (methergine) or ergonovine (ergotrate) as used
prophylactically during third and fourth stage ✔✔Uterotonic; for postpartum
hemorrhage; second line after pitocin
Contraindication: hypertension
SE: cramping, n/v, hypertension, seizure, and/or HA
List tissues disrupted with 1st, 2nd, 3rd, and 4th degree lacerations of the
perineum ✔✔1st: skin, vaginal mucosa, and posterior fourchette
2nd: skin, vaginal mucosa, posterior fourchette, extending into the fascia and
musculature, but not anal sphincter. Includes superficial and deep transverse
perineal muscle and fibers of the pubococcygeus and bulbocavernosus muscles
3rd: skin, vaginal mucosa, posterior fourchette, perineal muscles, and external
anal sphincter; 3a - < 50% of the external anal sphincter; 3b - > 50% of the
external anal sphincter; 3c - complete rupture of the external anal sphincter and
internal anal sphincter is torn
4th: skin, vaginal mucosa, posterior fourchette, and perineal muscles, extending
through the anal sphincter and anterior rectal muscle
Define and know the significance of placental calcifications ✔✔Maternal surface is
usually smooth but may have gritty white areas of calcification.
Generally, the quantity of calcification is of no importance
, Define and know the significance of succenturiate placenta ✔✔One or more
smaller accessory lobes are developed in the membranes and are attached to the
main placenta by fetal vessels
More common in multiple gestations
Accessory lobes may be retained, leading to postpartum hemorrhage or infection
Can be associated with velamentous insertion of the cord
Define and know the significance of circumvallate placenta ✔✔Membranes
appear to arise not from the normal edge of the placenta, but a short distance
inward toward the cord
Area of the chorionic plate is thus reduced
Fetal membranes fold back in on themselves, creating a dense gray/white ring
around the outer margin where the fetal vessels stop
Risk of placental abruption is higher
Usually insignificant, but is associated with threatened abortion, preterm labor,
painless vaginal bleeding around 20 weeks and after, placental insufficiency, fetal
growth restriction, and intrapartum and postpartum hemorrhage
Know the components of evaluation of the uterus during the fourth stage
✔✔Every 5 to 15 minutes
Position: usually midline in the middle of the abdomen approx 2/3 to 3/4 of the
way up between the symphysis pubis and the umbilicus
If the uterus is above or deviated from the umbilicus it may be due to the
presence of blood and clots or displacement because of a full bladder
Consider evacuation of the uterus or emptying of bladder
Tone: should be firm to the touch
A soft boggy uterus is not well contracted - fundal massage and assessment og
bleeding is indicated in this case
Know the actions, indications, side effects of, and contraindications for oxytocin
(pitocin) as used prophylactically during third and fourth stage ✔✔Uterotonic; for
postpartum hemorrhage
Contraindications: never give undiluted in a bolus dose
SE: cramping; water intoxication
,Know the actions, indications, side effects of, and contraindications for
methylergonomine (methergine) or ergonovine (ergotrate) as used
prophylactically during third and fourth stage ✔✔Uterotonic; for postpartum
hemorrhage; second line after pitocin
Contraindication: hypertension
SE: cramping, n/v, hypertension, seizure, and/or HA
List tissues disrupted with 1st, 2nd, 3rd, and 4th degree lacerations of the
perineum ✔✔1st: skin, vaginal mucosa, and posterior fourchette
2nd: skin, vaginal mucosa, posterior fourchette, extending into the fascia and
musculature, but not anal sphincter. Includes superficial and deep transverse
perineal muscle and fibers of the pubococcygeus and bulbocavernosus muscles
3rd: skin, vaginal mucosa, posterior fourchette, perineal muscles, and external
anal sphincter; 3a - < 50% of the external anal sphincter; 3b - > 50% of the
external anal sphincter; 3c - complete rupture of the external anal sphincter and
internal anal sphincter is torn
4th: skin, vaginal mucosa, posterior fourchette, and perineal muscles, extending
through the anal sphincter and anterior rectal muscle
Define and know the significance of placental calcifications ✔✔Maternal surface is
usually smooth but may have gritty white areas of calcification.
Generally, the quantity of calcification is of no importance
, Define and know the significance of succenturiate placenta ✔✔One or more
smaller accessory lobes are developed in the membranes and are attached to the
main placenta by fetal vessels
More common in multiple gestations
Accessory lobes may be retained, leading to postpartum hemorrhage or infection
Can be associated with velamentous insertion of the cord
Define and know the significance of circumvallate placenta ✔✔Membranes
appear to arise not from the normal edge of the placenta, but a short distance
inward toward the cord
Area of the chorionic plate is thus reduced
Fetal membranes fold back in on themselves, creating a dense gray/white ring
around the outer margin where the fetal vessels stop
Risk of placental abruption is higher
Usually insignificant, but is associated with threatened abortion, preterm labor,
painless vaginal bleeding around 20 weeks and after, placental insufficiency, fetal
growth restriction, and intrapartum and postpartum hemorrhage
