BSNC 5000 OB FINAL TEST BANK
QUESTIONS WITH ALL CORRECT
ANSWERS
What non-pharmacological strategies can a labouring client use to manage pain -
Answer-bath, hot/cold pack, water injections, massage, ambulation, position change,
birth ball, focus points, rhythmic breathing, environment changes, support
First stage of labour - Answer-from the onset of regular uterine contractions to full
dilation of the cervix, lasts from less than 1 hour to over 18 hours
Latent phase: contractions become more regular and painful; cervical
effacement/dilation occur; 0-3 cm; ~6-8 hours
Active phase: contractions become more painful, frequent, longer, closer together;
cervical effacement/dilation continue to progress; 4-8 cm, cervix thins; ~3-6 hours
Transitional phase: contractions become explusive in nature, mother may want to bear
down; 8-10cm, cervix thins; ~20-40 minutes
Second stage of labour - Answer-from the time the cervix is fully dilated to the birth of
the fetus (1-2 hours)
Latent/passive descent: fetus continues to descend passively through the birth canal
and rotate to an anterior position as a result of ongoing uterine contractions
Active/descent phase: woman has strong urges to bear down as the presenting part of
the fetus descends and presses on the stretch receptors of the pelvic floor
Third stage of labour - Answer-from the birth of the fetus until the placenta is delivered,
normally lasts 3-5 minutes but can last up to 1 hour
Placenta normally separates with the third or fourth strong uterine contraction after the
infant has been born, and is then delivered with the next contraction
Separation is facilitated by decreased catecholamine production and increased oxytocin
production, thus a warm environment, skin-to-skin contact, and reduced fear and
anxiety are encouraged
,Fourth stage of labour - Answer-lasts about 2 hours after delivery of the placenta, period
of immediate recovery when homeostasis is re-established, the tone of the uterus is
reestablished as the uterus contracts again, and any remaining contents are expelled
1st hour: VS, fundus, lochia, pain Q15
2nd hour: is mom stable to be transferred
Golden hour: skin-to-skin first hour
Comfort measures (pharm, non pharm, nutrition, pain)
Perineal tear repair
Perineal tear degrees - Answer-1st degree: vaginal mucosa torn
2nd degree: perineal muscles torn (sutures, 2 week heal)
3rd degree: anal sphincter torn (OR/anesthetic repair, 3-6 weeks heal, dual leakage,
fecal incontinence, painful intercourse)
4th degree: rectum torn (OR repair with anesthesia, 6 weeks, fecal incontinence, painful
intercourse)
Factors that influence the labour process - Answer-passenger - movement of fetus and
placenta through birth canal influenced by size, presentation, attitude, position, etc.
passage - birth canal, composed of the mother's rigid body pelvis and the soft tissues of
the cervix, pelvic floor, vagina, and introitus
powers - contractions, involuntary (primary) and voluntary (secondary) powers combine
to expel the fetus and the placenta from the uterus
position - (of mother), affects woman's anatomical and physiological adaptations to
labor
psychology - state of woman, anxious, emotional, amount of sedation
How to assess contractions - Answer-How many contractions in 10 minutes, average for
30 minutes
Contractions assessed with palpation (resting tone between contractions, intensity,
strength, duration, frequency, catheter is used for high BMI)
Duration: how long one contraction lasts (seconds)
, Frequency: from beginning of one contraction to the beginning of the next
Postpartum hemorrhage - Answer-the loss of more than 500 mL of blood during a
vaginal birth and more than 1000 mL of blood during a Cesarean birth, although any
blood loss has the potential to cause hemodynamic instability should be considered
PPH
Early/acute/primary PPH - Answer-occurs within 24 hours of the birth
Late/secondary PPH - Answer-occurs more than 24 hours but less than 6 weeks after
the birth, is due to retained products, infection, or both
Risk factors of PPH - Answer-Tone, trauma, tissue, thrombin
Tone + what is uterine atony - Answer-overdistended uterus (large fetus, multiple
fetuses, hydramnios, distension with clots), anesthesia and analgesia (conduction
anesthesia), previous history of uterine atony, high parity, prolonged labor, oxytocin-
induced labor, magnesium sulfate administration during labor or postpartum period,
chorioamnionitis, uterine subinvolution
Leading cause of early PPH, associated with high parity, polyhydramnios, fetal
macrosomia, and multifetal gestation
marked hypotonia (relaxation) of the uterus, occurs when the uterus fails to contract
after the delivery of the baby (inability of the myometrium to contract sufficiently in
response to oxytocin). If the uterus is flaccid after detachment of all or part of the
placenta, brisk venous bleeding occurs, and normal coagulation of the open vasculature
is impaired and continues until the uterine muscle is contracted
Trauma - Answer-lacerations of the birth canal, trauma during labor and birth (forceps-
assisted birth, vacuum-assisted birth, cesarean birth), ruptured uterus, inversion of the
uterus, manual removal of a retained placenta
Lacerations of the perineum are the most common of all injuries in the lower portion of
the genital tract
Tissue - Answer-retained placental fragments, placenta accreta, increta, percreta,
placental abruption, placenta previa, clots
Thrombin - Answer-pre-existing or acquired coagulopathy, pre-eclampsia, anti-
coagulation
Stages of PPH - Answer-1 (mild): >500ml for SVD or >1000ml for C/S (or change in
VS), total EBL less than 1500 mL, 15-25% blood loss, slight systolic BP fall to 80-100.
S&S include anxiety, weakness, sweating, tachycardia, increased cap refill, cool
extremities. Bleeding stops quickly with direct treatment.
QUESTIONS WITH ALL CORRECT
ANSWERS
What non-pharmacological strategies can a labouring client use to manage pain -
Answer-bath, hot/cold pack, water injections, massage, ambulation, position change,
birth ball, focus points, rhythmic breathing, environment changes, support
First stage of labour - Answer-from the onset of regular uterine contractions to full
dilation of the cervix, lasts from less than 1 hour to over 18 hours
Latent phase: contractions become more regular and painful; cervical
effacement/dilation occur; 0-3 cm; ~6-8 hours
Active phase: contractions become more painful, frequent, longer, closer together;
cervical effacement/dilation continue to progress; 4-8 cm, cervix thins; ~3-6 hours
Transitional phase: contractions become explusive in nature, mother may want to bear
down; 8-10cm, cervix thins; ~20-40 minutes
Second stage of labour - Answer-from the time the cervix is fully dilated to the birth of
the fetus (1-2 hours)
Latent/passive descent: fetus continues to descend passively through the birth canal
and rotate to an anterior position as a result of ongoing uterine contractions
Active/descent phase: woman has strong urges to bear down as the presenting part of
the fetus descends and presses on the stretch receptors of the pelvic floor
Third stage of labour - Answer-from the birth of the fetus until the placenta is delivered,
normally lasts 3-5 minutes but can last up to 1 hour
Placenta normally separates with the third or fourth strong uterine contraction after the
infant has been born, and is then delivered with the next contraction
Separation is facilitated by decreased catecholamine production and increased oxytocin
production, thus a warm environment, skin-to-skin contact, and reduced fear and
anxiety are encouraged
,Fourth stage of labour - Answer-lasts about 2 hours after delivery of the placenta, period
of immediate recovery when homeostasis is re-established, the tone of the uterus is
reestablished as the uterus contracts again, and any remaining contents are expelled
1st hour: VS, fundus, lochia, pain Q15
2nd hour: is mom stable to be transferred
Golden hour: skin-to-skin first hour
Comfort measures (pharm, non pharm, nutrition, pain)
Perineal tear repair
Perineal tear degrees - Answer-1st degree: vaginal mucosa torn
2nd degree: perineal muscles torn (sutures, 2 week heal)
3rd degree: anal sphincter torn (OR/anesthetic repair, 3-6 weeks heal, dual leakage,
fecal incontinence, painful intercourse)
4th degree: rectum torn (OR repair with anesthesia, 6 weeks, fecal incontinence, painful
intercourse)
Factors that influence the labour process - Answer-passenger - movement of fetus and
placenta through birth canal influenced by size, presentation, attitude, position, etc.
passage - birth canal, composed of the mother's rigid body pelvis and the soft tissues of
the cervix, pelvic floor, vagina, and introitus
powers - contractions, involuntary (primary) and voluntary (secondary) powers combine
to expel the fetus and the placenta from the uterus
position - (of mother), affects woman's anatomical and physiological adaptations to
labor
psychology - state of woman, anxious, emotional, amount of sedation
How to assess contractions - Answer-How many contractions in 10 minutes, average for
30 minutes
Contractions assessed with palpation (resting tone between contractions, intensity,
strength, duration, frequency, catheter is used for high BMI)
Duration: how long one contraction lasts (seconds)
, Frequency: from beginning of one contraction to the beginning of the next
Postpartum hemorrhage - Answer-the loss of more than 500 mL of blood during a
vaginal birth and more than 1000 mL of blood during a Cesarean birth, although any
blood loss has the potential to cause hemodynamic instability should be considered
PPH
Early/acute/primary PPH - Answer-occurs within 24 hours of the birth
Late/secondary PPH - Answer-occurs more than 24 hours but less than 6 weeks after
the birth, is due to retained products, infection, or both
Risk factors of PPH - Answer-Tone, trauma, tissue, thrombin
Tone + what is uterine atony - Answer-overdistended uterus (large fetus, multiple
fetuses, hydramnios, distension with clots), anesthesia and analgesia (conduction
anesthesia), previous history of uterine atony, high parity, prolonged labor, oxytocin-
induced labor, magnesium sulfate administration during labor or postpartum period,
chorioamnionitis, uterine subinvolution
Leading cause of early PPH, associated with high parity, polyhydramnios, fetal
macrosomia, and multifetal gestation
marked hypotonia (relaxation) of the uterus, occurs when the uterus fails to contract
after the delivery of the baby (inability of the myometrium to contract sufficiently in
response to oxytocin). If the uterus is flaccid after detachment of all or part of the
placenta, brisk venous bleeding occurs, and normal coagulation of the open vasculature
is impaired and continues until the uterine muscle is contracted
Trauma - Answer-lacerations of the birth canal, trauma during labor and birth (forceps-
assisted birth, vacuum-assisted birth, cesarean birth), ruptured uterus, inversion of the
uterus, manual removal of a retained placenta
Lacerations of the perineum are the most common of all injuries in the lower portion of
the genital tract
Tissue - Answer-retained placental fragments, placenta accreta, increta, percreta,
placental abruption, placenta previa, clots
Thrombin - Answer-pre-existing or acquired coagulopathy, pre-eclampsia, anti-
coagulation
Stages of PPH - Answer-1 (mild): >500ml for SVD or >1000ml for C/S (or change in
VS), total EBL less than 1500 mL, 15-25% blood loss, slight systolic BP fall to 80-100.
S&S include anxiety, weakness, sweating, tachycardia, increased cap refill, cool
extremities. Bleeding stops quickly with direct treatment.
