ALARM EXAM REVIEW QUESTIONS AND CORRECT ANSWERS
Criteria cfor cDystocia c- cCORRECT cANS✔✔-4hrs cwith c<0.5cm/hr
-2hrs cwith cno cdilation
-1hr cwith cno cdescent cwith cpushing
Overall crate cof cCP c- cCORRECT cANS✔✔2-3/1000
Intrauterine cresuscitation c- cCORRECT cANS✔✔-get cHELP
-LATERAL cposition
-FLUID cload
-STOP cOXYTOCIN
-exam/rule cout ccord cprolapse
-consider cO2 cby cmask conly cif cmaternal chypoxia/hypovolemia
-consider camnioinfusion cor ctocolytics cin ccertain ccases
Fetal cscalp cblood csampling cpH c- cCORRECT cANS✔✔Indicated: catypical/abnormal cfetal cHR cpattern
pH>7.25 c= crepeat cpH cif cfetal cstatus cpersists
pH<7.20 c= cdelivery
pH7.2-7.25 c= crepeat cin c30mins cof cdeliver cif crapid cdecrease cpH csince clast csample
Frequency cof cfetal cheart crate cassessment c- cCORRECT cANS✔✔-not cnecessary cin clatent cphase
-every c15-30min cin cACTIVE cphase
- cevery c15mins c2nd cstage cBEFORE cpushing
-every c5min c2nd cstage cWHEN cpushing
indications cfor cassisted cvaginal cbirth c- cCORRECT cANS✔✔-atypical/abnormal cFHR cpattern
-labor cdystocia
-lack cof ceffective cmaternal cexpulsive cefforts
Specific cindication cfor cforceps cdelivery c- cCORRECT cANS✔✔correction cof cfetal chead cposition/attitude c(think cof cit cas
crepositioning cthe chead cto cget cthe cnarrowest cpart cfacing cthe coutlet)
Prerequisite cfor cAssisted cVaginal cBirth c(slide c14) c- cCORRECT cANS✔✔-consent
-no ccontraindications
-anesthesia
-bladder cempty
-head cengages
-cervix cfully cdilated
-fetal chead cposition cappropriate
-backup cplan
-ongoing cfetal/maternal cassessment
-pediatrics cstandby cfor cneonatal cresuscitation
Contraindication cfor cAVB c- cCORRECT cANS✔✔-fetal cconditions c(bleeding cdisorder)
-any ccontraindication cto cvaginal cdelivery
-non-cephalic cor cbrow cpresentation
When cto cstop cVacuum cattempt c- cCORRECT cANS✔✔-2 cpulls cno cprogress
-no cdelivery cin c4 ccontractions
-3 cpop-offs cwithout cobvious ccause
-20mins celapsed
Position cfor cSafety c- cCORRECT cANS✔✔*may cnot cactually cbe cimportant*
-Posterior cfontanelle
, -<1 cFinger cbreadth cbtw cforcep cand cskull
-Sagittal csuture cis cperpendicular cto cthe cforceps cplane
contraindication cspecific cto cvacuum c- cCORRECT cANS✔✔-need cfor crotation
-face cpresentation
-<34wks
VBAC csuccess crate c- cCORRECT cANS✔✔64.3 c- c76.1%
Risks cof celective crepeat cCS c(ERCS) c- cCORRECT cANS✔✔-infection
-hemorrhage, ctransfusion, cVTE
-sx cinjury cnow cor csubsequent
-increased cplacenta cprevia/accretion
-increased cTransient ctachypnea cof cnewborn
-increased cfetal/maternal crisks cwith cmultiple cCS
Maternal cmortality cin cCanada c- cCORRECT cANS✔✔ERCS c13.4/100,000
TOLAC c3.8/100,000
Contraindication cto cVBAC c- cCORRECT cANS✔✔-any ccontraindication cto clabor
-previous cclassic cof cT cincision cCS
-previous cuterine crupture
-previous cmajor cuterine creconstruction
-inability cto cperform cemergency cCS
-woman crequests cERCS
Indicators cof cscar crupture c- cCORRECT cANS✔✔-AbNormal cfetal cvitals
-vaginal cbleeding/ chematuria
-ease cof cfetal cpalpating
-change cin cuterine cactivity
-elevation cof cpresenting cpart
-acute conset cscar
-maternal chemodynamic cinstability
-CP/shoulder ctip cpain/SOB
MgSO4 cdose cto cprevent ceclampsia c(and cfor cpreterm cbirth c<32wks cGA) c- cCORRECT cANS✔✔4g cIV cbolus cthen c1-2g cIV/hr
Angidote cto cMgSO4 coverdose c- cCORRECT cANS✔✔-10% cCalcium cgluconate c10mL cover c3mins
-stop cMAG
-resp csupport
Vaginal cprogesterone c(prevent cpreterm cbaby) c- cCORRECT cANS✔✔-100mg cdaily c20-36wks cif cPREVIOUS csingleton
cspontaneous cPTB cM34wks
-200mg cdaily cat c20-36wks cif cincidental cshort ccervix c(20mm cat c<24wks)
tocolytic cexamples c- cCORRECT cANS✔✔nifedipine
indomethacin
Nifedepine cdose c- cCORRECT cANS✔✔10mg cpo cq15-20mins c(max c40 cin c1st chr, cthen c10-20 cmg cq6-8hr)
-stop cafter csteroid ccourse cover
Indomethacin cdose c- cCORRECT cANS✔✔100mg cPR cfor ctransport c25-100mg cq6h cx cmax c48hrs cbut cdon't cexceed c32wks
*can cget coligohydramnios cas ca cside ceffect*
Neonatal cdeath cis creduced cby: c- cCORRECT cANS✔✔prophylactic csteroids c(<34wks)
risk cof cearly cPROM c(prelabor crupture cof cmembranes) c- cCORRECT cANS✔✔pulmonary chypoplasia
Antibiotics cfor cGBS c- cCORRECT cANS✔✔-Pen cG c5million cunits cIV cthen c2.5million cunits cq4h cuntil cdelivery
-cefazolin c2gIV cthen c1g cq8h
-clindamycin c900mg cIV cq8h cuntil cdelivery
-vancomycin c1g cIV cq12h
Antibiotics cfor cBV c- cCORRECT cANS✔✔-clindamycin c300mg cpo cBID cx c7d
-or cmetronidazole
Adequate cContractions c- cCORRECT cANS✔✔-Moderate-strong
-last c60 csecs
-IUPC c50-60mmHg
-4-5 cContractions/10min
Active cmgmt c3rd cstage cmeds c+ cdoses c- cCORRECT cANS✔✔OXYTOCIN
-10U cIM cafter canterior cshoulder
-5-10U cIV cover c1-2mins
-20-40U cIV cin c1L cNS c@ c100cc/hr
Criteria cfor cDystocia c- cCORRECT cANS✔✔-4hrs cwith c<0.5cm/hr
-2hrs cwith cno cdilation
-1hr cwith cno cdescent cwith cpushing
Overall crate cof cCP c- cCORRECT cANS✔✔2-3/1000
Intrauterine cresuscitation c- cCORRECT cANS✔✔-get cHELP
-LATERAL cposition
-FLUID cload
-STOP cOXYTOCIN
-exam/rule cout ccord cprolapse
-consider cO2 cby cmask conly cif cmaternal chypoxia/hypovolemia
-consider camnioinfusion cor ctocolytics cin ccertain ccases
Fetal cscalp cblood csampling cpH c- cCORRECT cANS✔✔Indicated: catypical/abnormal cfetal cHR cpattern
pH>7.25 c= crepeat cpH cif cfetal cstatus cpersists
pH<7.20 c= cdelivery
pH7.2-7.25 c= crepeat cin c30mins cof cdeliver cif crapid cdecrease cpH csince clast csample
Frequency cof cfetal cheart crate cassessment c- cCORRECT cANS✔✔-not cnecessary cin clatent cphase
-every c15-30min cin cACTIVE cphase
- cevery c15mins c2nd cstage cBEFORE cpushing
-every c5min c2nd cstage cWHEN cpushing
indications cfor cassisted cvaginal cbirth c- cCORRECT cANS✔✔-atypical/abnormal cFHR cpattern
-labor cdystocia
-lack cof ceffective cmaternal cexpulsive cefforts
Specific cindication cfor cforceps cdelivery c- cCORRECT cANS✔✔correction cof cfetal chead cposition/attitude c(think cof cit cas
crepositioning cthe chead cto cget cthe cnarrowest cpart cfacing cthe coutlet)
Prerequisite cfor cAssisted cVaginal cBirth c(slide c14) c- cCORRECT cANS✔✔-consent
-no ccontraindications
-anesthesia
-bladder cempty
-head cengages
-cervix cfully cdilated
-fetal chead cposition cappropriate
-backup cplan
-ongoing cfetal/maternal cassessment
-pediatrics cstandby cfor cneonatal cresuscitation
Contraindication cfor cAVB c- cCORRECT cANS✔✔-fetal cconditions c(bleeding cdisorder)
-any ccontraindication cto cvaginal cdelivery
-non-cephalic cor cbrow cpresentation
When cto cstop cVacuum cattempt c- cCORRECT cANS✔✔-2 cpulls cno cprogress
-no cdelivery cin c4 ccontractions
-3 cpop-offs cwithout cobvious ccause
-20mins celapsed
Position cfor cSafety c- cCORRECT cANS✔✔*may cnot cactually cbe cimportant*
-Posterior cfontanelle
, -<1 cFinger cbreadth cbtw cforcep cand cskull
-Sagittal csuture cis cperpendicular cto cthe cforceps cplane
contraindication cspecific cto cvacuum c- cCORRECT cANS✔✔-need cfor crotation
-face cpresentation
-<34wks
VBAC csuccess crate c- cCORRECT cANS✔✔64.3 c- c76.1%
Risks cof celective crepeat cCS c(ERCS) c- cCORRECT cANS✔✔-infection
-hemorrhage, ctransfusion, cVTE
-sx cinjury cnow cor csubsequent
-increased cplacenta cprevia/accretion
-increased cTransient ctachypnea cof cnewborn
-increased cfetal/maternal crisks cwith cmultiple cCS
Maternal cmortality cin cCanada c- cCORRECT cANS✔✔ERCS c13.4/100,000
TOLAC c3.8/100,000
Contraindication cto cVBAC c- cCORRECT cANS✔✔-any ccontraindication cto clabor
-previous cclassic cof cT cincision cCS
-previous cuterine crupture
-previous cmajor cuterine creconstruction
-inability cto cperform cemergency cCS
-woman crequests cERCS
Indicators cof cscar crupture c- cCORRECT cANS✔✔-AbNormal cfetal cvitals
-vaginal cbleeding/ chematuria
-ease cof cfetal cpalpating
-change cin cuterine cactivity
-elevation cof cpresenting cpart
-acute conset cscar
-maternal chemodynamic cinstability
-CP/shoulder ctip cpain/SOB
MgSO4 cdose cto cprevent ceclampsia c(and cfor cpreterm cbirth c<32wks cGA) c- cCORRECT cANS✔✔4g cIV cbolus cthen c1-2g cIV/hr
Angidote cto cMgSO4 coverdose c- cCORRECT cANS✔✔-10% cCalcium cgluconate c10mL cover c3mins
-stop cMAG
-resp csupport
Vaginal cprogesterone c(prevent cpreterm cbaby) c- cCORRECT cANS✔✔-100mg cdaily c20-36wks cif cPREVIOUS csingleton
cspontaneous cPTB cM34wks
-200mg cdaily cat c20-36wks cif cincidental cshort ccervix c(20mm cat c<24wks)
tocolytic cexamples c- cCORRECT cANS✔✔nifedipine
indomethacin
Nifedepine cdose c- cCORRECT cANS✔✔10mg cpo cq15-20mins c(max c40 cin c1st chr, cthen c10-20 cmg cq6-8hr)
-stop cafter csteroid ccourse cover
Indomethacin cdose c- cCORRECT cANS✔✔100mg cPR cfor ctransport c25-100mg cq6h cx cmax c48hrs cbut cdon't cexceed c32wks
*can cget coligohydramnios cas ca cside ceffect*
Neonatal cdeath cis creduced cby: c- cCORRECT cANS✔✔prophylactic csteroids c(<34wks)
risk cof cearly cPROM c(prelabor crupture cof cmembranes) c- cCORRECT cANS✔✔pulmonary chypoplasia
Antibiotics cfor cGBS c- cCORRECT cANS✔✔-Pen cG c5million cunits cIV cthen c2.5million cunits cq4h cuntil cdelivery
-cefazolin c2gIV cthen c1g cq8h
-clindamycin c900mg cIV cq8h cuntil cdelivery
-vancomycin c1g cIV cq12h
Antibiotics cfor cBV c- cCORRECT cANS✔✔-clindamycin c300mg cpo cBID cx c7d
-or cmetronidazole
Adequate cContractions c- cCORRECT cANS✔✔-Moderate-strong
-last c60 csecs
-IUPC c50-60mmHg
-4-5 cContractions/10min
Active cmgmt c3rd cstage cmeds c+ cdoses c- cCORRECT cANS✔✔OXYTOCIN
-10U cIM cafter canterior cshoulder
-5-10U cIV cover c1-2mins
-20-40U cIV cin c1L cNS c@ c100cc/hr
