NSPN 7100 COMPREHENSIVE QUESTIONS AND
ANSWERS SET A+
✔✔Suggest some positions that may facilitate fetal rotation during the second stage of
labor. - ✔✔•Squatting, using the squatting bar that can be inserted into most birthing
beds.
•The use of a birthing stool
•The lateral lying position, upper leg held by labor supporter.
•Early second stage pushing on a toilet.
•Water birth, although this is not widely used in hospitals it is used by some midwives
for home births.
✔✔Deflexed head - ✔✔A deflexed head presents a wider diameter of the head and is
often associated with a longer, slower labour. It is not uncommon when a fetus is in the
posterior position, that it also has a deflexed head.
✔✔Asynclitism - ✔✔The best way to describe asynclitism is rather than the head being
positioned in alignment with the shoulders, it is tilted to one side or the other. On vaginal
exam the sagittal suture will not be in the midline.
✔✔Persistent Cervical Lip - ✔✔However, sometimes as labour progresses to second
stage, a thin ribbon or lip of cervix persists. This partial lip of cervix may be at the front
of the cervix (anterior lip) or at one side of the cervix. Persistent cervical lip is often
associated with an OP position and a strong urge to push prior to full dilatation. This
maternal urge to push can force the presenting part onto the lip of cervix, causing
edema and more resistance to dilatation.Various positions, such as hands and knees or
side lying, can help take the pressure off of the cervix. Should the cervical lip persist
and/or the labouring woman is unable to avoid pushing, epidural analgesia may take
away the urge to push, helping to prevent or eliminate cervical edema.
✔✔Think about what you have learned regarding nursing care during labour. List some
nursing care measures that promote normal progress in labour and may facilitate
,progress when labour is prolonged. - ✔✔-Helping women to use labour enhancing
positions.
-Providing other non-pharmacological comfort techniques.
-Ensuring that the maternal bladder is emptied frequently during labour.
-Attention to the hydration and nutritional needs of the labouring woman.
-Providing 1:1 nursing support during active labour.
-Providing a calm and safe environment for the labouring woman.
-Providing ongoing emotional support to the woman and her family. This includes
offering encouragement and information in regards to labour progress.
-Ongoing assessment of maternal status, including contraction frequency, duration,
strength, resting tone, and maternal responses.
-Ongoing assessment of fetal status, including FHR responses to prolonged labour,
fetal position, and descent.
-Assessment of membranes and drainage if the membranes are ruptured.
-VEs when indicated to assess cervical dilatation and fetal descent. Monitor labour
progress by comparing VE findings to previous examinations.
Waiting until a woman has an urge to push before active pushing commences. (passive
descent)
Promoting position changes during the second stage of labour.
-Documentation of all findings on the partogram and communication of labour progress
to the primary caregiver.
-Anticipation of and preparation for medical interventions.
-Protecting the labouring woman from unnecessary labour interventions.
✔✔What factors should you consider if labour is not progressing? - ✔✔-Are there
alterations in the characteristics of contractions?
-Have there been any changes to cervical dilatation and fetal descent?
-Are there fetal factors hampering labour progress?
-Are there maternal factors impacting on labour progress?
-What are the maternal and fetal responses to prolonged labour?
-Has the primary care provider been informed about slow progress in labour and given a
full report on maternal and fetal status?
✔✔Maternal age: - ✔✔-Women 35 and over were more likely to have a Caesarean
delivery, with rates 44% higher than for those age 20 to 34.
-Among those 40 and over, one in three mothers had a Caesarean delivery.
-Among first-time mothers 40 and over with singletons, one of every two had a
Caesarean delivery.
-Women 35 and over were at double the risk of those 20 to 34 for placenta previa
-Among those age 40 and over, placenta previa rates were three times higher than for
those age 20 to 34 and more than 10 times higher than for mothers under the age of 20.
✔✔Maternal weight: - ✔✔-Obesity increases the risk of inadequate uterine contractions,
labour dystocia, caesarean birth, and macrosomia (Vinayagam & Chandraharan, 2012).
(Obesity is also a risk factor for hypertension and diabetes, which will affect fetal growth
and development and labour.)
,-Severely underweight women more likely to delivery preterm and have low birth weight
infants (Lowdermilk et al, 2016).
✔✔Practice point for Variations in power. - ✔✔In practice you will often see an
overemphasis on cervical dilatation and limited attention paid to descent and rotation of
the fetus as signs of labour progress. For example, you may notice that the cervical
dilatation has not changed, but the presenting part has descended from station minus 2
to station 0 and the position has changed from occiput transverse to occiput anterior.
When we connect this assessment data to the cardinal movements of labour, this can
be seen as progress. It is also important to remember that it is common for there to be
no cervical dilatation for more than 2 hours in active phase
✔✔Amniotomy - ✔✔When labour is progressing slowly, one of the first medical
interventions considered to augment the labour is an artificial rupture of membranes
(ARM) or amniotomy.During a vaginal exam the physician or midwife uses a long
handled hook to open (rupture) the membranes surrounding the fetus.
✔✔What drug is used to augment labour? - ✔✔-synthetic oxytocin,
-the drug most commonly associated with adverse events
-The goal of induction or augmentation with oxytocin is to produce contractions that
mimic normal physiologic labour
✔✔What are maternal risks of using synthetic oxytocin? - ✔✔-Uterine hyperstimulation
(tachysystole)
-Placental abruption
-Uterine rupture
-Unnecessary caesarean birth due to abnormal --FHR patterns
-Post-partum hemorrhage
✔✔What are the fetal risks of using synthetic oxytocin? - ✔✔-Poor fetal oxygenation
-Abnormal fetal heart rate
-Hypoxemia
-Acidosis
✔✔Define uterine hyperstimulation. - ✔✔-as 6 or more contractions in 2 consecutive 10
minute windows or contractions lasting longer than 120 second.
-appropriate term is tachysystole
-tachysystole is defined as more than 5 contractions per 10 minute period over 30
minutes. It can be further divided into with or without fetal heart rate changes.
Hypertonus refers to contractions that last longer than 120 seconds.
✔✔what happened to fetal oxygen saturation when there are 5 or more contractions in
10 minutes over a 30 minute time frame? - ✔✔oxygen saturation decreases 20-29%
✔✔What does the perinatal nurse assess following an amniotomy? - ✔✔Color of fluid
, Amount of fluid
Fetal response
✔✔Augmenting labor is necessary when: - ✔✔Uterine contractions are not strong or
frequent enough to result in cervical dilatation and fetal descent
✔✔Uterine hyperstimulation is defined as: - ✔✔the presence of 6 or more contractions
in 10 minutes, measured over two 10-minute window frames on the EFM
✔✔If uterine hyperstimulation occurs, the nurse should: - ✔✔Discontinue or decrease
the rate of oxytocin
✔✔If labour does not progress despite the use of oxytocin, you may see the primary
care provider utilize an intrauterine pressure catheter (IUPC). What is that? - ✔✔An
IUPC is a soft flexible catheter that is inserted through the cervix alongside the fetus. It
provides a specific numeric measurement of the strength, frequency, and duration of the
uterine contractions. An IUPC may also be used when a woman is obese and the nurse
is unable to palpate contractions due to the amount of adipose tissue.
✔✔The admitting nurse does a full assessment of Vali and her fetus. The nurse finds
the fetus in an LOA position and engaged. Contractions are every 8 minutes, lasting 40
seconds. VE reveals a cervix that is 2 cm dilated, 1.5cm long, and the presenting part at
spines with the membranes intact. The FHR is normal. Also noted is that Vali is very
tired and tearful and not handling her contractions well.What care would you
recommend for Vali at this time? - ✔✔The assessment findings indicate that Vali is still
in early labour. Although she is tired and finding contractions difficult to deal with the
best recommendation for her at this time is discharge home until contractions are more
frequent. Vali and Doug should be reassured that labour has commenced but is still
early and offered suggestions for comfort techniques that will help in dealing with
contractions. Suggestions may include various breathing techniques, bathing, or
showers. The couple should also be given the telephone number of the birthing suite so
they can call if they have any concerns or to verify that they should return to the
hospital.
✔✔The physician looking after Vali recommends a therapeutic sleep and orders 10 mg
IM of Morphine. Vali is admitted to the birthing unit and given the prescribed Morphine.
The EFM is attached to monitor the fetus.
06.00 The nurse doing assessments notes that Vali has managed to get some sleep.
The EFM shows that contractions are now every 10 minutes, lasting 40 seconds and
that the fetal heart is 130 with decreased variability. The nurse calls Dr. Jones to inform
him of the decreased variability and the spacing of contractions. Dr. Jones says to
continue monitoring and he will be in around 7 am.What is your opinion of the care that
ANSWERS SET A+
✔✔Suggest some positions that may facilitate fetal rotation during the second stage of
labor. - ✔✔•Squatting, using the squatting bar that can be inserted into most birthing
beds.
•The use of a birthing stool
•The lateral lying position, upper leg held by labor supporter.
•Early second stage pushing on a toilet.
•Water birth, although this is not widely used in hospitals it is used by some midwives
for home births.
✔✔Deflexed head - ✔✔A deflexed head presents a wider diameter of the head and is
often associated with a longer, slower labour. It is not uncommon when a fetus is in the
posterior position, that it also has a deflexed head.
✔✔Asynclitism - ✔✔The best way to describe asynclitism is rather than the head being
positioned in alignment with the shoulders, it is tilted to one side or the other. On vaginal
exam the sagittal suture will not be in the midline.
✔✔Persistent Cervical Lip - ✔✔However, sometimes as labour progresses to second
stage, a thin ribbon or lip of cervix persists. This partial lip of cervix may be at the front
of the cervix (anterior lip) or at one side of the cervix. Persistent cervical lip is often
associated with an OP position and a strong urge to push prior to full dilatation. This
maternal urge to push can force the presenting part onto the lip of cervix, causing
edema and more resistance to dilatation.Various positions, such as hands and knees or
side lying, can help take the pressure off of the cervix. Should the cervical lip persist
and/or the labouring woman is unable to avoid pushing, epidural analgesia may take
away the urge to push, helping to prevent or eliminate cervical edema.
✔✔Think about what you have learned regarding nursing care during labour. List some
nursing care measures that promote normal progress in labour and may facilitate
,progress when labour is prolonged. - ✔✔-Helping women to use labour enhancing
positions.
-Providing other non-pharmacological comfort techniques.
-Ensuring that the maternal bladder is emptied frequently during labour.
-Attention to the hydration and nutritional needs of the labouring woman.
-Providing 1:1 nursing support during active labour.
-Providing a calm and safe environment for the labouring woman.
-Providing ongoing emotional support to the woman and her family. This includes
offering encouragement and information in regards to labour progress.
-Ongoing assessment of maternal status, including contraction frequency, duration,
strength, resting tone, and maternal responses.
-Ongoing assessment of fetal status, including FHR responses to prolonged labour,
fetal position, and descent.
-Assessment of membranes and drainage if the membranes are ruptured.
-VEs when indicated to assess cervical dilatation and fetal descent. Monitor labour
progress by comparing VE findings to previous examinations.
Waiting until a woman has an urge to push before active pushing commences. (passive
descent)
Promoting position changes during the second stage of labour.
-Documentation of all findings on the partogram and communication of labour progress
to the primary caregiver.
-Anticipation of and preparation for medical interventions.
-Protecting the labouring woman from unnecessary labour interventions.
✔✔What factors should you consider if labour is not progressing? - ✔✔-Are there
alterations in the characteristics of contractions?
-Have there been any changes to cervical dilatation and fetal descent?
-Are there fetal factors hampering labour progress?
-Are there maternal factors impacting on labour progress?
-What are the maternal and fetal responses to prolonged labour?
-Has the primary care provider been informed about slow progress in labour and given a
full report on maternal and fetal status?
✔✔Maternal age: - ✔✔-Women 35 and over were more likely to have a Caesarean
delivery, with rates 44% higher than for those age 20 to 34.
-Among those 40 and over, one in three mothers had a Caesarean delivery.
-Among first-time mothers 40 and over with singletons, one of every two had a
Caesarean delivery.
-Women 35 and over were at double the risk of those 20 to 34 for placenta previa
-Among those age 40 and over, placenta previa rates were three times higher than for
those age 20 to 34 and more than 10 times higher than for mothers under the age of 20.
✔✔Maternal weight: - ✔✔-Obesity increases the risk of inadequate uterine contractions,
labour dystocia, caesarean birth, and macrosomia (Vinayagam & Chandraharan, 2012).
(Obesity is also a risk factor for hypertension and diabetes, which will affect fetal growth
and development and labour.)
,-Severely underweight women more likely to delivery preterm and have low birth weight
infants (Lowdermilk et al, 2016).
✔✔Practice point for Variations in power. - ✔✔In practice you will often see an
overemphasis on cervical dilatation and limited attention paid to descent and rotation of
the fetus as signs of labour progress. For example, you may notice that the cervical
dilatation has not changed, but the presenting part has descended from station minus 2
to station 0 and the position has changed from occiput transverse to occiput anterior.
When we connect this assessment data to the cardinal movements of labour, this can
be seen as progress. It is also important to remember that it is common for there to be
no cervical dilatation for more than 2 hours in active phase
✔✔Amniotomy - ✔✔When labour is progressing slowly, one of the first medical
interventions considered to augment the labour is an artificial rupture of membranes
(ARM) or amniotomy.During a vaginal exam the physician or midwife uses a long
handled hook to open (rupture) the membranes surrounding the fetus.
✔✔What drug is used to augment labour? - ✔✔-synthetic oxytocin,
-the drug most commonly associated with adverse events
-The goal of induction or augmentation with oxytocin is to produce contractions that
mimic normal physiologic labour
✔✔What are maternal risks of using synthetic oxytocin? - ✔✔-Uterine hyperstimulation
(tachysystole)
-Placental abruption
-Uterine rupture
-Unnecessary caesarean birth due to abnormal --FHR patterns
-Post-partum hemorrhage
✔✔What are the fetal risks of using synthetic oxytocin? - ✔✔-Poor fetal oxygenation
-Abnormal fetal heart rate
-Hypoxemia
-Acidosis
✔✔Define uterine hyperstimulation. - ✔✔-as 6 or more contractions in 2 consecutive 10
minute windows or contractions lasting longer than 120 second.
-appropriate term is tachysystole
-tachysystole is defined as more than 5 contractions per 10 minute period over 30
minutes. It can be further divided into with or without fetal heart rate changes.
Hypertonus refers to contractions that last longer than 120 seconds.
✔✔what happened to fetal oxygen saturation when there are 5 or more contractions in
10 minutes over a 30 minute time frame? - ✔✔oxygen saturation decreases 20-29%
✔✔What does the perinatal nurse assess following an amniotomy? - ✔✔Color of fluid
, Amount of fluid
Fetal response
✔✔Augmenting labor is necessary when: - ✔✔Uterine contractions are not strong or
frequent enough to result in cervical dilatation and fetal descent
✔✔Uterine hyperstimulation is defined as: - ✔✔the presence of 6 or more contractions
in 10 minutes, measured over two 10-minute window frames on the EFM
✔✔If uterine hyperstimulation occurs, the nurse should: - ✔✔Discontinue or decrease
the rate of oxytocin
✔✔If labour does not progress despite the use of oxytocin, you may see the primary
care provider utilize an intrauterine pressure catheter (IUPC). What is that? - ✔✔An
IUPC is a soft flexible catheter that is inserted through the cervix alongside the fetus. It
provides a specific numeric measurement of the strength, frequency, and duration of the
uterine contractions. An IUPC may also be used when a woman is obese and the nurse
is unable to palpate contractions due to the amount of adipose tissue.
✔✔The admitting nurse does a full assessment of Vali and her fetus. The nurse finds
the fetus in an LOA position and engaged. Contractions are every 8 minutes, lasting 40
seconds. VE reveals a cervix that is 2 cm dilated, 1.5cm long, and the presenting part at
spines with the membranes intact. The FHR is normal. Also noted is that Vali is very
tired and tearful and not handling her contractions well.What care would you
recommend for Vali at this time? - ✔✔The assessment findings indicate that Vali is still
in early labour. Although she is tired and finding contractions difficult to deal with the
best recommendation for her at this time is discharge home until contractions are more
frequent. Vali and Doug should be reassured that labour has commenced but is still
early and offered suggestions for comfort techniques that will help in dealing with
contractions. Suggestions may include various breathing techniques, bathing, or
showers. The couple should also be given the telephone number of the birthing suite so
they can call if they have any concerns or to verify that they should return to the
hospital.
✔✔The physician looking after Vali recommends a therapeutic sleep and orders 10 mg
IM of Morphine. Vali is admitted to the birthing unit and given the prescribed Morphine.
The EFM is attached to monitor the fetus.
06.00 The nurse doing assessments notes that Vali has managed to get some sleep.
The EFM shows that contractions are now every 10 minutes, lasting 40 seconds and
that the fetal heart is 130 with decreased variability. The nurse calls Dr. Jones to inform
him of the decreased variability and the spacing of contractions. Dr. Jones says to
continue monitoring and he will be in around 7 am.What is your opinion of the care that
