NM704 Exam 4 QUESTIONS 100% Verified Questions &
Answers
Q: Describe active management of the 3rd stage of labor:
Answer:
The Three Components of AMTSL according to the ICM/FIGO Joint Statement (2003) 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.
Q: Compare outcomes between expectant v. active management of third stage labor:
Answer:
When labor and birth are physiological, a physiological third stage results in comparable bleeding outcomes as when
AMTSL is implemented with a general population at mixed risk for excessive bleeding.
Q: How can shared decision making be utilized in third stage labor?
Answer:
Discuss ways ahead of time to support normalcy in 3rd stage, discuss interventions known to decrease risk of
hemmorhage, avoid procedures that increase postpartum blood loss (induction, augmentation, episiotomy)
Q: What is the 4th stage of labor?
Answer:
The first hour following the expulsion of the placenta. (Also, this is the time when women are at highest risk for
postpartum hemorrhage)
Q: What should be evaluated during fourth stage in terms of the uterus?
Answer:
Check position and tone every 5-15 minutes, position in relation to the umbilicus, tone- firm, boggy
Q: What two medications are commonly used to manage the stage of labor?
Answer:
Oxytocin and Methergine
Q: Oxytocin: action, indication, side effx, contraindications for 4th stage labor
Answer:
Action: promotes contractions by increasing the intracellular Ca2+. Oxytocin has specific receptors in the myometrium
and the receptor concentration increases greatly during pregnancy, reaching a maximum in early labor at term.
Q: Indication: Pitocin is indicated to produce uterine contractions during the third stage of labor and to control
postpartum bleeding or hemorrhage. Side effects: Anaphylactic reaction, Premature ventricular contractions, Postpartum
hemorrhage, Pelvic hematoma, Cardiac arrhythmia, Subarachnoid hemorrhage, Fatal afibrinogenemia, Hypertensive
, episodes, Nausea, Rupture of the uterus, Vomiting Contraindications: Antepartum contraindications include: o Where
there is significant cephalopelvic disproportion; o In unfavorable fetal positions or presentations, such as transverse lies,
which are undeliverable without conversion prior to delivery; o In obstetrical emergencies where the benefit-to-risk ratio
for either the fetus or the mother favors surgical intervention; o In fetal distress where delivery is not imminent; o Where
adequate uterine activity fails to achieve satisfactory progress; o Where the uterus is already hyperactive or hypertonic; o
In cases where vaginal delivery is contraindicated, such as invasive cervical carcinoma, active herpes genitalis, total
placenta previa, vasa previa, and cord presentation or prolapse of the cord; o In patients with hypersensitivity to the drug.
Methergine: action, indication, side effx, contraindications for 4th stage labor
Answer:
Action: acts directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of rhythmic
contractions. Thus, it induces a rapid and sustained titanic uterotonic effect which shortens the third stage of labor and
reduces blood loss.
Q: Indication: Following delivery of placenta, for routine management of uterine atony, hemorrhage and subinvolution of
the uterus. Side effects: The most common adverse reaction is hypertension associated in several cases with seizure and/or
headache. Hypotension has also been reported. Abdominal pain (caused by uterine contractions), nausea and vomiting
have occurred occasionally Contraindications: Hypertension; toxemia; pregnancy; and hypersensitivity. Methergine is not
to be used within 12 hours of breastfeeding. What is the difference in the nature of contractions when oxytocin or
methergine is used?
Answer:
Methergine tends to cause a sustained uterine contraction while oxytocin causes rhythmic uterine contractions.
Q: Pubococcygeus muscle
Answer:
part of the levator ani muscle, primary portion of the levantor ani. Originates at posterior border of the symphysis pubis
and sweeps back to insert on lateral margins of coccyx.
Q: Bulbocavernosus muscle
Answer:
Attaches posteriorly to central tendinous point on perineum, anteriorily inters to corpus cavernous of the clitoris, laterally
surround orifice of the vagina and cover vestibular bulbs and Bartholin glands on either side
Q: Superficial transverse perineal muscle
Answer:
Arises from inner and anterior surfaces of the ischial tuberosity of the superior ramus of the ischium by a small tendon.
They insert into the central tendinous point of the perineum.
Q: A fibromuscular structure. Midline between vagina and anus. Point of fusion for both superior and inferior fascia of
the urogenital diaphragm.
Answer:
Central tendinous point of the perineum
Q: Common point of attachment for Bulbocavernosus, superficial transverse perineal, and pubococcoygeus. What should
be inspected in terms of the cervix, vagina and perineum during 4th stage?
Answer:
Answers
Q: Describe active management of the 3rd stage of labor:
Answer:
The Three Components of AMTSL according to the ICM/FIGO Joint Statement (2003) 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.
Q: Compare outcomes between expectant v. active management of third stage labor:
Answer:
When labor and birth are physiological, a physiological third stage results in comparable bleeding outcomes as when
AMTSL is implemented with a general population at mixed risk for excessive bleeding.
Q: How can shared decision making be utilized in third stage labor?
Answer:
Discuss ways ahead of time to support normalcy in 3rd stage, discuss interventions known to decrease risk of
hemmorhage, avoid procedures that increase postpartum blood loss (induction, augmentation, episiotomy)
Q: What is the 4th stage of labor?
Answer:
The first hour following the expulsion of the placenta. (Also, this is the time when women are at highest risk for
postpartum hemorrhage)
Q: What should be evaluated during fourth stage in terms of the uterus?
Answer:
Check position and tone every 5-15 minutes, position in relation to the umbilicus, tone- firm, boggy
Q: What two medications are commonly used to manage the stage of labor?
Answer:
Oxytocin and Methergine
Q: Oxytocin: action, indication, side effx, contraindications for 4th stage labor
Answer:
Action: promotes contractions by increasing the intracellular Ca2+. Oxytocin has specific receptors in the myometrium
and the receptor concentration increases greatly during pregnancy, reaching a maximum in early labor at term.
Q: Indication: Pitocin is indicated to produce uterine contractions during the third stage of labor and to control
postpartum bleeding or hemorrhage. Side effects: Anaphylactic reaction, Premature ventricular contractions, Postpartum
hemorrhage, Pelvic hematoma, Cardiac arrhythmia, Subarachnoid hemorrhage, Fatal afibrinogenemia, Hypertensive
, episodes, Nausea, Rupture of the uterus, Vomiting Contraindications: Antepartum contraindications include: o Where
there is significant cephalopelvic disproportion; o In unfavorable fetal positions or presentations, such as transverse lies,
which are undeliverable without conversion prior to delivery; o In obstetrical emergencies where the benefit-to-risk ratio
for either the fetus or the mother favors surgical intervention; o In fetal distress where delivery is not imminent; o Where
adequate uterine activity fails to achieve satisfactory progress; o Where the uterus is already hyperactive or hypertonic; o
In cases where vaginal delivery is contraindicated, such as invasive cervical carcinoma, active herpes genitalis, total
placenta previa, vasa previa, and cord presentation or prolapse of the cord; o In patients with hypersensitivity to the drug.
Methergine: action, indication, side effx, contraindications for 4th stage labor
Answer:
Action: acts directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of rhythmic
contractions. Thus, it induces a rapid and sustained titanic uterotonic effect which shortens the third stage of labor and
reduces blood loss.
Q: Indication: Following delivery of placenta, for routine management of uterine atony, hemorrhage and subinvolution of
the uterus. Side effects: The most common adverse reaction is hypertension associated in several cases with seizure and/or
headache. Hypotension has also been reported. Abdominal pain (caused by uterine contractions), nausea and vomiting
have occurred occasionally Contraindications: Hypertension; toxemia; pregnancy; and hypersensitivity. Methergine is not
to be used within 12 hours of breastfeeding. What is the difference in the nature of contractions when oxytocin or
methergine is used?
Answer:
Methergine tends to cause a sustained uterine contraction while oxytocin causes rhythmic uterine contractions.
Q: Pubococcygeus muscle
Answer:
part of the levator ani muscle, primary portion of the levantor ani. Originates at posterior border of the symphysis pubis
and sweeps back to insert on lateral margins of coccyx.
Q: Bulbocavernosus muscle
Answer:
Attaches posteriorly to central tendinous point on perineum, anteriorily inters to corpus cavernous of the clitoris, laterally
surround orifice of the vagina and cover vestibular bulbs and Bartholin glands on either side
Q: Superficial transverse perineal muscle
Answer:
Arises from inner and anterior surfaces of the ischial tuberosity of the superior ramus of the ischium by a small tendon.
They insert into the central tendinous point of the perineum.
Q: A fibromuscular structure. Midline between vagina and anus. Point of fusion for both superior and inferior fascia of
the urogenital diaphragm.
Answer:
Central tendinous point of the perineum
Q: Common point of attachment for Bulbocavernosus, superficial transverse perineal, and pubococcoygeus. What should
be inspected in terms of the cervix, vagina and perineum during 4th stage?
Answer:
