NM704 Exam - Questions With A+ Solutions
Friedman recommended considering intervention when a labor arrest is
diagnosed, which he defined as Right Ans - two hours with no progress in
active labor.
One suggested criterion for normal progress is about _____ centimeters per
hour. Right Ans - 0.5
if the results of a vag exam will not change your management plan the
Right Ans - exam should not be done
ACOG states that labor epidurals affect labor by
Cochrane finds that labor epidurals affect labor by Right Ans - first stage
labor, citing several studies with this finding
not prolonging first state
In the current Cochrane review on epidural the conclusion in regards to this
c/s issue is Right Ans - "epidural analgesia had no statistically significant
impact on the risk of caesarean section"
How was the Cochrane finding on epidurals and c/s outcome challenged?
Right Ans - "...the most recent Cochrane meta-analysis (is)deeply flawed by
the inclusion of many studies of women who suffered from complex medical
conditions, and many studies that randomized women late, particularly since
conventional practice is to use epidurals earlier. Clearly, any meta-analysis is
only as good as the individual studies included—illustrating the well-known
principle: garbage in, garbage out
ACOG Practice Bulletin on Obstetric Analgesia and Anesthesia in 2017 - states
Right Ans - "Randomized trials and systematic reviews including thousands of
patients have shown that the initiation of epidural analgesia at any stage
during labor does not increase the risk of cesarean delivery.
These conclusions stem primarily from Cochrane reviews, which, as discussed
above, may not be the best source of data for this issue.
,The evidence IS clear that epidural use is associated with Right Ans - longer
second stages, oxytocin augmentation and operative vaginal birth
Types of labor support Right Ans - 1. Emotional (presence, reassurance,
encouragement)
2. Tangible assistance
3. Knowledge support
benefits of continuous labor support Right Ans - less pain meds
fewer c/s births
less oxytocin
more satisfied with birth experience
benefits strongest if not in social group or hospital staff
ACOG
The following recommendations are based on good and consistent scientific
evidence (Level A): Right Ans - • Neuraxial analgesia does not appear to
increase the cesarean delivery rate and, therefore, should not be withheld for
that concern.
• Opioids are associated with adverse effects for the woman and the fetus or
newborn, most significantly respiratory depression, so attention should be
paid to respiratory status.
critics of water birth cite Right Ans - Critics cite the risk of neonatal water
inhalation and maternal/neonatal infection.
Evidence suggests that water immersion during the first stage of labour
reduces Right Ans - the use of epidural/spinal analgesia and duration of the
first stage of labour
Cluett and Burns review on waterbirth - There is no evidence of Right Ans -
increased adverse effects to the fetus/neonate or woman from labouring in
water or waterbirth.
However, the studies are very variable and considerable heterogeneity was
detected for some outcomes. Further research is needed
It has been suggested that waterbirth may Right Ans - reduce the uptake of
pharmacological pain relief and likelihood of perineal trauma
, and increase birth experience satisfaction
When the mother is not fearful, Right Ans - oxytocin is released to
stimulate effective contractions
laboring in water is linked with reduced Right Ans - catecholemines which
inhibit oxytocin and labor progress
Concerns raised in a survey and case reports about birth in water for the baby
include Right Ans - 1) thermoregulation during labour,
2) infection,
3) respiratory difficulties and
4) snapped cord
The theory underpinning increased fetal morbidity and mortality was based
on pregnant ewes in '78 Right Ans - The fetus responded to an increase in
maternal temperature by becoming tachycardiac, reducing resistance in the
placenta bed and thus heat dissipation. As the temperature increased, there
was a tendency to exceed the heat that could be dissipated by the placenta,
leading to an increased risk of fetal mortality
fetal heat transfer Right Ans - This heat is transferred to the mother
primarily via the circulatory system, the umbilical cord and placenta where
the large surface area and constant blood flow facilitate heat transfer.
a second way - A second pathway for heat transfer is via fetal skin, to amniotic
fluid, the uterus and maternal system.
to ensure heat transfer, the fetus is Right Ans - 0.5 degrees warmer than
mom
when maternal temp is increased Right Ans - heat transfer is inhibited and
the fetal temperature rises, until transfer is again possible.
Also,
metabolic activity and oxygen demands increase as temperature increases, the
effect of which may be seen in fetal heart rate changes, and which may
contribute to fetal compromise during labour.
Friedman recommended considering intervention when a labor arrest is
diagnosed, which he defined as Right Ans - two hours with no progress in
active labor.
One suggested criterion for normal progress is about _____ centimeters per
hour. Right Ans - 0.5
if the results of a vag exam will not change your management plan the
Right Ans - exam should not be done
ACOG states that labor epidurals affect labor by
Cochrane finds that labor epidurals affect labor by Right Ans - first stage
labor, citing several studies with this finding
not prolonging first state
In the current Cochrane review on epidural the conclusion in regards to this
c/s issue is Right Ans - "epidural analgesia had no statistically significant
impact on the risk of caesarean section"
How was the Cochrane finding on epidurals and c/s outcome challenged?
Right Ans - "...the most recent Cochrane meta-analysis (is)deeply flawed by
the inclusion of many studies of women who suffered from complex medical
conditions, and many studies that randomized women late, particularly since
conventional practice is to use epidurals earlier. Clearly, any meta-analysis is
only as good as the individual studies included—illustrating the well-known
principle: garbage in, garbage out
ACOG Practice Bulletin on Obstetric Analgesia and Anesthesia in 2017 - states
Right Ans - "Randomized trials and systematic reviews including thousands of
patients have shown that the initiation of epidural analgesia at any stage
during labor does not increase the risk of cesarean delivery.
These conclusions stem primarily from Cochrane reviews, which, as discussed
above, may not be the best source of data for this issue.
,The evidence IS clear that epidural use is associated with Right Ans - longer
second stages, oxytocin augmentation and operative vaginal birth
Types of labor support Right Ans - 1. Emotional (presence, reassurance,
encouragement)
2. Tangible assistance
3. Knowledge support
benefits of continuous labor support Right Ans - less pain meds
fewer c/s births
less oxytocin
more satisfied with birth experience
benefits strongest if not in social group or hospital staff
ACOG
The following recommendations are based on good and consistent scientific
evidence (Level A): Right Ans - • Neuraxial analgesia does not appear to
increase the cesarean delivery rate and, therefore, should not be withheld for
that concern.
• Opioids are associated with adverse effects for the woman and the fetus or
newborn, most significantly respiratory depression, so attention should be
paid to respiratory status.
critics of water birth cite Right Ans - Critics cite the risk of neonatal water
inhalation and maternal/neonatal infection.
Evidence suggests that water immersion during the first stage of labour
reduces Right Ans - the use of epidural/spinal analgesia and duration of the
first stage of labour
Cluett and Burns review on waterbirth - There is no evidence of Right Ans -
increased adverse effects to the fetus/neonate or woman from labouring in
water or waterbirth.
However, the studies are very variable and considerable heterogeneity was
detected for some outcomes. Further research is needed
It has been suggested that waterbirth may Right Ans - reduce the uptake of
pharmacological pain relief and likelihood of perineal trauma
, and increase birth experience satisfaction
When the mother is not fearful, Right Ans - oxytocin is released to
stimulate effective contractions
laboring in water is linked with reduced Right Ans - catecholemines which
inhibit oxytocin and labor progress
Concerns raised in a survey and case reports about birth in water for the baby
include Right Ans - 1) thermoregulation during labour,
2) infection,
3) respiratory difficulties and
4) snapped cord
The theory underpinning increased fetal morbidity and mortality was based
on pregnant ewes in '78 Right Ans - The fetus responded to an increase in
maternal temperature by becoming tachycardiac, reducing resistance in the
placenta bed and thus heat dissipation. As the temperature increased, there
was a tendency to exceed the heat that could be dissipated by the placenta,
leading to an increased risk of fetal mortality
fetal heat transfer Right Ans - This heat is transferred to the mother
primarily via the circulatory system, the umbilical cord and placenta where
the large surface area and constant blood flow facilitate heat transfer.
a second way - A second pathway for heat transfer is via fetal skin, to amniotic
fluid, the uterus and maternal system.
to ensure heat transfer, the fetus is Right Ans - 0.5 degrees warmer than
mom
when maternal temp is increased Right Ans - heat transfer is inhibited and
the fetal temperature rises, until transfer is again possible.
Also,
metabolic activity and oxygen demands increase as temperature increases, the
effect of which may be seen in fetal heart rate changes, and which may
contribute to fetal compromise during labour.
