Name: Score:
44 Multiple choice questions
Definition 1 of 44
2 points for respirations (as he is crying vigorously)
2 for heart rate (as he has a heart rate of more than 100)
2 for tone (as his arms and legs are moving and mostly flexed)
2 for responsiveness or irritability (as he grimaces and coughs with suctioning)
1 for color (as while his body and face are pink, his hands and feet are blue--acrocyanosis)
After about two minutes, Dr. Barnett asks you to clamp the cord twice. Since Ms. Gold's support
people were unable to make it in time for the delivery, Dr. Barnett hands you the scissors, and
shows you where to cut.
Dr. Barnett then asks you to clamp another segment of the cord and save it in case you need to
send a cord gas. You then collect some cord blood in the container that Debbie has provided
you.
ASSIGNING THE APGAR SCORE
Rule out HELLP (Hemolysis, Elevated Liver enzymes AND Low Platelets) syndrome or
preeclampsia with severe features via evaluation of renal and liver function, including a
spot urine protein/ creatinine ratio, as well as a complete blood count to look for
hemoconcentration or thrombocytopenia.
Labor Pain Management - Alternatives to Epidural
Reassuring Fetal Status
Definition 2 of 44
Late decelerations are decelerations in the fetal heart rate that begin after a contraction begins,
with the nadir after the peak of the contraction.
They can be an indication of utero-placental insufficiency, meaning that the baby may not be
getting enough oxygen and late decelerations can be an early sign of hypoxemia during
contractions.
Treatment
Late Decelerations
Delivery
Establishing Breastfeeding
,Definition 3 of 44
When evaluating fetal heart rate tracings, it is useful to follow a systematic approach.
1) Consider the uterine activity: Ms. Gold is having contractions every three to four minutes at
this point.
2) Determine the baseline FHR: It is about 135 on this segment of the strip, which is a normal rate.
3) Determine the heart rate variability: It is moderate on this strip (more than 5 bpm and less
than 25).
4) Look for accelerations: None on this strip.
5) Look for decelerations: Two smooth-appearing decelerations with the nadir after the peak of
the contractions (late decelerations), and one variable deceleration at the end of this segment
of the strip. The first deceleration is clearly a late, and the second one is probably a late but is
less clear.
Overall assessment: This intrapartum strip is not category I (A) because of the late and variable
decelerations, but it is also not category III (C) because the variability is moderate (as opposed
to absent). Therefore, this is a category II (B) fetal heart rate tracing.
Prior to her discharge from the hospital, how would you approach Ms. Gold regarding her
breastfeeding concerns?
Select all that apply.
The best options are indicated below. Your selections are indicated by the shaded boxes.
A. "Giving the baby formula could delay your milk production further because the baby
will be too full to nurse."
B. "Go ahead and give your baby a little formula if you're worried. Then you'll be able to
sleep a little more as well."
C. "I wouldn't give your baby any formula, or you'll never be able to breast feed."
D. "Tell me more about your concerns. Did you breastfeed your last baby? What was your
experience then? What was your mother's experience with breastfeeding?"
Which of the following would be considered a Category I strip?
Choose the single best answer.
The best option is indicated below. Your selections are indicated by the shaded boxes.
A. FHR of 130 with moderate variability, accelerations, and occasional variable
decelerations.
B. FHR of 144 with absent variability and late decelerations
C. FHR of 155 with moderate variability and some early decelerations.
D. FHR of 180 with minimal variability
Approach to Evaluating Fetal Heart Rate Tracings
When evaluating fetal heart rate tracings, it is useful to follow a systematic approach.
1) Consider the uterine activity
2) Determine the baseline FHR
3) Determine the heart rate variability
, 4) Look for accelerations
5) Look for decelerations
Overall assessment
Many intrapartum fetal heart rate tracings will be classified as category II, and they may
still be reassuring overall, or they could be concerning overall, depending on the
specifics of the findings and the situation with the patient.
A 32-year-old patient at 34 weeks and 5 days gestation (G2P1) presents to the clinic with
headache and RUQ abdominal pain. Blood pressure is 172/121 mmHg on examination
while seated. No visual changes noted. Edema is present in the hands, bilaterally. Urine
dipstick demonstrated 4+ protein. FHT are 117.
Which of the following is the most appropriate next step in the management of this
patient?
The best option is indicated below. Your selections are indicated by the shaded boxes.
A. Daily aspirin
B. Expedited delivery of the premature fetus
C. Lisinopril
D. Strict bed rest until 37 weeks
E. Twice-weekly non-stress testing
Definition 4 of 44
A labor curve is often used to plot the labor progress in terms of cervical dilation, effacement,
and fetal descent in order to help diagnosis labor dystocia.
You may also diagnose this condition in the second stage of labor if the fetal presenting part
does not descend significantly in the pelvis after two hours of pushing (or three hours with an
epidural), adding an hour for each, for primiparous women.
Prognosis
Treatment
Diagnosis
Evaluation
, Definition 5 of 44
Clear, health literate communication about options for pain management are a benefit of group
prenatal care, not adherence to a particular pain management plan.
Answer choices A, C, D, and E are benefits of group prenatal care.
Advantages of group prenatal visits:
Increase prenatal knowledge, labor preparedness, support network, shared education
between patients, and patient satisfaction
Provide more time for prenatal education and anticipatory guidance
Improve provider efficiency
Preterm delivery less likely (more significant for African-American women) -preterm birth is the
number one cause for neonatal death in African-American infants
Increased birth weight of preterm infants (a significant survival determinant)
Combat racial health disparities
Used for a variety of medical conditions, including diabetes and chronic pain.
A 21-year-old G1P0 patient presents to the clinic as a new patient to establish prenatal
care. Which statement represents something that would not be expected to be a benefit
of group prenatal care for this patient?
The best option is indicated below. Your selections are indicated by the shaded boxes.
A. Decreases the likelihood of preterm delivery
B. Increases adherence to techniques for pain management during labor
C. Increases physician contact
D. Increases support network
E. Shared education between patients
Which of the following would meet the diagnosis of preeclampsia with severe features?
Choose the single best answer.
The best option is indicated below. Your selections are indicated by the shaded boxes.
A. 100 mg/dL of protein on a urine dipstick
B. 2+ pitting edema of the lower extremities
C. Blood pressure of 180/125 mmHg
D. Serum creatinine of 0.7 mg/dL
A 32-year-old patient at 34 weeks and 5 days gestation (G2P1) presents to the clinic with
headache and RUQ abdominal pain. Blood pressure is 172/121 mmHg on examination
while seated. No visual changes noted. Edema is present in the hands, bilaterally. Urine
dipstick demonstrated 4+ protein. FHT are 117.
Which of the following is the most appropriate next step in the management of this
patient?
The best option is indicated below. Your selections are indicated by the shaded boxes.
A. Daily aspirin
B. Expedited delivery of the premature fetus
44 Multiple choice questions
Definition 1 of 44
2 points for respirations (as he is crying vigorously)
2 for heart rate (as he has a heart rate of more than 100)
2 for tone (as his arms and legs are moving and mostly flexed)
2 for responsiveness or irritability (as he grimaces and coughs with suctioning)
1 for color (as while his body and face are pink, his hands and feet are blue--acrocyanosis)
After about two minutes, Dr. Barnett asks you to clamp the cord twice. Since Ms. Gold's support
people were unable to make it in time for the delivery, Dr. Barnett hands you the scissors, and
shows you where to cut.
Dr. Barnett then asks you to clamp another segment of the cord and save it in case you need to
send a cord gas. You then collect some cord blood in the container that Debbie has provided
you.
ASSIGNING THE APGAR SCORE
Rule out HELLP (Hemolysis, Elevated Liver enzymes AND Low Platelets) syndrome or
preeclampsia with severe features via evaluation of renal and liver function, including a
spot urine protein/ creatinine ratio, as well as a complete blood count to look for
hemoconcentration or thrombocytopenia.
Labor Pain Management - Alternatives to Epidural
Reassuring Fetal Status
Definition 2 of 44
Late decelerations are decelerations in the fetal heart rate that begin after a contraction begins,
with the nadir after the peak of the contraction.
They can be an indication of utero-placental insufficiency, meaning that the baby may not be
getting enough oxygen and late decelerations can be an early sign of hypoxemia during
contractions.
Treatment
Late Decelerations
Delivery
Establishing Breastfeeding
,Definition 3 of 44
When evaluating fetal heart rate tracings, it is useful to follow a systematic approach.
1) Consider the uterine activity: Ms. Gold is having contractions every three to four minutes at
this point.
2) Determine the baseline FHR: It is about 135 on this segment of the strip, which is a normal rate.
3) Determine the heart rate variability: It is moderate on this strip (more than 5 bpm and less
than 25).
4) Look for accelerations: None on this strip.
5) Look for decelerations: Two smooth-appearing decelerations with the nadir after the peak of
the contractions (late decelerations), and one variable deceleration at the end of this segment
of the strip. The first deceleration is clearly a late, and the second one is probably a late but is
less clear.
Overall assessment: This intrapartum strip is not category I (A) because of the late and variable
decelerations, but it is also not category III (C) because the variability is moderate (as opposed
to absent). Therefore, this is a category II (B) fetal heart rate tracing.
Prior to her discharge from the hospital, how would you approach Ms. Gold regarding her
breastfeeding concerns?
Select all that apply.
The best options are indicated below. Your selections are indicated by the shaded boxes.
A. "Giving the baby formula could delay your milk production further because the baby
will be too full to nurse."
B. "Go ahead and give your baby a little formula if you're worried. Then you'll be able to
sleep a little more as well."
C. "I wouldn't give your baby any formula, or you'll never be able to breast feed."
D. "Tell me more about your concerns. Did you breastfeed your last baby? What was your
experience then? What was your mother's experience with breastfeeding?"
Which of the following would be considered a Category I strip?
Choose the single best answer.
The best option is indicated below. Your selections are indicated by the shaded boxes.
A. FHR of 130 with moderate variability, accelerations, and occasional variable
decelerations.
B. FHR of 144 with absent variability and late decelerations
C. FHR of 155 with moderate variability and some early decelerations.
D. FHR of 180 with minimal variability
Approach to Evaluating Fetal Heart Rate Tracings
When evaluating fetal heart rate tracings, it is useful to follow a systematic approach.
1) Consider the uterine activity
2) Determine the baseline FHR
3) Determine the heart rate variability
, 4) Look for accelerations
5) Look for decelerations
Overall assessment
Many intrapartum fetal heart rate tracings will be classified as category II, and they may
still be reassuring overall, or they could be concerning overall, depending on the
specifics of the findings and the situation with the patient.
A 32-year-old patient at 34 weeks and 5 days gestation (G2P1) presents to the clinic with
headache and RUQ abdominal pain. Blood pressure is 172/121 mmHg on examination
while seated. No visual changes noted. Edema is present in the hands, bilaterally. Urine
dipstick demonstrated 4+ protein. FHT are 117.
Which of the following is the most appropriate next step in the management of this
patient?
The best option is indicated below. Your selections are indicated by the shaded boxes.
A. Daily aspirin
B. Expedited delivery of the premature fetus
C. Lisinopril
D. Strict bed rest until 37 weeks
E. Twice-weekly non-stress testing
Definition 4 of 44
A labor curve is often used to plot the labor progress in terms of cervical dilation, effacement,
and fetal descent in order to help diagnosis labor dystocia.
You may also diagnose this condition in the second stage of labor if the fetal presenting part
does not descend significantly in the pelvis after two hours of pushing (or three hours with an
epidural), adding an hour for each, for primiparous women.
Prognosis
Treatment
Diagnosis
Evaluation
, Definition 5 of 44
Clear, health literate communication about options for pain management are a benefit of group
prenatal care, not adherence to a particular pain management plan.
Answer choices A, C, D, and E are benefits of group prenatal care.
Advantages of group prenatal visits:
Increase prenatal knowledge, labor preparedness, support network, shared education
between patients, and patient satisfaction
Provide more time for prenatal education and anticipatory guidance
Improve provider efficiency
Preterm delivery less likely (more significant for African-American women) -preterm birth is the
number one cause for neonatal death in African-American infants
Increased birth weight of preterm infants (a significant survival determinant)
Combat racial health disparities
Used for a variety of medical conditions, including diabetes and chronic pain.
A 21-year-old G1P0 patient presents to the clinic as a new patient to establish prenatal
care. Which statement represents something that would not be expected to be a benefit
of group prenatal care for this patient?
The best option is indicated below. Your selections are indicated by the shaded boxes.
A. Decreases the likelihood of preterm delivery
B. Increases adherence to techniques for pain management during labor
C. Increases physician contact
D. Increases support network
E. Shared education between patients
Which of the following would meet the diagnosis of preeclampsia with severe features?
Choose the single best answer.
The best option is indicated below. Your selections are indicated by the shaded boxes.
A. 100 mg/dL of protein on a urine dipstick
B. 2+ pitting edema of the lower extremities
C. Blood pressure of 180/125 mmHg
D. Serum creatinine of 0.7 mg/dL
A 32-year-old patient at 34 weeks and 5 days gestation (G2P1) presents to the clinic with
headache and RUQ abdominal pain. Blood pressure is 172/121 mmHg on examination
while seated. No visual changes noted. Edema is present in the hands, bilaterally. Urine
dipstick demonstrated 4+ protein. FHT are 117.
Which of the following is the most appropriate next step in the management of this
patient?
The best option is indicated below. Your selections are indicated by the shaded boxes.
A. Daily aspirin
B. Expedited delivery of the premature fetus
