MYLES FLASH CARDS
Terms in this set (63)
T or F? Prior to touching the woman, a sound explanation of the proposed examination and their significance should be given.
What is a partogram or paragraph?
Effective way to record the progress of labor.
T or F? Placing the hand on the uterus is a good way to assess strength, length and frequency of contractions.
Can the descent of the head during first stage be followed by abdominal palpation?
Yes This is not stated in this edition, but it is an important thing to understand.
List two methods described in "Assessing Progress" in addition to examination of the cervix.
1) visualization of the purple line, appearing from the woman's anal margin gradually extending to the nap of the buttocks (Hobbs 1998; Shepherd et al 2010)
2) observing the Rhombus of Michaelis, a kit-shaped area between the sacrum and ilea which becomes increasingly visible as the fetal head descends in the pelvis (Shepherd et al 2010)
T or F? Vaginal examinations should be used judiciously when more information is required if it cannot be gleaned from external observations of women in labour.
Give seven indications for vaginal examination.
1) positive identification of the presentation
2) head is engaged in case of doubt
3) ascertain whether the firewaters have ruptured or AROM
4) exclude cord prolapse after rupture of the forewaters, especially if ill-fitting presentating part or FHR change
5) assess progress or slow labour
6) confirm full dilation of the cervix
7) confirm the axis of the fetus and presentation of the second twin in a multiple pregnancy in order to rupture the second amniotic sac if necessary
NOTE: If there is considerable bleeding, after trying to locate the placenta, a midwife can very gently do a vaginal exam with no poking. Women who dilate extremely fast often have considerable bleeding from the cervix.
Described in "maternal observations" list four ways to assess the wellbeing.
1) Pulse 2) Temperature 3) Blood Pressure 4) Fluid balance and urinalysis
What would you suggest if a laboring woman is spilling ketones in her urine?
Feed the mother some juice, broth, soup, herbal tea, light food.
List six things that can increase the pulse rate of a laboring woman.
1) anxiety 2) pain 3) infection 4) ketosis 5) hemorrhage 6) warm water bath
What advantages have been found for the mother being mobile during labor?
1) more effective uterine action 2) shorter labors 3) less oxytocin augmentation 4) reduced need for pharmacological analgesia 5) fewer operative deliveries 6) lower incidence of fetal compromise 5) fewer episiotomies 8) increasing woman's control
Why do hospital policies usually restrict food intake during labor?
Prevent gastric aspiration
How often is it recommended for the laboring mother to empty her bladder?
4 hours or more frequently
List five problems that can result from a full bladder.
1) increase pain 2) reduce efficiency of uterine contractions 3) delay in labor 4) does not allow presenting part to come down 5) after placenta delivered, encourages placenta site to open up and bleed more
What is lightening?
Two or three weeks (usually 1st x mom) before the onset of labor, the lower uterine segment expands and allows the fetal head to sink lower and it may engage in the pelvis. This allows more room for the lungs making breathing easier and there is less pressure on the heart and stomach. There also is more pressure in pelvis making walking more difficult and increasing urinary urges and vaginal secretions.
What is the latent phase of labor?
Prior to active first stage and may last 6 - 8 hours in first time mothers when the cervix dilates from 0 cm to 3-4 cm and the cervical canal shortens from 3 cm long to less than 0.5 cm.
What is transition?
When the cervix is around (7) 8 until fully dilated. There is often a brief lull in the intensity of uterine activity.
List six things that influence the length of labor.
1) parity 2) birth interval 3) psychological state 4) presentation and position of the fetus 5) maternal pelvic shape and size 6) character of uterine contractions
Taking up of the cervical canal into the lower uterine segment. Important Note: Page 330 "It is believed that this process takes place from above downward, meaning that the muscle fibers surrounding the internal os are drawn upward by the retracted upper segment and the cervix merges into the lower uterine segment." This statement would lead you to believe that the upward movement of the cervix is on the inside of the internal os. However, the upward movement of the cervix starts at the external os and goes up on the outside leaving the internal os to stand by itself. Dianne Bjarnson
What is uterine muscle retraction?
The contraction does not pass off entirely. The muscle fibers retain some of the shortening of the contraction instead of being completely relaxed.
What is the retraction ring? When is it called Bandle's ring?
Ridge between upper and lower uterine segments. It is called Bandle's ring when the ring becomes exaggerated and is visible in obstructed labor.
What conclusion might you come to if the waters are leaking and on vaginal exam the bago of waters are felt?
Forewaters intact, hindwaters have a hole in them.
List two main reasons why an intact membrane is often preferred over broken membranes during labor?
1) optimizes oxygen supply to the fetus 2) helps prevent intra-uterine infection. Also early rupture can lead to C-Section.
What is fetal axis pressure?
During contraction the uterus rises forward and the force of the fundal contraction is transmitted to the upper pole of the fetus, down the long axis of the fetus and applied by the presenting part to the cervix.
T or F? Binding the mother's belly or having her pull up and in on her belly during contractions increases the pressure on the cervix. If the mother has a pendulous uterus it helps to bring the baby in at a better angle.
What is the negative affect of the pain relief model?
Under minds the woman's confidence in herself and her body to give birth without the aid of medication.
How can the working with pain model consider pain in labor?
Pain of normal labor is positive and has a purpose and should be philosophically embraced.
Name five changes that may occur in the body due to a painful stimulus.
1) increased pulse 2) rise in blood press 3) release of adrenaline into the blood stream 4) an increase in blood glucose levels 5) decrease in gastric motility 6) reduction in blood supply to the skin, causing sweating
What is the common name for nitrous oxide?
List three considerations in the storage of Entonox.
1) gasses separate at -7 C 2) store cylinders on side 3) if gas has been cold, need to put in a warm room and invert the cylinder at least three times to remix.
List three side-effects of opiate drugs on the newborn.
1) reduction in fetal heart rate variability 2) depression of the baby's respiratory center at birth 3) sleepy baby affecting the establishment of breastfeeding
List three side-effects of opiate drugs on the mother.
1) nausea and vomiting 2) delayed emptying the stomach 3) drowsiness or sedation which may impair decision making.
List five complications of epidural analgesia
1) hypertension, dural pucture and consequent headache 2) total spinal leading to respiratory arrest 3) local anaesthic toxicity leading to cardiac arrest 4) fetal compromise 5) loss of bladder sensation 6) increased need for assisted vaginal birth 7) neurological sequelae 8) long-term backache.
What percentage of all pregnancies have prelabor rupture of membranes (PROM) at term?
8 - 10%
T or F? Most women with PROM at term will labor spontaneously withing 24 hours.
Instead of using antibiotics in the case of prelabor rupture of membranes what can a midwife recommend to the mother to take?
Vit C, anti-occidents, colloidal silver, garlic, cayenne, etc. Answer not in test.
What happens to a contraction pattern in 2nd stage?
Contractions become stronger and longer and usually less frequent.
T or F? Pressure from the presenting part stimulates nerve receptors in the pelvic floor which stimulates the urge to push
Note: Underline or mark in you mind, page 369: "Some women feel a strong desire to push before full dilation occurs. Traditionally, it has been assumed that an early urge to push will lead to maternal exhaustion and/or cervical oedema or trauma. More recent research indicates that the early pushing urge may in fact be experienced by a significant minority of women, and that, in certain circumstances spontaneous early pushing may be physiological..."
What is the anal cleft line or the purple line?
Pigmented mark in the clef of the buttocks which gradually ascends the anal clef as the labor progresses
How can you tell if the mother can continue on with a long second stage of labor?
Mother's and baby's vitals are good and the mother has enough energy.
NOTE: Underline or mark in your mind, page 370: "There is no good evidence about the absolute time limits of physiological labour (Downe 2004; NICE 2007; Ahang et al 2010). Most researchers who have examined this are have shown that, for healthy women and babies, the second stage of labour can last for up to three hours or so before the risk of maternal and/or fetal compromis begins to increase (Albers 1999; Allen et al 2009)
What increase is there in the pelvis when the mother is squatting?
1 cm transverse diameter and 2 cm in the antero-posterior diameter
List three common principles that are common to all mechanisms of normal labor.
1) descent takes place 2) whichever part leads and first meets the resistance of the pelvic floor will rotate forward until it comes under the symphysis pubis 3) whatever emerges from the pelvis will pivot around the pubic bone
T or F? The shoulders undergo a similar rotation to that of the head to lie in the widest diameter of the pelvic outlet, the anteroposterior.
T or F? The shoulders are usually born sequentially. This enables a smaller diameter to distend the vaginal orifice than if both shoulders were born simultaneously.
When the mother is in a supported sitting position, which shoulder is usually born first?
Name four factors that need to be monitored in order to determine whether the second stage is continuing safely.
1) uterine contractions 2) descent, rotation and flexion of the presenting part 3) fetal condition 4) maternal condition
How can a midwife help prevent rapid extension of the head?
Light support on the baby's head with her hand.
After the head is born, what is the next thing the midwife should check for?
If during a birth under water the birth of the shoulders is delayed, what should the midwife get the mother to do?
Get out of the water.
Simply what is the process by which the placenta detaches from the uterine wall?
See page 396 - 7. Uterus becomes smaller after the baby comes out. Placenta site diminishes in size. Maternal system closes off so blood cannot drain back into it. Vessels burst and start to split placenta off wall.
Give some tips for delivering trailing membranes.
Should be teased out gently, by turning the placenta around and twisting them into a 'rope' thus stripping the ends gently from the uterine wall. Can use hemostats to clamp onto piece of membrane hanging out to better be able to work with it.
Name 4 drugs that stimulate the smooth muscle of the uterus to contract.
1) ergometrine 2) ergometrine and oxytocin combined 3) oxytocin 4) prostaglandins
Tending to ward off disease, preventative treatment.
List some possible effects of early clamping of the umbilical cord.
1) Reduces the volume of blood returning to the fetus. 2) For a baby who is slow to breathe, prematurely interrupting the respiratory function of the placenta plus prevention of acidosis 3) Lower neonatal bilirubin levels 4) Increases likelihood of fetomaternal transfusion 5) Results in truncated umbilical vessel contain a quantity of clotted blood...May breed bacterial growth 6) Heavier placental weight has also been associated with early cord clamping which may cause difficulty with delivery of the placenta, particularly when the cervix has contracted following administration of a uterotonic.
List some advantages of late clamping of the umbilical cord.
1) The route to the low resistance placental circulation remains patent, which provides the newborn with a safety valve for any raised system blood pressure. 2) The length of time for the cord to separate postnatally is reduced. 3) There is transfusion of the full quota of placental blood to the newborn 4) higher mean birth weight 5) higher neonatal hematorit and improved iron status in infants up to six months post birth 6) may decrease the risk of fetomaternal transfusion
T or F? Recent research has shown that controlled cord traction has no effect on severe hemorrhage and little effect on mild post partum hemorrhage, if any.
True. The main key is watching for the separation of the placenta. After that occurs you can actually put quite a bit of pressure on the cord. Be sure to place on hand above the pubic bone and push to prevent the placenta getting caught up there and with the other hand pull the cord towards the mother's anus.
T or F? If a cord blood sample is recommended, the sample should be taken as soon as possible from the fetal surface of the placenta where the blood vessels are congested and easily visible.
Define primary postpartum hemorrhage.
Bleeding from the genital tract in excess of 500 ml at any time following the baby's birth up to 24 hours postpartum.
List 11 causes of atonic uterine action resulting in postpartum hemorrhage (PPH).
1) Incomplete placental separation 2) Retained cotyledon, placental fragment or membranes 3) Precipitous labor 4) Prolonged labor 5) Polyhydramnios or multiple pregnancy 6) Placenta previa 7) Placenta abruption 8) General anesthesia 9) Mismanagement of the 3rd stage of labor 10) A full bladder 11) Etiology unknown 12) Induction or augmentation of labor with oxytocin 13) Episiotomy
List 6 factors that may increase the likelihood of excessive bleeding.
1) Previous history of postpartum hemorrhage or retained placenta 2) High parity resulting in uterine scare tissue 3) Presence of fibroids 4) Maternal anemia 5) HIV/AIDS 6) Ketosis 7) Previous c-section.
List 7 signs of postpartum hemorrhage (PPH).
1) visible bleeding 2) maternal collapse 3) pallor 4) rising pulse rate 5) falling blood pressure 6) altered level of consciousness; the mother may become restless or drowsy 7) an enlarged uterus "body" -- may be little or no visible loss of blood.
What management suggestions would you have when working with a woman who has a history of postpartum hemorrhage?
1) early detection and treatment of anemia 2) prevent prolonged labor and ketoacidosis 3) have bladder empty before 2nd stage 4) perhaps prophylactic administration of a uterotonic agent in 3rd stage.
What should be the first action in the treatment of postpartum hemorrhage at a home birth?
For home birth the first action in the treatment of postpartum hemorrhage is to empty the uterus and stop the bleeding by holding the uterus down.