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Book 2: Maternal and Fetal Care
UNIT 11: ABNORMAL LABOR PROGRESS AND DIFRCULT DELIVERIES
Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.
Shoulder dystocia occurs more commonly in all of the following conditions, except
A. Fetal macrosomia
B. Late term gestation
C. Maternal diabetes
D. Vaginal birth after cesarean delivery
You see the sudden onset of severe variable decelerations on a fetal heart rate tracing. Of the following actions , what is the first thing you should do?
A. Check for umbilical cord prolapse.
B. Check the woman's blood pressure.
C. Prepare to administer a tocolytic medicatio n.
D. Prepare for emergency cesarean delivery.
With meconium-stained amniotic fluid, the baby's mouth and nose should be suctioned after delivery of the head, but before delivery of the shoulders.
True
False
Narcotics given to a laboring woman may cause minimal or absent fetal heart rate variability.
True
False
Face presentation puts a baby at risk for spinal cord injury.
True
False
The fetal head should be engaged before a forceps delivery is attempted.
True
False
Once normal fetal size, presentation, and position and adequate pelvic size have been determined, oxytocin augmentation is the treatment of choice for hypertonic uterine dysfunction.
True
False
When cord prolapse occurs, one appropriate way to elevate the presenting part off of the cord is to fill the woman's bladder with 500 ml of sterile saline and have her assume the knee-chest position.
True
False
Contraction quality is poor, but baseline tonus is usually increased with hypotonic uterine dysfunction
True
False
Which of the following conditions should always be present before forceps or vacuum extraction delivery is attempted?
Which of the following conditions should always be present before forceps or vacuum extraction delivery is attempted?
Yes
No
Estimated fetal weight of 4,000 g (8 lb 13 oz) or more
Adequate maternal anesthesia
Complete cervical dilation
Evaluation of fetal size, presentation, and position
Oxytocin augmentation of labor
In which of the following situations is oxytocin augmentation of labor likely to be useful (assuming normal fetal size, presentation, and position and normal pelvic size are present)?
In which of the following situations is oxytocin augmentation of labor likely to be useful (assuming normal fetal size, presentation, and position and normal pelvic size are present)?
Yes
No
Arrested second stage with normal contraction pattern
Hypotonic uterine dysfunction during the active phase
Hypertonic uterine dysfunction during the latent phase
Maternal fatigue with weak pushing efforts but normal labor pattern
Maternal risks of rapid labor include all of the following complications, except
A. Postpartum hemorrhage
B. Postpartum endometritis
C. Lacerations of the birth canal
D. Uterine atony
Which of the following interventions are appropriate when rapid cervical dilation is occurring and rapid delivery is anticipated?
Which of the following interventions are appropriate when rapid cervical dilation is occurring and rapid delivery is anticipated?
Yes
No
Begin broad-spectrum antibiotics.
Investigate for placental abruption.
Check cervical dilation frequently.
Prepare for delivery.
Anticipate the need for neonatal resuscitation.
Place the woman in reverse Trendelenburg position.
Administer large doses of narcotic analgesia to the laboring woman .
Which of the following are associated with vaginal breech delivery?
Which of the following are associated with vaginal breech delivery?
Yes
No
Placental abruption
Birth trauma
Growth-restricted fetus
Prolapsed umbilical cord
If there is excessive bleeding during the third stage of labor, oxytocin should be administered to cause the uterus to contract and expel the placenta .
True
False
The second stage of labor normally lasts 6 hours or longer.
True
False
Oxytocin infusion may be appropriate treatment for second stage arrest of labor.
True
False
If delivery of the placenta does not occur within 30 minutes of delivery of the baby, but there is no evidence of vaginal bleeding, it is best to wait for spontaneous delivery of the placenta.
True
False
Ultrasonographic estimation of fetal weight is less accurate when the fetal head is deep in the woman's pelvis.
True
False
The hallmark of active labor is contractions with progressive cervical dilation.
True
False
Goiter and tumors of the fetal neck are associated with an increased likelihood of a fetus being in face or brow presentation
True
False
The most common cause of prolonged labor is breech presenattion .
True
False
A woman is exhausted and can no longer push effectively. The fetus is vertex, right occiput posterior, at +3 station. Manual rotation of the head and low forceps delivery is one appropriate approach to this situation.
True
False
Artificially rupturing the membranes to stimulate labor in a woman with a prolonged latent phase will require a cesarean delivery if labor does not progress.
True
False
When fetal gestational age is 34 weeks or less and an operative vaginal delivery is indicated, a vacuum extractor is preferred to forceps.
True
False
Which of the following conditions is most likely to be a cause of a prolonged latent phase?
A. Fetal malformation
B. Uterine fibroids
C. Excessive maternal sedation
D. Grand multiparity
Which of the following conditions is the best indication of active labor?
A. Regular contractions
B. Rupture of membranes
C. Painful contractions
D. Cervical dilation
Once labor becomes established, clues to abnormal progress include all of the following situations, except
A. The cervix becomes edematous.
B. The fetal presenting part remains unengaged.
C. Contractions occur every minute.
D. Cervical dilation averages 1.5 cm/h.
Evaluation of a prolonged active phase reveals fetal hydrocephalus. The fetus is vertex, with a reassuring fetal heart rate pattern. Which of the following actions are appropriate to take?
Evaluation of a prolonged active phase reveals fetal hydrocephalus. The fetus is vertex, with a reassuring fetal heart rate pattern. Which of the following actions are appropriate to take?
Yes
No
Begin oxytocin augmentation.
Drain the hydrocephalus with a needle and monitor labor for fetal descent.
Advise the parent or parents that hydrocephalus is a fatal malformati on.
Perform cesarean delivery.
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