NM704 (6) EXAM QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED GRADED A++
Friedman recommended considering intervention when a labor arrest is
diagnosed, which he defined as
two hours with no progress in active labor.
One suggested criterion for normal progress is about _____ centimeters per hour.
0.5
if the results of a vag exam will not change your management plan the
exam should not be done
ACOG states that labor epidurals affect labor by
Cochrane finds that labor epidurals affect labor by
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
"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?
,"...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
"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
longer second stages, oxytocin augmentation and operative vaginal birth
Types of labor support
1. Emotional (presence, reassurance, encouragement)
2. Tangible assistance
3. Knowledge support
benefits of continuous labor support
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):
• 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
Critics cite the risk of neonatal water inhalation and maternal/neonatal infection.
Evidence suggests that water immersion during the first stage of labour reduces
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
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
reduce the uptake of pharmacological pain relief and likelihood of perineal trauma
and increase birth experience satisfaction
, When the mother is not fearful,
oxytocin is released to stimulate effective contractions
laboring in water is linked with reduced
catecholemines which inhibit oxytocin and labor progress
Concerns raised in a survey and case reports about birth in water for the baby
include
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
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
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.
SOLUTIONS VERIFIED GRADED A++
Friedman recommended considering intervention when a labor arrest is
diagnosed, which he defined as
two hours with no progress in active labor.
One suggested criterion for normal progress is about _____ centimeters per hour.
0.5
if the results of a vag exam will not change your management plan the
exam should not be done
ACOG states that labor epidurals affect labor by
Cochrane finds that labor epidurals affect labor by
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
"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?
,"...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
"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
longer second stages, oxytocin augmentation and operative vaginal birth
Types of labor support
1. Emotional (presence, reassurance, encouragement)
2. Tangible assistance
3. Knowledge support
benefits of continuous labor support
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):
• 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
Critics cite the risk of neonatal water inhalation and maternal/neonatal infection.
Evidence suggests that water immersion during the first stage of labour reduces
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
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
reduce the uptake of pharmacological pain relief and likelihood of perineal trauma
and increase birth experience satisfaction
, When the mother is not fearful,
oxytocin is released to stimulate effective contractions
laboring in water is linked with reduced
catecholemines which inhibit oxytocin and labor progress
Concerns raised in a survey and case reports about birth in water for the baby
include
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
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
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.
