NM704 EXAM 1 ACTUAL QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Malpractice law suits are often a result of
anger at and dissatisfaction with a perceived lack of openness and honesty on the part
of the practitioner after an adverse outcome.
'97 review of closed claims found these three issues among claims against
midwives in Britain
1) failure to identify a shift from normal to
abnormal labor
2) failure to advocate for the woman when the midwife had concerns about medical
management
3) "shortcomings" in the interpretation of
electronic fetal monitor tracings
Seven major categories of liability risk, in order (by closed claim analysis)
1) FHR monitoring interpretation (38.3%)
* (also noted here was fetal scalp stim not done or if it was, not documented)
*DOCUMENT & Use chain of command
2) shoulder dystocia (27.6%)
3) resuscitation efforts (staffing)
,4) diagnostic errors
* (Pre-E, HELLP, abruption, breast ca)
5) VBAC
* (pit no OB on unit, provider-provider communication)
6) testing measures
* (lack of follow up)
7) laceration repair and healing
* (helpful to the midwives were meticulous documentation)
Factors that improved midwife outcomes in shoulder dystocia cases
1) having the
consultant in the room
or close by when or if shoulder dystocia was anticipated
2) discussing shoulder dystocia or having a
"big baby" talk
with a woman during pregnancy, including explanation of potential complications during
shoulder dystocia
3) implementing
all maneuvers
to free the anterior
shoulder
,4) documenting
each step thoroughly.
How does fetus adapt to low o2 environement
More hgb
Higher affinity for o2
over perfusion of certain organs/area of brain
relative to adult - more caps, increased CO, increased HR
Intrapartum asphyxia
Anaerobic metabolism not sustained - - - Asphyxia occurs when gas exchange is
impaired long enough to cause significant met. acidosis ---- as it progresses, fetus loses
ability to protect vital organs --- CO drops --- BP and cardiac/brain perfusion decreased
--- CNS damage a result of duration and severity ---- eventually progressive cell, tissue,
organ and fetal death.
intrapartum pathway to fetal metabolic acidosis
UCs decrease o2, increase Co2. If repetitive or sustained - hypoxia and hypoxemia. If
this persists - anaerobic metabolism, build up of lactic acidosis and = metabolic acidosis
Fetal adaptive mechanisms to compensate for hypoxia in labr
1) Decrease HR
2) Decrease o2 consumption by reducing gross body movement
3) Blood to essential organs only
4) Anaerobic metabolism
Neonatal Encephalopathy defined as
, disturbed neurologic function seen in first 72 hours of life of a term or near term baby.
Manifested by -
respiratory problems, irregular, apnea
decreased tone
decreased or absent moro reflexes
decreased LOC
seizures.
decreased spontaneous movement
abnormal cry and suck,
altered papillary responses
stupor
Cerebral Palsy
chronic, nonprogressive disorders appearing early in life, in which the defining
symptoms are
- abnormal control of movement and posture.
Cerebral Palsy results from
abnormal development of or
damage to the regions of the brain that control
posture and movement.
Incidence of cerebral palsy in US
1.0 - 2.3 per 1,000; major causes are prematurity and antepartum infection.
"Asphyxia as an initiating pathology [for cerebral
palsy], usually involving the whole organism, must be
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Malpractice law suits are often a result of
anger at and dissatisfaction with a perceived lack of openness and honesty on the part
of the practitioner after an adverse outcome.
'97 review of closed claims found these three issues among claims against
midwives in Britain
1) failure to identify a shift from normal to
abnormal labor
2) failure to advocate for the woman when the midwife had concerns about medical
management
3) "shortcomings" in the interpretation of
electronic fetal monitor tracings
Seven major categories of liability risk, in order (by closed claim analysis)
1) FHR monitoring interpretation (38.3%)
* (also noted here was fetal scalp stim not done or if it was, not documented)
*DOCUMENT & Use chain of command
2) shoulder dystocia (27.6%)
3) resuscitation efforts (staffing)
,4) diagnostic errors
* (Pre-E, HELLP, abruption, breast ca)
5) VBAC
* (pit no OB on unit, provider-provider communication)
6) testing measures
* (lack of follow up)
7) laceration repair and healing
* (helpful to the midwives were meticulous documentation)
Factors that improved midwife outcomes in shoulder dystocia cases
1) having the
consultant in the room
or close by when or if shoulder dystocia was anticipated
2) discussing shoulder dystocia or having a
"big baby" talk
with a woman during pregnancy, including explanation of potential complications during
shoulder dystocia
3) implementing
all maneuvers
to free the anterior
shoulder
,4) documenting
each step thoroughly.
How does fetus adapt to low o2 environement
More hgb
Higher affinity for o2
over perfusion of certain organs/area of brain
relative to adult - more caps, increased CO, increased HR
Intrapartum asphyxia
Anaerobic metabolism not sustained - - - Asphyxia occurs when gas exchange is
impaired long enough to cause significant met. acidosis ---- as it progresses, fetus loses
ability to protect vital organs --- CO drops --- BP and cardiac/brain perfusion decreased
--- CNS damage a result of duration and severity ---- eventually progressive cell, tissue,
organ and fetal death.
intrapartum pathway to fetal metabolic acidosis
UCs decrease o2, increase Co2. If repetitive or sustained - hypoxia and hypoxemia. If
this persists - anaerobic metabolism, build up of lactic acidosis and = metabolic acidosis
Fetal adaptive mechanisms to compensate for hypoxia in labr
1) Decrease HR
2) Decrease o2 consumption by reducing gross body movement
3) Blood to essential organs only
4) Anaerobic metabolism
Neonatal Encephalopathy defined as
, disturbed neurologic function seen in first 72 hours of life of a term or near term baby.
Manifested by -
respiratory problems, irregular, apnea
decreased tone
decreased or absent moro reflexes
decreased LOC
seizures.
decreased spontaneous movement
abnormal cry and suck,
altered papillary responses
stupor
Cerebral Palsy
chronic, nonprogressive disorders appearing early in life, in which the defining
symptoms are
- abnormal control of movement and posture.
Cerebral Palsy results from
abnormal development of or
damage to the regions of the brain that control
posture and movement.
Incidence of cerebral palsy in US
1.0 - 2.3 per 1,000; major causes are prematurity and antepartum infection.
"Asphyxia as an initiating pathology [for cerebral
palsy], usually involving the whole organism, must be
