NM704 FINAL EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
What do we know about pain meds in second stage of labor?
They prolong 2nd stage labor
Increase the likelihood of operative vaginal deliveries
Studies are unclear whether they increase or do not increase the rate of csection
Which pain med is short acting and has very few side effects compared to
morphine?
Fentanyl
Do epidurals increase the length of 3rd stage labor?
no, false
Direted or coached pushing is known to decrease the length of 2nd stage labor
by up to an hour compared to spontaneous pushing
False. Coached oushing can decrease the amount of oxygen for the parent and the
child and make them acidotic
What is more likely to occur with prolonged second stage labor?
MAternal morbidity rises
neonatal outcomes are unclear
fever, fistulas, choreoamnionitis
,When does the fetal ejection reflex (ferguson reflex/urge to push) occur? What
precipitates it?
The stretch receptors on the pelvic floor are activated by downward progression of the
fetus and signals a positive feedback loop to continue to push the fetus out
The nerves send a message to the brain, the brain makes more oxytocin, oxytocin
makes contractions stronger which emphasizes increased pressure and stretch. this
occurs until fetus is expelled
what are the outcomes of water birth compared to traditional?
outcomes are similar across both types of births
What are the signs of placental separation?
1. fresh flow of blood from vagina
2. umbilical cord lengthens outside vagina
3. uterine fundus rises up
4. uterus goes from discoid and becomes firm and globular
How do we avoid 3rd stage complications?
do not pull on the cord
do not massage the fundus
What is expectant management of 3rd stage labor? (use SDM)
Expectant management of third stage in the context of a physiological labor and birth is
a more recent topic of research. There is a growing body of research whose findings
support expectant management of third stage labor when first and second stages of
labor have been spontaneous and without complication or intervention. This population
, of birthing people also has no prenatal or intrapartum risk factors for PPH. The AMTSL
research did not look at this population.
The current body of evidence has shown the following outcomes for expectant
management of third stage in birthing people at low risk of PPH who experience a
normal labor and birth, as defined above:
No increase in blood loss compared with AMTSL in a general population
No increased risk of PPH compared with AMTSL in a general population
When labor and birth are normal in a healthy and well person, expectant management
of third stage results in comparable bleeding outcomes as when AMTSL is implemented
with a general population of birthing people at mixed risk for excessive bleeding.
What is ACTIVE management of 3rd stage labor? (use SDM)
Three Components of AMTSL according to the ICM/FIGO Joint Statement (2004)
are:
Administration of a uterotonic medication within one minute of the birth of the baby, after
ruling out multiple gestation.
Oxytocin is the preferred medication.
Controlled cord traction to assist with placental expulsion.
Uterine massage immediately after placental expulsion, and then as needed
What are the medications used during uncomplicated 3rd and 4th stage of labor?
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
What do we know about pain meds in second stage of labor?
They prolong 2nd stage labor
Increase the likelihood of operative vaginal deliveries
Studies are unclear whether they increase or do not increase the rate of csection
Which pain med is short acting and has very few side effects compared to
morphine?
Fentanyl
Do epidurals increase the length of 3rd stage labor?
no, false
Direted or coached pushing is known to decrease the length of 2nd stage labor
by up to an hour compared to spontaneous pushing
False. Coached oushing can decrease the amount of oxygen for the parent and the
child and make them acidotic
What is more likely to occur with prolonged second stage labor?
MAternal morbidity rises
neonatal outcomes are unclear
fever, fistulas, choreoamnionitis
,When does the fetal ejection reflex (ferguson reflex/urge to push) occur? What
precipitates it?
The stretch receptors on the pelvic floor are activated by downward progression of the
fetus and signals a positive feedback loop to continue to push the fetus out
The nerves send a message to the brain, the brain makes more oxytocin, oxytocin
makes contractions stronger which emphasizes increased pressure and stretch. this
occurs until fetus is expelled
what are the outcomes of water birth compared to traditional?
outcomes are similar across both types of births
What are the signs of placental separation?
1. fresh flow of blood from vagina
2. umbilical cord lengthens outside vagina
3. uterine fundus rises up
4. uterus goes from discoid and becomes firm and globular
How do we avoid 3rd stage complications?
do not pull on the cord
do not massage the fundus
What is expectant management of 3rd stage labor? (use SDM)
Expectant management of third stage in the context of a physiological labor and birth is
a more recent topic of research. There is a growing body of research whose findings
support expectant management of third stage labor when first and second stages of
labor have been spontaneous and without complication or intervention. This population
, of birthing people also has no prenatal or intrapartum risk factors for PPH. The AMTSL
research did not look at this population.
The current body of evidence has shown the following outcomes for expectant
management of third stage in birthing people at low risk of PPH who experience a
normal labor and birth, as defined above:
No increase in blood loss compared with AMTSL in a general population
No increased risk of PPH compared with AMTSL in a general population
When labor and birth are normal in a healthy and well person, expectant management
of third stage results in comparable bleeding outcomes as when AMTSL is implemented
with a general population of birthing people at mixed risk for excessive bleeding.
What is ACTIVE management of 3rd stage labor? (use SDM)
Three Components of AMTSL according to the ICM/FIGO Joint Statement (2004)
are:
Administration of a uterotonic medication within one minute of the birth of the baby, after
ruling out multiple gestation.
Oxytocin is the preferred medication.
Controlled cord traction to assist with placental expulsion.
Uterine massage immediately after placental expulsion, and then as needed
What are the medications used during uncomplicated 3rd and 4th stage of labor?
