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NM 704 Exam 2 Questions With Complete
Solutions
Malpractice law suits are often a result of -
.....ANSWER... ✔✔ 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 - .....ANSWER...
✔✔ 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) - .....ANSWER... ✔✔ 1) FHR
monitoring interpretation (38.3%)
* (also noted here was fetal scalp stim not done or if it
was, not documented)
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*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 - .....ANSWER... ✔✔ 1) having the
consultant in the room
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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 -
.....ANSWER... ✔✔ 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 - .....ANSWER... ✔✔ 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
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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 -
.....ANSWER... ✔✔ 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 - .....ANSWER... ✔✔ 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 - .....ANSWER...
✔✔ 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
NM 704 Exam 2 Questions With Complete
Solutions
Malpractice law suits are often a result of -
.....ANSWER... ✔✔ 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 - .....ANSWER...
✔✔ 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) - .....ANSWER... ✔✔ 1) FHR
monitoring interpretation (38.3%)
* (also noted here was fetal scalp stim not done or if it
was, not documented)
,2|Page
*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 - .....ANSWER... ✔✔ 1) having the
consultant in the room
,3|Page
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 -
.....ANSWER... ✔✔ 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 - .....ANSWER... ✔✔ 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
, 4|Page
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 -
.....ANSWER... ✔✔ 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 - .....ANSWER... ✔✔ 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 - .....ANSWER...
✔✔ 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
