CRAFTON HILLS COLLEGE RESP 139 Quiz Mike All shiz he gave us
CRAFTON HILLS COLLEGE RESP 139 Quiz 1 (Mike) All the shiz he gave us
What is Parturition?
Parturition is the process of giving birth and consists of
Rupture of the membranes
Dilation of the cervix
Contraction of the uterus
Separation of the placenta
Shrinking of the uterus
How many stages of labor are there?
4, but 3 main that we worry about, and labor is actually one continuous event
What is stage 1 of labor and delivery?
Onset of regular contractions to complete dilatation of the cervix.
How long will stage 1 usually last?
What factors influence the duration of ALL stages?
Multigravida vs. Primigravida
What is stage 2 of labor and delivery?
Full dilatation and effacement of the cervix to delivery of the fetus
Dilatation is the widening of the cervical opening. A 10 cm diameter cervical opening is considered fully dilated.
Effacement is the stretching and thinning of the cervix. 100% effacement is when the cervix is not distinguishable from the uterus
How long does stage 2 of labor and delivery last?
20 min to 1-2 hours
What is stage 3 of labor and delivery?
Delivery of the fetus to delivery of the placenta
The fetus is in the head down position is the most common presentation. (Vertex position)
There is also a fourth stage (not considered a major stage) where the uterus begins to shrink back to normal
How long does stage 3 of labor and delivery last?
Lasts 3-4 minutes up to 45 minutes
What is the most common process and presentation of the fetus?
As the fetus begins down the birth canal, the head turns to a face down position for passage through the pelvis.
Upon delivery of the head, the fetus rotates internally to ease passage of the shoulders through the pelvis.
The upper shoulder delivers first, followed by the lower shoulder.
After delivery of the shoulders, the rest of the body exits rather quickly.
The umbilical cord is clamped and the baby begins life outside the uterus
What is Tocolysis?
the process of stopping labor (drug induced)
What are the different types of Pharmacologic Tocolysis?
Beta adrenergics (terbutaline sulfate or ritodrine).
- Relaxation of smooth muscle in the uterus
Magnesium sulfate to decrease muscle contractility
Indomethacin to inhibit prostoglandin synthesis.
- Softens the cervix making it more susceptible to contraction
Calcium channel blockers like nifedipine.
- The uterus is a large muscle made up of thousands of muscle cells. When calcium enters these cells, the muscle contracts and tightens. When calcium flows back out of the cell, the muscle relaxes. Calcium channel blockers work by preventing calcium from moving into the muscle cells of the uterus, making it less able to contract.
What are the different types of Non-Pharmacologic Tocolysis?
Comprehensive accessible family planning.
Risk assessment and counseling before conception.
Risk assessment for prenatal patients.
Patient education to identify signs of premature labor and when to seek help.
What is Dystocia?
prolonged and difficult labor
What are common causes of Dystocia?
Dysfunction of the uterus.
Abnormality in size or shape of birth canal.
Excessive fetal size.
What is the Breech presentation?
The most common of all abnormal presentations (3-5% of all births).
- Complete breech. Feet , legs, and buttocks present together.
- Incomplete or footling breech. One or both feet descend into the birth canal first.
- Frank breech. The legs are flexed against the body with the feet near the face with the buttocks being the presenting part.
What is Face Presentation?
Abnormal fetal presentation: The head enters the birth canal so the sutures cannot override each other and the head must pass at its full size
What is Transverse lie?
Abnormal fetal presentation: The fetus is positioned perpendicular to the birth canal with the back or back shoulders being presented
What is Prolapse of umbilical cord?
Abnormal fetal presentation: Prolapse is when the umbilical cord passes through the birth canal ahead of a body part crimping the cord
What is Occult compression?
Abnormal fetal presentation: When the cord is compressed between the fetus and the wall of the birth canal
What is Nuchal cord
Abnormal fetal presentation: Where the umbilical cord wraps around the fetus's neck
What is placenta previa?
fetus implantation blocking cervix
What is low implantation placenta previa?
Placenta implants low near cervix instead of fundus
What is partial placenta previa?
Placenta partially blocks cervix
What is total placenta previa?
Placenta completely blocks cervix
What is Abruptio Placentae?
Premature separation from the uterine wall.
May be partial or complete separation
There is always hemorrhage associated with abruptio placentae
- Vaginal bleeding may or may not be visible.
- External hemorrhage. Visible bleeding.
- Concealed hemorrhage. No visible bleeding
What are Indications for cesarean deliveries?
Prior cesarean delivery.
Fetal (or maternal) distress.
Why are multiple gestations high risk pregnancies?
Higher incidence of premature labor and delivery
Increased risk of congenital defects
Higher incidence of bacterial infections
Intra-uterine growth retardation (IUGR)
What 3 factors come into play at birth for transition to respiration?
- Increased PaCO2, decreased PaO2, and decreased pH.
- Stimulate the respiratory chemoreceptors, which stimulates gasping breathing
- The thorax is compressed when passing the birth canal and on exiting the chest recoils outward drawing air into the chest
- As the fetus exits it leaves a warm dark environment into one that is bright, loud, and cold.
- This, in turn, stimulates a cry reflex
How much cmH2O can be required to iniciate our first breath?
The presence of __________ overcomes the surface tension forces, once the newborn begins normal breathing.
What is the importance of FRC?
re-inflation of the lungs easier with each passing breath
What closes ductus venosus and ductus arteriosus?
first breath to increase PO2, which then decreases prostoglandin synthesis
What factors cause the change from fetal to adult circulation?
Alteration of circulatory pressures.
Closure of fetal shunts.
Clamping of the umbilical cord
What percent of new borns require some assistance, and what percent require major resuscitation to survive?
What is a normal transition from intrauterine life to extrauterine life?
Alveolar fluid is absorbed into lung tissue and replaced by air.
Umbilical arteries and veins are clamped, removing the low resistance placental circuit and increasing systemic blood pressure.
Blood vessels in lung tissue dilate, increasing pulmonary blood flow.
What can go wrong with transition from intrauterine life to extrauterine life?
Lack of ventilation of the newborn�s lungs results in sustained constriction of the pulmonary arterioles, preventing systemic arterial blood from being oxygenated
Prolonged lack of adequate perfusion and oxygenation to the baby�s organs can lead to brain damage, damage to other organs, or death
What are signs of a compromised newborn?
Poor muscle tone
Depressed respiratory drive
Low blood pressure
Why and how does prematurity affect the need for resuscitation?
Possible surfactant deficiency
Decreased drive to breathe
Rapid heat loss, poor temperature control
Susceptible to brain hemorrhage
Susceptible to hypovolemia secondary to blood loss
Weak muscles make spontaneous breathing difficult
Immature tissues may be damaged by excessive oxygen
Define and describe primary vs. secondary apnea and how to treat each.
Primary Apnea: When a fetus/newborn FIRST becomes deprived of oxygen (Asphyxia), an initial period of attempted rapid breathing is followed by primary apnea and dropping heart rate that will improve with tactile stimulation
Secondary Apnea: If oxygen deprivation (Asphyxia) continues, secondary apnea occurs, accompanied by a continued fall in heart rate and blood pressure
Secondary apnea cannot be reversed with stimulation; assisted ventilation must be provided
What does effective positive-pressure ventilation during secondary apnea usually result it?
Rapid improvement of heart rate
What are resuscitation risk factors? (most of the time which can be anticipated by identifying the presence of risk factors associated with the need for neonatal resuscitation)
- Obstetric history
- Maternal history
- Current obstetric status
NRP divides resuscitation risk factors into what and what? (be familiarized, don't need to memorize)
What are the equipment necessary for resuscitation?