Term
| T or F If, despite your best efforts, the mother has retained membranes, she is at high risk for postpartum hemorrhage. |
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Definition
| False. She is at some increased risk of postpartum endometritus, but not of hemorrhage (as would be the case with retained placental fragments). (V 910) |
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Term
| Give the correct dosage for providing methergine to a woman who has retained membranes. |
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Definition
| Methergine .2 mg q 4 hours for 6 doses. Some midwives follow this with .2 mg Metehergine t.i.d. for 3 days. Also, if you estimate that a large portion of membranes was retained, you can give an immediate dose of .2 mg Methergine IM. NOTE: Methergine is contraindicated if the woman is hypertensive. (V 910) |
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Term
| Name at least three signs of placental separation. |
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Definition
| 1. Sudden trickle or small gush of blood 2. lengthening of the cord visible at the vaginal introitus 3. change in shape of uterus from discoid to globular as uterus contracts on itself 4. change in position of uterus: it rises in the abdomen due to the bulk of the placenta in the lower uterine segment displacing the uterus upward. (V 906) |
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Term
| Schultz mechanism of placental expulsion is... |
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Definition
| fetal side presenting. (Shiny Schultz) (V 906) |
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Term
| Dunan mechanism of placental expulsion is... |
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Definition
| maternal side presenting. (Dirty Duncan) (V 906) |
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Term
| Describe active management of third stage. |
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Definition
| 1. IM pitocin given with delivery of anterior shoulder (no undiagnosed twin) 2. immediate cord clamping 3. controlled cord traction for delivery of placenta (V 907) |
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Term
| T or F Uterine inversion is troublesome but not an obstetric emergency. |
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Definition
| F It is an obstetric emergency. Avoid it by guarding the uterus, avoiding uterine massage before placenta is separated, not pulling on cord before separation, not pulling on the cord with an uncontracted uterus. (V 907) |
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Term
| T or F It is important to drain the placenta before delivering it. |
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Definition
| F There is no harm in this, but its rationale is of questionable value. Be sure to keep that blood separate so that you can accurately estimate blood loss. (V 907) |
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Term
| Define "guarding the uterus." |
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Definition
| Your hand is in a position to continually tell the shape, position, and consistency of the uterus, and it keeps others away from it. You simply hold your hand there to assess and protect. (V 908) |
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Term
| T or F If the uterus is massaged prior to placental separation, it will most likely separate completely, facilitating expulsion. |
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Definition
| F Actually the most likely result is partial separation of the placenta and hemorrhage. (V 908) |
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Term
| Describe the "modified Brandt Andrews maneuver" for checking for placental separation. |
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Definition
| Hold cord taut at introitus, using clamp for leverage. Bring tips of other hand close against each other and straight down into lower abdomen just above pubic bone and watch umbilical cord. If cord recedes into vagina, not separated. If it doesn't, it has and you may proceed with expulsion. (V 908) |
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Term
| Explain how to check for placental separation by following the cord. |
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Definition
| Hold cord tautly with one hand at introitus and with other hand follow cord into vagina until you can either feel where it inserts into placenta or continues through the cervix and beyond your reach. If you can feel the placenta, it's safe to assume it's separated. If not, wait. Note: This is invasive and risks infection so should not be standard. (V 908-9) |
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Term
| Describe how to facilitate placental expulsion with a mother reclined or semi reclined. |
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Definition
| When mother experiences contractions and other signs point to separation, use abdominal hand to ensure uterus is contracted and to brace it by using palmar surface just above pubis and pressing up slightly. Other hand exerts traction on the cord using the clamp while asking mom to push or cough. Follow curve of Carus. (V 909) |
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Term
| Explain method(s) of placental expulsion that do not require the midwife to facilitate. |
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Definition
| Squatting, sitting on toilet with bowl beneath. (V 909) |
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Term
| Describe the way of teasing out membranes that did not come out with the placenta using instrument(s). |
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Definition
| 1. Use large clamp (Kelly or ring forceps) to grasp membranes at introitus. Stabilize uterus with one hand and use other to manipulate the clamped membranes by rocking a little up and down and side to side exerting the slightest bit of traction. Stop if you feel a "tearing give." Periodically reclamp at introitus as needed, as you have more control there. (V 910) |
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Term
| Describe how to tease out membranes without using instruments. |
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Definition
| Hold placenta in your hands and turn it over and over to twist the membranes until delivered. More difficult for inexperienced hands because placenta is slippery. (V 910) |
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Term
| Retained placenta is defined as: |
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Definition
| a placenta that has not separated and creates no visible hemorrhage. (V 913) |
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Term
| The frequency of retained placenta is increased as gestational age is increased/decreased. |
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Definition
| decreased. Retained placenta is more likely in preterm delivery. Hemorrhage also increases in preterm delivery. (V 913) |
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Term
| Give four ideas for encouraging a placenta to detach and separate *in the absence of hemorrhage.* |
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Definition
| Put baby to breast, nipple stimulation, have woman squat, provide privacy for couple to have non-coital lovemaking, ensure empty bladder. (V 913) |
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Term
| Define third stage hemorrhage and give the main reason for it in normal birth. |
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Definition
| Bleeding due to partial separation of the placenta. Most commonly due to mismanagement of third stage. (V 914) |
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Term
| Steps in managing third-stage hemorrhage at home are.... |
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Definition
| 1. Have EMS and consulting physician called 2. Thoroughly massage uterus and use controlled cord traction. 3. Start IV with Ringer's Lactate. 4. Monitor for s/s of shock. 5. Manually remove the placenta (be sure bladder is empty first). NOTE: I would give 10 units 1 ml IM pitocin at the beginning of this. Also we don't do IV at home. |
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Term
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Definition
| an abnormal partial or total adherence of the placenta to the uterine wall. (V 914) |
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Term
| While placenta accreta, increta, and percreta are rare, they are associated with what three things? |
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Definition
| placenta previa, previous cesarean section, unexplained elevated MSAFP. (V 914) |
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Term
| T or F A complete placenta accreta is accompanied by acute, profuse hemorrhage. |
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Definition
| False. Because it is complete, there is no bleeding. A partial placenta accreta causes acute, profuse bleeding. (V 914-5) |
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Term
| A placenta accreta will most likely be resolved with ______ |
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Definition
| emergency hysterectomy. (V 915) |
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Term
| T or F Uterine inversion can be easily solved at home simply by un-inverting the uterus. |
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Definition
| False. This is a very dangerous situation, requiring EMS transport and treatment for shock and repositioning the uterus, done by a physician. It is a medical emergency. Very rare. (V 915-6) |
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