Midwifery test 1
Apgar - Heart rate, resps, colour, tone, response - answer Heart rate: <60 (0) <100
(1) >100 (2)
Resps: none (0) support (1) steady (2)
Colour: blue (0) blue extremit(1) pink (2)
Tone: floppy (0) sluggish (1) gd mvt (2)
Response: none (0) slow(1) alert(2)
Neonatal Norms: - answer Heart Rate: 100 - 160bpm;
Temp: 36.6 - 37.2 C
Resps: 40 - 60 per/min
Blood sugar: 2.5-5.5 mmol/L
02 sat: <1250g 88-90%, >1250g 90-94%
>2000g >94%
Blood pH: 7.26; PCo2: 49-52; Po2: 17
Neonatal Scalp Lactate during labour - answer pH lactate action
>7.25 <4.2 observe, ctg
7.2-7.25 4.2-4.8 recheck in 30 mins
<7.2 >4.8 deliver asap
take cord blood gases after birth
Challenges for the Full Term Neonate - answer air, circulation,temp maintained,
feeding, maintaining blood sugars, colonising skin, colonising gut, bonding.
Neonatal energy triangle - answer warm, pink and sweet -
avoid -hypothermia, hypoxia & hypoglycaemia,
Placental assessment - answer Cord insertion: central, battledore, succenturate,
Velamous, circumvilliate, bi-partite, lobes and membranes complete, 3 vessel cord -
AVA
Resp Distress Syndrome -
Try Really Hard Now, Good Child - answer Tachapnea, Retracted chest, Hyper
inflation, Nasal flaring, Grunt on expulsion, Central cynosis (heart defect).
Risk factors: hypoxia, hylenated memb disease, cardaic, hypothermia, aspiration,
sepsis
Neonatal RESUS - answer Airways: open - establish and maintain
Breathing: apnea or HR<100bpm - cpap/neopuff
5 rescue, then breathing rate 30 secs
Circulation: HR<60bpm - cpap & chest comp 1:3
, Drugs -naloxone(pethadine)0.1mg/kg(0.2ml/kg IM); Adrenaline sublingual 1mg/10ml
(1ml/kg)
Usually airways+ breathing stabilises
Iatrogenic birth injuries - answer physical injury from being born:
Macrosomic, prem, CPD, malpresent, dystocia, prolonged labour
looks like: caput, cephalhaemotomia, bruising, paralysis, fractures, brachial nerve palsy
Post natal maternal checks - BUBBLE + - answer breasts, Uterus, Bowel, Bladder,
Lochia, Episo(perineum), + contraception, wellbeing, support,
Postnatal baby check - - answer Fontanelles, head circumference, eyes, mouth,
skin, cord, output, responsiveness, feeding, sleeping. Hips, RER 1 week
Metabolic testing NZ:
7 fat aunties and 28 hairy cyber freaks gave blood - answer 7 - major groups of
metabolic disorders
Fatty acid (lipid) enzymes missing
Amino acid (protein) - PKU, Maple syrup,
Adrenal hyperplasia- enzyme missing
28 tests.....to date
Hyperthyroidism - missing /defective thyroid Cystic Fibrosis - gene >protein=>mucus
Glactosemia - enzyme lactose
Bionase deficiency - b vitamin
Immunisations NZ - answer 6 wks, 3mths, 5 mths, (15mths, 4 yrs....).
2 injects. PCV7 - pneumococcal
DTaP-IPV-HepB/Hib -diphtheria,tetanus,
pertussis, inact polio,hep b,haemophilus
influenze type b.
(Hib, MMR, PCV7; Dtap-IPV, MMR)
Palpation Findings - answer Fundus, Lie, Attitude,Presentation, Position,
Engagement, Denominator
Placenta Functions - answer Growth, gas exchange, nutrition, waste
removal,hormones, protection, support
Placental exchanges - answer tetragens, drugs, environmental influences,
hormones, micro-organisms, antibodies,
HIV, CMV, Syphilis, listeria, toxoplasmosis, rubella, varicella
Antenatal Screening - answer antenatal bloods; Hb, Antibodies, Hep B, Rubella,
Syphillis, HIV, along with Fe and often MSU and vag swab.
Apgar - Heart rate, resps, colour, tone, response - answer Heart rate: <60 (0) <100
(1) >100 (2)
Resps: none (0) support (1) steady (2)
Colour: blue (0) blue extremit(1) pink (2)
Tone: floppy (0) sluggish (1) gd mvt (2)
Response: none (0) slow(1) alert(2)
Neonatal Norms: - answer Heart Rate: 100 - 160bpm;
Temp: 36.6 - 37.2 C
Resps: 40 - 60 per/min
Blood sugar: 2.5-5.5 mmol/L
02 sat: <1250g 88-90%, >1250g 90-94%
>2000g >94%
Blood pH: 7.26; PCo2: 49-52; Po2: 17
Neonatal Scalp Lactate during labour - answer pH lactate action
>7.25 <4.2 observe, ctg
7.2-7.25 4.2-4.8 recheck in 30 mins
<7.2 >4.8 deliver asap
take cord blood gases after birth
Challenges for the Full Term Neonate - answer air, circulation,temp maintained,
feeding, maintaining blood sugars, colonising skin, colonising gut, bonding.
Neonatal energy triangle - answer warm, pink and sweet -
avoid -hypothermia, hypoxia & hypoglycaemia,
Placental assessment - answer Cord insertion: central, battledore, succenturate,
Velamous, circumvilliate, bi-partite, lobes and membranes complete, 3 vessel cord -
AVA
Resp Distress Syndrome -
Try Really Hard Now, Good Child - answer Tachapnea, Retracted chest, Hyper
inflation, Nasal flaring, Grunt on expulsion, Central cynosis (heart defect).
Risk factors: hypoxia, hylenated memb disease, cardaic, hypothermia, aspiration,
sepsis
Neonatal RESUS - answer Airways: open - establish and maintain
Breathing: apnea or HR<100bpm - cpap/neopuff
5 rescue, then breathing rate 30 secs
Circulation: HR<60bpm - cpap & chest comp 1:3
, Drugs -naloxone(pethadine)0.1mg/kg(0.2ml/kg IM); Adrenaline sublingual 1mg/10ml
(1ml/kg)
Usually airways+ breathing stabilises
Iatrogenic birth injuries - answer physical injury from being born:
Macrosomic, prem, CPD, malpresent, dystocia, prolonged labour
looks like: caput, cephalhaemotomia, bruising, paralysis, fractures, brachial nerve palsy
Post natal maternal checks - BUBBLE + - answer breasts, Uterus, Bowel, Bladder,
Lochia, Episo(perineum), + contraception, wellbeing, support,
Postnatal baby check - - answer Fontanelles, head circumference, eyes, mouth,
skin, cord, output, responsiveness, feeding, sleeping. Hips, RER 1 week
Metabolic testing NZ:
7 fat aunties and 28 hairy cyber freaks gave blood - answer 7 - major groups of
metabolic disorders
Fatty acid (lipid) enzymes missing
Amino acid (protein) - PKU, Maple syrup,
Adrenal hyperplasia- enzyme missing
28 tests.....to date
Hyperthyroidism - missing /defective thyroid Cystic Fibrosis - gene >protein=>mucus
Glactosemia - enzyme lactose
Bionase deficiency - b vitamin
Immunisations NZ - answer 6 wks, 3mths, 5 mths, (15mths, 4 yrs....).
2 injects. PCV7 - pneumococcal
DTaP-IPV-HepB/Hib -diphtheria,tetanus,
pertussis, inact polio,hep b,haemophilus
influenze type b.
(Hib, MMR, PCV7; Dtap-IPV, MMR)
Palpation Findings - answer Fundus, Lie, Attitude,Presentation, Position,
Engagement, Denominator
Placenta Functions - answer Growth, gas exchange, nutrition, waste
removal,hormones, protection, support
Placental exchanges - answer tetragens, drugs, environmental influences,
hormones, micro-organisms, antibodies,
HIV, CMV, Syphilis, listeria, toxoplasmosis, rubella, varicella
Antenatal Screening - answer antenatal bloods; Hb, Antibodies, Hep B, Rubella,
Syphillis, HIV, along with Fe and often MSU and vag swab.
