Normal Labor and Delivery

Question 1

What is the smallest anatomic position of the fetal head?

Answer 1

Well flexed (suboccipitobregmatic- 9.5cm)

Question 2

What is fetal lie?

Answer 2

Reference of maternal to fetal spine

Determines if infant is longitudinal, transverse, or oblique

Question 3

What does fetal presentation refer to? What are the different presentations?

Answer 3

Presenting part to the pelvis

Can be vertex, breech, transverse, or compound

Question 4

What is the first stage of labor and how long does it last in primiparae vs. multiparas?

Answer 4

Onset of labor to complete cervical dilation (Latent and active)
Primiparas: 6-18 hours
Multiparas: 2-10 hours

Question 5

What is the rate of cervical dilation in primiparae vs multiparae in the first stage of labor?

Answer 5

Primiparas: 1.2cm per hour
Multiparas: 1.5cm per hour

Question 6

What intervals of fetal monitoring should be done in an uncomplicated pregnancy in labor?

Answer 6

Monitor q30 mins in active phase of 1st stage

Monitor q15 mins in second stage of labor

Question 7

What intervals of fetal monitoring should be done in a complicated pregnancy during labor?

Answer 7

Monitor q15 mins in active phase (following contraction)

Monitor q5 mins during second stage of labor

Question 8

How long does the second stage of labor (descent through pelvis–> delivery) last in primiparas and multiparas with and without epidurals?

Answer 8

Primipara wi/out epidural= 2 hours
Primipara with epidural= 3 hours
Multipara wi/out epidural= 1 hour
Multipara with epidural= 2 hours

Question 9

In order, what are the cardinal movements of labor?

Answer 9

Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

Question 10

At what time is a retained placenta diagnosed?

Answer 10

If not delivered within 30 mins

Question 11

What are the classic signs of placental separation?

Answer 11

Gush of blood, lengthening of umbilical cord, funds of uterus rises up, change in shape of uterine funds from discoid–> globular

Question 12

What are the 2 cervical ripening drugs and when are they contraindicated?

Answer 12

Cervadil vaginal insert (Dinoprostone- can pull out if needed) and Cytotec (misoprostol)
Contraindicated in patients with previous C section

Question 13

What is uterine tachysystole?

Answer 13

> 5 contractions in a 10 minute period

Question 14

What is a favorable and unfavorable Bishop score for labor induction?

Answer 14

Score 8 is favorable