Normal Labor

Question 1

What is a normal fetal HR?

Answer 1

110-160 per minute

Question 2

What is fetal Bradycardia?

Answer 2

Baseline <110 bpm for 10 minutes

Question 3

What is fetal Tachycardia?

Answer 3

baseline >160 bpm for 10 minutes

Question 4

What are normal accelerations?

Answer 4

Increase in HR of 15 bpm or more above the HR baseline for longer than 15-20 seconds: if this happens 2x in 20 minutes it is reassuring or normal

Question 5

What are early decelerations?

Answer 5

Autonomic changes in fetal intracranial pressure and/or cerebral blood flow that cause temporary decrease in HR

Question 5

How would you describe Early Decelerations on tracing?

Answer 5

Decrease in HR that occurs with Contraction: a mirror image

Question 6

What causes early decelerations?

Answer 6

Head Compression

Question 7

How would you describe Variable Decelerations on tracing?

Answer 7

Decrease in HR and return to baseline with no relationship to contractions

Question 8

What are variable decelerations?

Answer 8

compression of the umbilical cord reduces venous return: baroreceptor-mediated reflex raises HR in response, Further compression occludes umbilical arteries abruptly raising peripheral resistance and BP causing HR to reflexively decrease

Question 9

What is the cause of Variable Decelerations?

Answer 9

Cord Compression

Question 10

What are the most serious and dangerous type of decelerations?

Answer 10

Late decelerations

Question 11

How would you describe late decelerations on tracing?

Answer 11

Decrease in HR after contraction started: no return to baseline until contraction ends

Question 12

What are late decelerations?

Answer 12

Uterine contraction causes transient hypoxemia: triggers a reflexive drop in fetal HR

Compression of maternal vessels: decreases placental perfusion; reducing oxygen diffusion to fetus; decreased fetal pO2 : causes chemoreceptor-mediated reflex drop in HR

Question 13

What causes late decelerations?

Answer 13

Fetal Hypoxia

Question 14

What are 3 physiological changes seen before labor?

Answer 14

Lightening
Braxton-Hicks Contractions
Bloody show

Question 15

what is Lightening?

Answer 15

Fetal descent into the pelvic brim

Question 16

What is the bloody show?

Answer 16

Blood-tinged mucus from vagina released with cervical effacement

Question 17

What is stage 1 of labor?

Answer 17

Onset of labor to full dilation of cervix

Question 18

What is stage 1 of labor broken into?

Answer 18

Latent and Active phase

Question 19

What is the Latent phase of Labor stage 1?

Answer 19

From onset of labor to 6cm dilation

Question 20

What is the Active phase of labor stage 1?

Answer 20

From 6cm dilation to full dilation

Question 21

What is stage 2 of labor?

Answer 21

From full dilation of cervix to delivery of neonate

Question 22

What is stage 3 of labor?

Answer 22

Delivery of neonate to delivery of placenta

Question 23

What do you monitor during stage 1 of labor?

Answer 23

Maternal BP and Pulse
Electronic fetal Monitoring: Fetal HR and uterine contractions
Examine cervix to monitor for progression of labor
-cervical dilation
-cervical effacement
-fetal station

Question 24

What is fetal station?

Answer 24

number of CM of the bony edge of the presenting part above or below the level of the ischial spines

Question 25

How is fetal station conventionally measured?

Answer 25

-3 through +3: divided the upper and lower parts of the pelvis into thirds

Question 26

What determines the progression of stage 2 of labor?

Answer 26

Rate of fetal head descent

Question 27

What are signs of placental separation in stage 3 of labor?

Answer 27

Fresh bleeding from vagina Umbilical cord lengthening Uterine fundus lowering Uterus becoming firm

Question 28

What does it mean to Induce labor?

Answer 28

Start labor via medical means

Question 29

What are the 3 most common methods of inducing labor?

Answer 29

Prostaglandin E2 Oxytocin Amniotomy

Question 30

What is the role of Prostaglandin E2 in labor induction?

Answer 30

Ripening the cervix

Question 31

What is the role of Oxytocin in labor induction?

Answer 31

Exaggerates uterine contractions

Question 32

What is the role of Amniotomy in labor induction?

Answer 32

Puncture the amniotic sac via amnio hook

Question 33

What do you need to palpate for prior to performing amniotomy to induce labor?

Answer 33

Prolapsed umbilical cord before puncturing the amniotic sac