Normal Labor

Question 1

What happens in the latent phase of labor (1st phase)

Answer 1

Initial part of labor in which cervix mainly effaces rather than dilates
* Cervical dilation usually less than 4 cm

Question 2

When is the active stage of labor deemed to have begun?

Answer 2

when cervical dilation has reached 4-5 cm and cervix is almost fully effaced

Question 3

what is normal time frame of latent labor in nulliparous woman? multiparous?

Answer 3

1. nulli: ~18-20 hrs

2. multip: under 14 hours

Question 4

Timeframe of active labor for nullip and multi?

Answer 4

1. nullip: 1.2cm/hr

2. multip: 1.5 cm/hr

Question 5

What is second stage of labor?

Answer 5

From complete cervical dilation to expulsion of infant

Question 6

Normal timeframe for 2nd stage in nulliparous?

Answer 6

2 hours or less

* 3 hours or less if has epidural

Question 7

Noral timeframe for 2nd stage in a multiparous woman?

Answer 7

1 hour or less

*2 hours or less if epidural

Question 8

What is the third stage of labor?

Answer 8

delivery of placenta

Question 9

timeframe for normal 3rd stage in all women?

Answer 9

30 minutes or less

Question 10

definition of protraction of active phase?

Answer 10

cervical dilation that is less than the 1.2 or 1.5 cm of cervical dilation

Question 11

first stage of labor

Answer 11

onset t complete dilation of cervix; divided into latent and active stages

Question 12

arrest of active labor def

Answer 12

no progress in active stage of labor for 2 hours

Question 13

what defines adequate uterine contractions

Answer 13

contractions every 2-3 minutes, firm on palpation, and lasting for at least 40-60 seconds

*some examine for 10 minutes and add up each contractions rise above baseline–> over 200 Montevideo units is termed an adequate uterine contraction pattern

Question 14

What findings on fetal heart tracing are normal and reassuring

Answer 14

normal heart rate (110-160) with accelerations and variability

Question 15

Which type of decelerations are benign? what causes them?

Answer 15

Early decelerations, caused by cord compression

• these are mirror images of the uterine contractions

Question 16

What are the most common decelerations seen? What causes them?

Answer 16

Variable decelerations–> caused by cord compression

• have an abrupt decline and abrupt resolution = shaped like a “V”

Question 17

How are late decelerations defined?

Answer 17

Onset is after the onset of a contraction and the nadir comes after the the contraction peak and return to baseline is after contraction resolution

Question 18

What do late decelerations indicate?

Answer 18

Generally indicate fetal hypoxia

Question 19

What two findings would make one worried about fetal academy?

Answer 19

recurrent late decelerations (with over 50% of ctx) along with decreased variability

Question 20

What 3 scenarios would make a tracing a category 3?

Answer 20

1. Absent baseline variability with recurrent late or variable decelerations
2. Absent baseline variability with bradycardia
3. Sinusoidal heart rate pattern (needs emergent delivery)