NORMAL LABOR

Question 1

Criteria for Diagnosis

Answer 1

1. Uterine contractions (1 in 10 mins; 4 in 20 mins) by direct observation or by electronic fetal monitor
   - at least 200 Montevideo units (MVU)
2. Documented progressive changes in cervical dilatation and effacement
3. Cervical EFFACEMENT > 70-80%
4. Cervical DILATATION > 3 cm

Question 2

Bishop Score

Answer 2

used to predict labor induction

<5 - unfavorable
>9 - successful induction

Question 3

Latent Phase

Answer 3

Onset of labor to about 3-5 cm dilatation

Question 4

Factors that affect Latent Phase duration

Answer 4

excessive sedation or epidural anesthesia
unfavorable cervical condition
false labor

Question 5

Active Phase

Answer 5

From 3-5 cm dilatation up to full dilatation

Question 6

Factors that affect Active Phase duration

Answer 6

Epidural anesthesia - prolonged labor curve to 1 hr
Maternal obesity - prolonged to 30-60 minutes
Maternal fear - prolonged to 45 minutes

Question 7

Cardinal Movements

Answer 7

Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation (Restitution)
Expulsion

Question 8

Engagement

Answer 8

BPD passes through the pelvic inlet

Question 9

Descent

Answer 9

First requisite for birth of the newborn

Question 10

Four forces of Descent

Answer 10

pressure of the amniotic fluid
direct pressure of the fundus upon the breech with contraction
bearing down efforts of maternal abdominal muscles
extension and straightening of the fetal body

Question 11

Flexion

Answer 11

descending head meets resistance (cervix, pelvic walls and pelvic floor)

Question 12

Internal Rotation

Answer 12

occiput movers toward the symphysis pubis

Question 13

Extension

Answer 13

2 forces

1. uterus exertion – acts more posteriorly
2. resistant pelvic floor and symphysis - acts more anteriorly

Question 14

External Rotation

Answer 14

rotation of the fetal body

bring bisacromial diameter into relation with the anteroposterior diameter of the pelvic outlet

Question 15

Expulsion

Answer 15

anterior shoulder appears under the symphysis pubis

after delivery of the shoulders the rest of the body quickly passes

Question 16

Goals of 3rd Stage Labor

Answer 16

delivery of an intact placenta
avoidance of uterine inversion
avoidance of post-partum hemorrhage

Question 17

Signs of Placental Separation

Answer 17

1. globular and firmer fundus (Calkin’s sign)
2. sudden gush of blood
3. lengthening of umbilical cord
4. rise of uterus into the abdomen

Question 18

EINC

Answer 18

1. Immediate and thorough drying
2. Early skin-to-skin contact
3. Properly timed cord clamping
4. Non-separation for early breastfeeding (for 6 hrs)
   - eye care
   - immunization
   - rooming in

Question 19

Indications for Episiotomy

Answer 19

1. Expedite delivery in the 2nd stage of labor
2. When spontaneous delivery is likely
3. Maternal or fetal distress
4. Breech position
5. Assisted forces
6. Large baby
7. Maternal exhaustion

Question 20

Perineal Lacerations

Answer 20

1st -4th degree

Question 21

1st Degree of Perineal Laceration

Answer 21

Fourchette, perineal skin and vaginal mucous membrane but NOT the underlying fascia and muscle

Question 22

2nd Degree of Perineal Laceration

Answer 22

Skin and mucous membrane + fascia and muscles of the perineal body

Question 23

3rd Degree of Perineal Laceration

Answer 23

Lacerations extend through skin, mucous membrane, perineal body and anal sphincter

Question 24

4th Degree of Perineal Laceration

Answer 24

Extension of laceration through the rectal mucosa to expose lumen of the rectum

Question 25

Functional Divisions of Labor

Answer 25

Preparatory Dilatational Pelvic Division

Question 26

Preparatory Division

Answer 26

similar to phase 1 latent phase + acceleration phase little dilatation of the cervix sedation and analgesia - capable of arresting this labor division

Question 27

Dilatational Division

Answer 27

active phase rapid dilatational rate of cervix (maximum dilatation =maximum slope) UNAFFECTED by anesthesia and sedation

Question 28

2 Phases of Dilatational Division

Answer 28

Latent Phase | Active Phase

Question 29

Latent Phase

Answer 29

corresponds to the PREPARATORY division

Question 30

Active Phase

Answer 30

corresponds to the DILATATIONAL division

Question 31

Division of Active Phase

Answer 31

Acceleration Phase Phase of Maximum Slope Deceleration Phase

Question 32

Prolonged Latent Phase

Answer 32

nulliparas - 20 hrs | multiparas - 14 hrs

Question 33

Threshold for active labor

Answer 33

uterine contractions and cervical dilatation of 3-5 cm or more

Question 34

Protraction

Answer 34

slow rate of cervical dilatation or descent - nulliparas - < 1.2 cm dilatation/hr - multiparas < 1.5 cm dilatation/hr or 2 descent per hour

Question 35

Pelvic Division

Answer 35

active phase deceleration + 2nd stage of labor cardinal movements of fetus occurs

Question 36

Acceleration

Answer 36

4-5 cm | predictive of outcome labor

Question 37

Maximum Slope

Answer 37

7-9 cm | descent of nullipara occurs here

Question 38

Deceleration

Answer 38

8-9 cm | heralds entry into the pelvic division of labor

Question 39

Arrest of Dilatation

Answer 39

2 h without cervical change

Question 40

Arrest of Descent

Answer 40

1 h without fetal descent

Question 41

Injury to only the vaginal epithelium or perineal skin

Answer 41

1st degree perineal laceration

Question 42

injury to perineum that spares the anal sphincter complex but involves the perineal muscles - bulbospongiosus and superficial transverse perineal muscles

Answer 42

2nd degree perineal laceration

Question 43

< 50 percent external anal sphincter (EAS) tear

Answer 43

3a

Question 44

> 50 percent EAS tear

Answer 44

3b

Question 45

EAS plus internal anal sphincter (lAS) tears

Answer 45

3c

Question 46

Laceration of the perineal body, entire anal sphincter complex and anorectal mucosa

Answer 46

4th degree perineal laceration