Normal Labor/Delivery

Question 1

What defines Labor?

Answer 1

Uterine contractions + Cervical Change!

Question 2

What are Braxton-Hicks contractions?

Answer 2

Irregular uterine contractions WITHOUT cervical change

Question 3

What are the 2 parts of the 1st stage of labor?

Answer 3

Latent
Active

Question 4

Latent 1st stage of labor

Answer 4

Onset of labor to 6 cm dilated
– longest portion of labor

Question 5

Active 1st stage of labor

Answer 5

6 cm dilated to 10 cm dilated

Question 6

What is the average speed of dilation during the Active 1st stage of labor for nulliparous and multiparous women?

Answer 6

Nulliparous = 1.2cm/hr
Multiparous = 1.5cm/hr

Question 7

2nd stage of labor

Answer 7

Complete cervical dilation to delivery of baby

Question 8

3rd stage of labor

Answer 8

Delivery of baby to delivery of placenta

Question 9

What is the fetal Station?

Answer 9

Position of the fetal head in relation to an imaginary line drawn through the ischial spines

Question 10

What does (-) station mean?

Answer 10

Fetal head is superior to the imaginary line between the ischial spines

Question 11

What does (+) station mean?

Answer 11

Fetal head is inferior to the imaginary line between the ischial spines

Question 12

What are 2 ways to measure fetal HR and what is the normal range?

Answer 12

• Electrode attached to fetal scalp
• External US
  = 110 - 160 is normal

Question 13

With Low-Risk pregnancies, how often should the FHR be monitored during the 1st and 2nd stages of labor?

Answer 13

1st = q30 minutes
2nd = q15 minuts

Question 14

With Low-Risk pregnancies, how often should the FHR be monitored during the 1st and 2nd stages of labor?

Answer 14

1st = q30 minutes
2nd = q15 minutes

Question 15

With High-Risk pregnancies, how often should the FHR be monitored during the 1st and 2nd stages of labor?

Answer 15

1st = q15 minutes
2nd = q5 minutes

Question 16

What is Variability and what is normal Variability?

Answer 16

Fluctuations in the baseline FHR
– Normal = 6-25 bpm

Question 17

What defines Minimal Variability? What are some things that can cause this? (4)

Answer 17

< 6 bpm fluctuations in baseline FHR
= Fetal acidemia, hypoxia, opioids, fetal sleep

Question 18

What defines Marked Variabiliity?

Answer 18

> 25 bpm fluctuations ini baseline FHR

Question 19

If Variability is sinusoidal in shape, what can that indicate?

Answer 19

Fetal anemia
- Maternal Meperidine use

Question 20

What is an Acceleration?

Answer 20

FHR increases by more than 15 bpm for more than 15 seconds
– NORMAL and reassuring of fetal status

Question 21

What is a Deceleration?

Answer 21

FHR decreases by more than 15 bpm for more than 15 seconds

Question 22

What are the 3 types of Decelerations?

Answer 22

Variable
Early
Late

Question 23

What does a Variable Deceleration look like?

Answer 23

ABRUPT onset to nadir in < 30 seconds occurring anywhere in relation to the contraction

Question 24

What does a Variable Deceleration look like?

Answer 24

ABRUPT onset to nadir in < 30 seconds occurring anywhere in relation to the contraction

Question 25

What does an Early Deceleration look like?

Answer 25

GRADUAL onset with return to baseline that mirrors the contractioin

Question 26

What does an Early Deceleration look like?

Answer 26

GRADUAL onset with return to baseline that mirrors the contraction

Question 27

What does a Late Deceleration look like?

Answer 27

GRADUAL onset with the onset, nadir and recovery all being AFTER the end of the contraction

Question 28

What does a Late Deceleration look like?

Answer 28

GRADUAL onset with the onset, nadir and recovery all being AFTER the end of the contraction

Question 29

What is the pneumonic to remember common causes of the types of Decelerations?

Answer 29

VEaL CHoP

Question 30

VEaL CHoP

Answer 30

Variable --> Cord compression Early --> Head compression Late --> Placental insufficiency

Question 31

Common cause of Variable, Early and Late Decelerations?

Answer 31

VEaL CHoP Variable --> Cord compression Early --> Head compression Late --> Placental insufficiency

Question 32

What is a normal result when measuring fetal movement over a span of 2 hours?

Answer 32

More than 10 movements felt

Question 33

2 possible results of a Nonstress test?

Answer 33

Reactive Non-reactive

Question 34

Reactive Nonstress test

Answer 34

> 2 FHR accelerations in a 20 minute period

Question 35

What is a normal result of a Nonstress test?

Answer 35

Reactive = > 2 FHR accelerations in a 20 minute period

Question 36

If the Nonstress test is Non-reactive, then what?

Answer 36

Further testing should be done < 2 FHR accelerations in a 20 minute period

Question 37

What is a Contraction Stress test?

Answer 37

Measurement of FHR with INDUCED uterine contractions

Question 38

(+) Contraction Stress test? What should you do?

Answer 38

Late Decelerations following most the contractions = Deliver!

Question 39

(-) Contraction Stress test?

Answer 39

NO late decelerations following most the contractions -- this is reassuring

Question 40

What is the pneumonic for what the Biophysical Profile measures?

Answer 40

Test the Baby MAN

Question 41

Test the Baby MAN for Biophysical Profile

Answer 41

Tone Breathing Movement Amniotic Fluid index Nonstress test result

Question 42

When should you use an Umbilical A. Doppler Velocimetry?

Answer 42

Only when IUGR is suspected

Question 43

What may be seen on Umbilical A. Doppler Velocimetry if IUGR is present?

Answer 43

Reduction/Reversal of umbilical A. diastolic flow

Question 44

What results do you want for the Nonstress test and Contraction Stress test?

Answer 44

Nonstress test = Reactive Contraction Stress test = (-)

Question 45

Biophysical Profile measures? What is a worrisome result?

Answer 45

0-4 = Worrisome Tone Breathing Movement Amniotic Fluid index Nonstress test