Stages of Labor

Question 1

What are the 4 P’s of labor?

Answer 1

• Power
• Passenger
• Pelvis
• Psyche

Question 2

______ DO NOT dilate / efface the cervix

Answer 2

Braxton Hicks contractions

Question 3

Describe the occurrence of cervical effacement / dilation in primigravida mothers

Answer 3

Effacement typically occurs before dilation

Question 4

How often should the cervix be checked for dilation?

Answer 4

Once every hour

Question 5

What are the signs of impending labor? (6)

Answer 5

• Lightening
• Cervical ripening
• Bloody show
• Backache
• Nesting
• ROM

Question 6

When does lightening occur?

Answer 6

2 weeks before labor in primigravida

Question 7

When does bloody show occur?

Answer 7

24 - 48 hours before labor

Question 8

Describe the test used to determine ROM

Answer 8

Nitrazine paper - will turn blue if amniotic fluid

Question 9

Describe the signs of true labor (4)

Answer 9

• Contractions increase in duration / frequency
• Progressive effacement / dilation
• Back / lower abdomen pain - worse with activity
• Bloody show

Question 10

Describe the signs of false labor (4)

Answer 10

• No increase in contraction duration / frequency
• No effacement / dilation
• Groin / middle abdomen pain - improves with activity
• No bloody show

Question 11

Why is it important to NEVER lay supine when pregnant (regardless of labor stage)?

Answer 11

Risk of vena cava syndrome (cuts off blood return)

Question 12

Which position is best to prevent vena cava syndrome?

Answer 12

Left lateral position

Question 13

What are the manifestations of vena cava syndrome? (4)

Answer 13

• Pallor
• Clammy skin
• Hypotension
• Late decelerations

Question 14

What hormones trigger labor? (2)

Answer 14

• Prostaglandin
• Oxytocin

Question 15

What is the drug class of cervidil?

Answer 15

Prostaglandin

Question 16

What is the drug class of misoprostol (Cytotec)?

Answer 16

Prostaglandin

Question 17

What is the drug class of indomethacin?

Answer 17

Prostaglandin inhibitor

Question 18

What is the purpose of indomethacin?

Answer 18

Inhibits premature labor

Question 19

When can indomethacin be used?

Answer 19

≤ 32 weeks

Question 20

When is the first stage of labor?

Answer 20

Cervical effacement / dilation from 1 - 10 cm

Question 21

The first stage of labor consists of what 3 sub-phases?

Answer 21

• Latent phase
• Active phase
• Transition phase

Question 22

How effaced / dilated is the patient during the latent phase?

Answer 22

• 0% - 40% effaced
• 0 - 3 cm dilated

Question 23

How effaced / dilated is the patient during the active phase?

Answer 23

• 40% - 80% effaced
• 4 - 7 cm dilated

Question 24

How effaced / dilated is the patient during the transition phase?

Answer 24

• 80% - 100% effaced
• 8 - 10 cm dilated

Question 25

What is the frequency / duration of contractions during the latent phase?

Answer 25

Q 5 - 30 minutes, lasting 30 - 45 seconds

Question 26

What is the frequency / duration of contractions during the active phase?

Answer 26

Q 2 - 5 minutes, lasting 45 - 70 seconds

Question 27

What is the frequency / duration of contractions during the transition phase?

Answer 27

Q 2 - 3 minutes, lasting 45 - 90 seconds

Question 28

Describe longitudinal fetal lie

Answer 28

Fetal and mother spines are parallel (preferred)

Question 29

Describe transverse fetal lie

Answer 29

Fetal and mother spines are perpendicular (cannot deliver vaginally)

Question 30

What are the 3 types of fetal presentation?

Answer 30

- Cephalic - Breech - Transverse

Question 31

What are the complications associated with breech presentation? (2)

Answer 31

- Cord prolapse - Passage of meconium

Question 32

Which fetal position has the best outcome?

Answer 32

Occiput anterior

Question 33

Which fetal position is shown?

Answer 33

Right occiput anterior (ROA)

Question 34

Which fetal position is shown?

Answer 34

Left occiput anterior (LOA)

Question 35

Which fetal position is shown?

Answer 35

Right occiput posterior (ROP)

Question 36

Which fetal position is shown?

Answer 36

Left occiput posterior (LOP)

Question 37

Why is occiput posterior position not preferred?

Answer 37

Increased pressure on sacral nerves - causes back pain

Question 38

Which pelvis shape is round / wide (most favorable for vaginal delivery)?

Answer 38

Gynecoid

Question 39

Which pelvis shape is oval / narrow (adequate for vaginal delivery?

Answer 39

Anthropoid

Question 40

Which pelvis shape is heart shaped (not favorable for vaginal delivery)?

Answer 40

Android

Question 41

Which pelvis shape is flat (not favorable for vaginal delivery)?

Answer 41

Platypelloid

Question 42

When is the second stage of labor?

Answer 42

From 10 cm until the baby is born

Question 43

What are the 7 cardinal movements of labor?

Answer 43

1. Engagement 2. Descent 3. Flexion 4. Internal rotation 5. Extension 6. External rotation / restitution 7. Expulsion

Question 44

When is the fetus considered engaged?

Answer 44

When the biparietal diameter (BPD) passes through the pelvic inlet

Question 45

Where is 0 station?

Answer 45

The ischial spine

Question 46

What does negative station indicate?

Answer 46

Number of cm above the ischial spine

Question 47

What does positive station indicate?

Answer 47

Number of cm below the ischial spine

Question 48

Describe flexion

Answer 48

Chin becomes tucked

Question 49

Describe internal rotation

Answer 49

Fetal head turns to fit through pelvis (ideally assumes occiput anterior position)

Question 50

Describe extension

Answer 50

Fetal head is born (back of the head exits first)

Question 51

Describe external rotation / restitution

Answer 51

Realignment of head and shoulders (turn 45 degrees)

Question 52

Describe expulsion

Answer 52

Anterior shoulder is delivered, followed by posterior shoulder and rest of the body

Question 53

When is the third stage of labor?

Answer 53

Expulsion of the placenta

Question 54

Describe placental separation (2)

Answer 54

- Sudden gush of blood - 8 inches of umbilical cord exits vagina

Question 55

How long does placental expulsion typically take?

Answer 55

5 - 20 minutes

Question 56

A placenta is considered retained after ______

Answer 56

30 minutes

Question 57

When is the fourth stage of labor?

Answer 57

1 - 4 hours postpartum recovery

Question 58

What is the primary focus during the first 1 - 4 hours postpartum?

Answer 58

Uterine contractility

Question 59

How often should the uterus be assessed during the first 1 - 4 hours postpartum?

Answer 59

Q 15 minutes