uterine activity and management chapter 4

Question 1

during the _________phase of labor irregular and infrequent uterine cxt are associated with a gradual cervical softening dilation and effacement

Answer 1

During the Latent phase of labor irregular and infrequent uterine contractions are associated with the gradual cervical softening, dilation, and effacement

Question 2

during the _______phase of labor the rate of cervical dilation increases and the fetal presenting part descends

Answer 2

During the active phase of labor the rate of cervical dilation increases and the fetal presenting part descends

Question 3

uterine frequency usually ranges from ___-___ per 10 minute period with lower frequencies in the first stage and higher frequencies in the second stage

Answer 3

uterine frequency usually ranges from 2-5 per 10 minute period with lower frequencies in the first stage and higher frequencies in the second stage

Question 4

contraction duration remains fairly stable throughout the first and second states ranging from ___-___ and generally not exceeding ___ seconds

Answer 4

contraction duration remains fairly stable throughout the first and second states ranging from 40-70 and generally not exceeding 90 seconds

Question 5

uterine cxt usually range from peaking at ___-___ mm Hg in the first stage of labor and may rise to over ___ mm hg in the second stage of labor

Answer 5

uterine cxt usually range from peaking at 40-70 mm Hg in the first stage of labor and may rise to over 80 mm hg in the second stage of labor

Question 6

uterine cxt palpate as mild usually have a tone of less than ____

Answer 6

utnerine cxt palpate as mild if they have a tone less than 50 mm hg

Question 7

average resting tone of labor is usally ___mmhg

Answer 7

the average resting tone of labor is usually 10 mm hg

Question 8

relaxation time is usually ____sec or more in the first stage and ____seconds or more in the second stage of labor

Answer 8

relaxation time is usally 60 seconds or more in the first stage or 45 seconds or more in the second stage of labor

Question 9

mvus usually range from ____-___ in the first stage and may rise ____-_____ in the second stage contraction intensities of ____ or more and mvu’s of ___-___are generally sufficient to intiate spontaneous labor

Answer 9

mvu’s usually range from in the firs 100-250 and may rise to 300-400 in the second stage cxt intensities of 40 or more and mvu’s of 80-120 are usually sufficient to initiate labor

Question 10

the summary of terms suggested by the NICHD are for the classification of uterine activity utilizing the frequency of cxt averaged over a _____minute period.

Answer 10

the summary of terms suggested by the NICHD are for the classification of uterine activity utilizing the frequency of cxt averaged over a _____minute period

Question 11

“normal” frequency of cxt is defined as and average less than or equal to ___ contractions in 10 minutes

Answer 11

“normal” frequency of cxt is defined as and average less than or equal to 5 contractions in 10 minutes

Question 12

“tachysystole” is defined as and average of more than ____ contractions in 10 minutes averaged over a 30 minute period

Answer 12

“tachysystole” is defined as and average of more than 5 contractions in 10 minutes averaged over a 30 minute period

Question 13

hypertonus is defined as a uterine resting tone greater than____-____ mm Hg

Answer 13

hypertonus is defined as uterine resting tone of greater than 20-25 mm Hg

Question 14

Normal resting tone is ___-___mm hg and is generally not greater than ____

Answer 14

Normal resting tone is 8-12 mm hg and is generally not greater than ____

Question 15

“inadequate” relaxation time is defined as less than _____ seconds in the first stage of labor and less than 45-50 seconds in the _______stage of labor

Answer 15

“inadequate” relaxation time is defined as less than 60 seconds in the first stage of labor and less than 45-50 seconds in the second stage of labor

Question 16

common underlying causes of excess uterine activity:

1. use of pharmacologic cervical ________ agents
2. use of synthetic oxytocin for ___________ or ________ of labor ( more common in high dose high frequency administration)
3. abruptio ______
4. uterine _______________ whether iatrogenic from amnio-infusion or as a result of multiple gestation hydramnios or macrosomia

Answer 16

common underlying causes of excess uterine activity:

1. use of pharmacologic cervical ripening agents
2. use of synthetic oxytocin for augmentation or induction of labor ( more common in high dose high frequency administration)
3. abruptio placenta
4. uterine overdistention whether iatrogenic from amnio-infusion or as a result of multiple gestation hydramnios or macrosomia

Question 17

latent phase abnormalaties: in a primapara the latent phase of labor is considered prolonged if greater than ____ hours in a multipara the latent phase of labor is considered prolonged if longer than ___ hours

Answer 17

latent phase abnormalaties: in a primapara the latent phase of labor is considered prolonged if greater than ____ hours in a multipara the latent phase of labor is considered prolonged if longer than ___ hours

Question 18

There are three main active phase abnormalities:
__________ disorders. a slow rate of cervical dilation defined as the less than the 5th percentile statistically.
________ disorders where labor progresses normally initially in the active phase and then stops for a period of 2 hours.
______ disorders where slow progress precedes arrest

ACOG recommends that ________ infusion be attempted in these disorders to bring about adequate labor cxt

Answer 18

There are three main active phase abnormalities:
protraction disorders. a slow rate of cervical dilation defined as the less than the 5th percentile statistically.
arrest disorders where labor progresses normally initially in the active phase and then stops for a period of 2 hours.
combined disorders where slow progress precedes arrest

ACOG recommends that oxytocin infusion be attempted in these disorders to bring about adequate labor cxt

Question 19

management strategies for active phase disorders.
ensure that the cervix is ___ cm dilated before diagnosing an active phase disorder.
use standardized oxtocin infusion while avoiding___________
consider _______ if membranes intact
consider the use of an ______ to document the adequacy of cxt a minimum of _____ MVU is required
limit _____ management of labor to patients that are nulliparious, with singleton cephalic presentations
require at least _____ hours of adequate UA before the diagnosis of failure to progress.
provide ________ labor support.

Answer 19

management strategies for active phase disorders.
ensure that the cervix is 4 cm dilated before diagnosing an active phase disorder.
use standardized oxtocin infusion while avoiding tachysystole
consider amniotomyif membranes intact
consider the use of an IUPC to document the adequacy of cxt a minimum of 200 MVU is required
limit Active management of labor to patients that are nulliparious, with singleton cephalic presentations
require at least 4 hours of adequate UA before the diagnosis of failure to progress.
provide continuous labor support.

Question 20

prolonged second stage:
second stage is considered prolonged in primip if it is longer than ___ hours with anesthesia and __ hours without
second stage is considered prolonged in multip if it is longer than ___ hours with anesthesia and __ hours without

these time frames are not mandates for delivery by cesarean section but paramaters for assessment and intervention

Answer 20

prolonged second stage:
second stage is considered prolonged in primip if it is longer than 3 hours with anesthesia and 2 hours without
second stage is considered prolonged in multip if it is longer than 2 hours with anesthesia and 1 hours without

these time frames are not mandates for delivery by cesarean section but paramaters for assessment and intervention