Labor

Question 0

Normal cervical dilation rate in nulliparity versus woman with prior deliveries?

Protraction of active phase?

Answer 0

1.2 cm/h versus 1.5 cm/h

Cervical dilation that is less than expected

Question 1

Latent phase of labor versus active phase?

Arrest of active phase?

Answer 1

Cervix effaces (thins) until 4 cm dilation versus actively dilates

No progress of active phase for over two hours

Question 2

Baseline fetal heart rate? Accelerations?

Answer 2

110-160

Episodes of fetal heart rate increase for at least 15 BPM for at least 15 seconds

Question 3

Types of decelerations?

Answer 3

1. Early – mirror image of urine contractions
2. Variable – abrupt jagged dips below baseline
3. Late – follow uterine contraction

Question 4

Nullipara verse mulitipara:

1. Time of latent phase
2. Rate of active phase
3. Time of second stage of labor
4. Time of third stage of labor

Answer 4

1. Less than 20 hours versus less than 14 hours
2. 1.2 cm/h versus 1.5 cm/h
3. 2 hours (3 with epidural) versus 1 hour (2 if epidural)
4. 30 minutes for both

Question 5

Three P’s of labor abnormalities?

Answer 5

1. Power – give IV oxytocin to increase contractions

Question 6

Adequate contractions?

Answer 6

Every 2-3 minutes lasting for the 40-60 seconds

Question 7

Tool to measure adequacy of power? Unit? Adequate value?

Answer 7

Internal uterine catheter.

Each mm Hg rise is called a Montevideo unit – Total is sum of units over 10 minute window

200

Question 8

Type of acceleration and meaning?

Answer 8

VEAL CHOP

1. Variable – cord compression
2. Early – head compression
3. Acceleration – okay
4. Late – placental insufficiency (hypoxia vs acidemia)

Question 9

Station? Engagement? 0 station?

Answer 9

Relationship of the fetal head to ischial spines

Relationship of the widest diameter of the presenting part and its location in reference to the pelvic inlet

Bony part of the fetal head is at the plane of the ischial spines and not at the pelvic inlet

Question 10

Bloody show?

Answer 10

Loss of cervical mucous plug and blood – a sign of impending labor