Normal Labor

Question 1

What is cervical effacement?

Answer 1

• the progressive shortening and thinning of the cervix in labor

Question 2

This hormone upregulates uterotonic receptors.

Answer 2

• Estrogen

Question 3

A blood gas is performed to check for acidosis if the baby has a Apgar score of how low?

Answer 3

< 5

Question 4

How can we obtain a qualitative measure of the timing of contractions?

WILL NOT TELL YOU ABOUT STRENGTH OF CONTRACTIONS ONLY TIMING

Answer 4

• External tocometer

Question 5

What is the classic qualitative definition of adequate labor?

Answer 5

3-5 contractions in 10 minutes

Question 6

What signs/symptoms must be present to clinically diagnose labor?

Answer 6

• regular painful uterine contractions + progressive cervical effacement and dilatation

Question 7

What defines the second stage of labor (aka pushing phase)?

Answer 7

• period from full dilatation until delivery of the fetus

Question 8

How is fetal position determined?

Answer 8

• palpation of the sutures and posterior fontanelle

Question 9

What are the classifications of the Apgar score?

Answer 9

0-3 = critically low
4-6 = fairly low
7-10 = generally normal

Question 10

Maximum dilation is defined as?

Answer 10

10 cm

Question 11

An ideal pelvic shape is what?

Answer 11

round to slightly oval

Question 12

An episiotomy is consisted with what degree of perineal tear?

Answer 12

• second degree perineal tear

Question 13

What is considered the best test for an adequate pelvis?

Answer 13

• a trial of labor

Question 14

What does the evidence say about how fast cord clamping should be done?

Answer 14

• delayed cord clamping leads to better outcomes

Question 15

What defines the first stage of labor?

Answer 15

• interval between onset of labor and full cervical dilation

Question 16

Increased synthesis of this hormone in membranes and decidua leads to the transition to labor.

Answer 16

• Prostaglandins

Question 17

The third stage is considered to be prolonged if it is > ___ minutes.

Answer 17

> 30 minutes

Question 18

What is the difference between a third-degree and fourth-degree perineal tear?

Answer 18

• third degree = anal sphincter torn

- fourth degree = rectum torn

Question 19

How can we obtain a quantitative measure of the strength of contractions?

Answer 19

• internal pressure catheter (IPC)

Question 20

What is the easiest and most common pelvic shape?

Answer 20

• Gynecoid

Question 21

What does the term “engagement” mean?

Answer 21

• When the fetal head enters into the pelvic inlet

Question 22

When would you need a pundendal nerve block during pregnancy?

Answer 22

• if a patient needs a forceps delivery but does not have an epidural

Question 23

What is the most common presentation in vaginal delivery?

Answer 23

• cephalic

Question 24

What defines the third stage?

Answer 24

• time from delivery of baby to separation and expulsion of the placenta

Question 25

If you are using an internal pressure catheter (IPC) to quantitatively measure labor, what value is considered "adequate"?

Answer 25

- >200 montevideo units (MVUs)

Question 26

Withdrawal of this hormone may be associated with onset of labor.

Answer 26

- Progesterone

Question 27

Pulsatile release of this hormone causes contractions.

Answer 27

- Oxytocin

Question 28

What drug can be given to speed up the expulsion of the placenta?

Answer 28

- oxytocin (pitocin)

Question 29

What is the difference between the latent phase and active phase of the first stage of labor?

Answer 29

- latent phase = Onset of labor to point at which change in the slope of rate of cervical change (usually around 4 cm dilated) - activate phase = a faster rate of cervical dilation than latent phase

Question 30

By measuring the fetal size you can estimate this value.

Answer 30

- fetal weight

Question 31

Fetal station "0" is located at this bony landmark.

Answer 31

- Ischial spine

Question 32

The easiest vaginal delivery is when the posterior fontanelle of the fetus is facing ______.

Answer 32

- anterior

Question 33

How many measurements do you need to obtain to estimate the fetal weight using US?

Answer 33

4 measurements 2 of head, 1 of belly, 1 of thigh