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Questions and Answers
During which stage of labor is cervical dilation typically the fastest, often referred to as the 'acceleration phase'?
During which stage of labor is cervical dilation typically the fastest, often referred to as the 'acceleration phase'?
- Latent phase (0-3 cm)
- Active phase (3-8 cm) (correct)
- Transition phase (8-10 cm)
- Second stage (pushing)
What is the primary purpose of performing Leopold maneuvers during a prenatal examination?
What is the primary purpose of performing Leopold maneuvers during a prenatal examination?
- To determine the fetal position, presentation, and lie. (correct)
- To evaluate the strength and frequency of uterine contractions.
- To assess the mother's blood pressure and heart rate.
- To measure the amniotic fluid volume.
Which of the following cervical dilation measurements corresponds to the size of a lime slice?
Which of the following cervical dilation measurements corresponds to the size of a lime slice?
- 3 cm
- 9 cm
- 7 cm
- 5 cm (correct)
What is the typical duration of contractions during the transition phase of labor?
What is the typical duration of contractions during the transition phase of labor?
Which hormone, secreted by the fetal pituitary gland, contributes to increased prostaglandin production during labor?
Which hormone, secreted by the fetal pituitary gland, contributes to increased prostaglandin production during labor?
During which stage of labor are contractions typically the least frequent, occurring every 5-10 minutes?
During which stage of labor are contractions typically the least frequent, occurring every 5-10 minutes?
If the superior surface of the uterine fundus feels firm and round upon palpation during Leopold maneuvers, which fetal presentation is MOST likely?
If the superior surface of the uterine fundus feels firm and round upon palpation during Leopold maneuvers, which fetal presentation is MOST likely?
A cervical dilation of 7 cm is visually represented by which of the following?
A cervical dilation of 7 cm is visually represented by which of the following?
Which hormonal change primarily contributes to the increased uterine sensitivity to stimuli that promote contractions as pregnancy progresses?
Which hormonal change primarily contributes to the increased uterine sensitivity to stimuli that promote contractions as pregnancy progresses?
A pregnant woman experiences weak and irregular contractions in her late pregnancy. What type of contractions are these most likely to be?
A pregnant woman experiences weak and irregular contractions in her late pregnancy. What type of contractions are these most likely to be?
What is the role of fetal cortisol in the initiation of labor?
What is the role of fetal cortisol in the initiation of labor?
A woman presents with the expulsion of a mucus plug accompanied by a small amount of blood. How close is she to the onset of true labor?
A woman presents with the expulsion of a mucus plug accompanied by a small amount of blood. How close is she to the onset of true labor?
What role does oxytocin play in the process of labor?
What role does oxytocin play in the process of labor?
What is the primary role of prostaglandins in labor?
What is the primary role of prostaglandins in labor?
During pregnancy, a plug of mucus accumulates in the cervical canal. What is its primary function?
During pregnancy, a plug of mucus accumulates in the cervical canal. What is its primary function?
Which type of pelvis is considered the most ideal for vaginal delivery and childbirth due to its structural dimensions?
Which type of pelvis is considered the most ideal for vaginal delivery and childbirth due to its structural dimensions?
During which stage of labor does the expulsion of the placenta typically occur?
During which stage of labor does the expulsion of the placenta typically occur?
Which maneuver involves applying pressure to the uterus through the abdominal wall to aid in placental expulsion?
Which maneuver involves applying pressure to the uterus through the abdominal wall to aid in placental expulsion?
A 'dirty Duncan' presentation during the third stage of labor refers to the:
A 'dirty Duncan' presentation during the third stage of labor refers to the:
What clinical sign should prompt evaluation for a retained placental fragment?
What clinical sign should prompt evaluation for a retained placental fragment?
Which of the following pelvic types is considered the most favorable for vaginal delivery?
Which of the following pelvic types is considered the most favorable for vaginal delivery?
Which of the following factors is least likely to influence the progress of labor?
Which of the following factors is least likely to influence the progress of labor?
Dilation and effacement occur during which stage of labor?
Dilation and effacement occur during which stage of labor?
What is the primary physiological process that initiates and maintains labor contractions?
What is the primary physiological process that initiates and maintains labor contractions?
During a prenatal examination, a healthcare provider palpates both sides of the uterus. What aspect of the fetal assessment is being determined?
During a prenatal examination, a healthcare provider palpates both sides of the uterus. What aspect of the fetal assessment is being determined?
A clinician is assessing the 'degree of fetal fitting.' What information does this examination provide?
A clinician is assessing the 'degree of fetal fitting.' What information does this examination provide?
What is the primary focus when a healthcare provider assesses fetal attitude?
What is the primary focus when a healthcare provider assesses fetal attitude?
Why is the occiput anterior position considered the most favorable for vaginal birth?
Why is the occiput anterior position considered the most favorable for vaginal birth?
During which stage of labor does complete dilation and effacement typically occur?
During which stage of labor does complete dilation and effacement typically occur?
A patient is fully dilated and has complete effacement. According to the information, which stage of labor is the patient in?
A patient is fully dilated and has complete effacement. According to the information, which stage of labor is the patient in?
Which of the following fetal presentations, other than vertex, might require intervention due to potential complications during vaginal delivery?
Which of the following fetal presentations, other than vertex, might require intervention due to potential complications during vaginal delivery?
During a vaginal examination, a healthcare provider identifies the fetal buttocks as the presenting part. Which type of fetal presentation is this?
During a vaginal examination, a healthcare provider identifies the fetal buttocks as the presenting part. Which type of fetal presentation is this?
A primiparous woman in labor is fully dilated, and the fetal head is crowning. Which of the following actions is most important for the delivery team to perform at this time to minimize perineal tearing?
A primiparous woman in labor is fully dilated, and the fetal head is crowning. Which of the following actions is most important for the delivery team to perform at this time to minimize perineal tearing?
Delayed umbilical cord clamping is associated with which of the following benefits for the newborn?
Delayed umbilical cord clamping is associated with which of the following benefits for the newborn?
Following the delivery of the newborn, a healthcare provider is preparing for the third stage of labor. Which of the following findings would indicate that placental separation has occurred?
Following the delivery of the newborn, a healthcare provider is preparing for the third stage of labor. Which of the following findings would indicate that placental separation has occurred?
After delivering a healthy newborn, the obstetrician orders oxytocin to be administered to the mother. What is the primary rationale for this intervention during the third stage of labor?
After delivering a healthy newborn, the obstetrician orders oxytocin to be administered to the mother. What is the primary rationale for this intervention during the third stage of labor?
A woman in labor is experiencing intense back pain with each contraction. The fetal position is most likely:
A woman in labor is experiencing intense back pain with each contraction. The fetal position is most likely:
During the third stage of labor, what is the typical timeframe for the placenta to be delivered after the birth of the baby?
During the third stage of labor, what is the typical timeframe for the placenta to be delivered after the birth of the baby?
Which of the following interventions during labor is primarily aimed at promoting early maternal-neonatal bonding?
Which of the following interventions during labor is primarily aimed at promoting early maternal-neonatal bonding?
A newborn is delivered in the Occiput Anterior (OA) position. What is the significance of this position during labor and delivery?
A newborn is delivered in the Occiput Anterior (OA) position. What is the significance of this position during labor and delivery?
Flashcards
Gynecoid Pelvis
Gynecoid Pelvis
The gynecoid pelvis is the most common and structurally ideal for vaginal delivery.
Progesterone's Role in Pregnancy
Progesterone's Role in Pregnancy
Progesterone inhibits uterine contractions during the first several months of pregnancy. Towards the end of pregnancy, progesterone levels drop.
Estrogen to Progesterone Ratio
Estrogen to Progesterone Ratio
An increasing estrogen-to-progesterone ratio makes the myometrium more sensitive to stimuli that promote contractions.
Fetal Cortisol and Estrogen
Fetal Cortisol and Estrogen
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Braxton Hicks Contractions
Braxton Hicks Contractions
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Cervical Mucus Plug
Cervical Mucus Plug
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Oxytocin's Role in Labor
Oxytocin's Role in Labor
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Prostaglandins
Prostaglandins
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Fetal Oxytocin
Fetal Oxytocin
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First Stage of Labor
First Stage of Labor
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Complete Cervical Dilation
Complete Cervical Dilation
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Early (Latent) Phase
Early (Latent) Phase
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Active Phase
Active Phase
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Transition Phase
Transition Phase
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Leopold Maneuvers
Leopold Maneuvers
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Leopold's First Maneuver
Leopold's First Maneuver
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Occiput Anterior (OA)
Occiput Anterior (OA)
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Occiput Posterior (OP)
Occiput Posterior (OP)
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Modified Ritgen Maneuver
Modified Ritgen Maneuver
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Delayed Cord Clamping
Delayed Cord Clamping
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"Skin-to-Skin" Contact
"Skin-to-Skin" Contact
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Third Stage of Labor
Third Stage of Labor
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Placenta
Placenta
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Placental Separation
Placental Separation
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Fetal Position
Fetal Position
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Fetal Fitting Degree
Fetal Fitting Degree
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Fetal Attitude
Fetal Attitude
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Vertex Presentation (Occiput Anterior)
Vertex Presentation (Occiput Anterior)
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Face Presentation
Face Presentation
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Brow Presentation
Brow Presentation
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Breech Presentation
Breech Presentation
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Shoulder Presentation
Shoulder Presentation
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Shiny Schultz
Shiny Schultz
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Dirty Duncan
Dirty Duncan
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Brandt-Andrews Maneuver
Brandt-Andrews Maneuver
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Dublin Maneuver
Dublin Maneuver
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Missing cotyledon/membrane defect
Missing cotyledon/membrane defect
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Second stage of labor
Second stage of labor
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Study Notes
Objectives of Physiologic Labour
- Review and identify the different stages of labour
- Perform special maneuvers according to each stage of labour
- Deliver a baby in a simulated physiologic labour scenario
Introduction to Labour
- Progesterone inhibits uterine contractions throughout the first several months of pregnancy.
- As the pregnancy enters its seventh month, progesterone levels plateau and then drop.
- An increasing estrogen-to-progesterone ratio heightens myometrium sensitivity to stimuli, promoting contractions.
- Fetal cortisol rises in the eighth month, boosting estrogen production by the placenta, overpowering the uterine-calming progesterone effects.
- Some women feel weak, irregular peristaltic Braxton Hicks contractions, also known as false labor from decreasing progesterone levels late in pregnancy.
- Types of contractions include the real deal and Braxton Hicks
- A mucus plug accumulates in the cervical canal during pregnancy, blocking the uterus entrance.
- About 1-2 days before true labour, this plug loosens and is expelled, sometimes with a small amount of blood.
- The posterior pituitary boosts oxytocin secretion, a hormone stimulating labour contractions.
- Simultaneously, the myometrium increases its sensitivity to oxytocin, expressing more receptors for it.
- A positive feedback loop stimulates prostaglandin secretion from fetal membranes.
- The fetal pituitary secretes oxytocin, further increasing prostaglandins.
- Labour is also known as Parturition.
First Stage - Complete Cervix Dilation
- Dilation of the cervix happens during delivery
- Cervix effaces making it thinner and it dilates opening it up
- Comparing centimeters of dilation to common objects:
- 1 cm = Cheerios
- 2 cm = Grape
- 3 cm = Banana Slice
- 4 cm = Cracker
- 5 cm = Lime Slice
- 6 cm = Cookie
- 7 cm = Orange Slice
- 8 cm = Halved Apple
- 9 cm = Donut
- 10 cm = Cantaloupe
- First stage of labor is split into the following:
- Early or latent
- 0-3 CM
- 30-45 second contractions
- 5-10 minutes between contractions
- Active
- 3-8 CM
- 45-60 second contractions
- 3-5 minutes between contractions (acceleration phase)
- Transition
- 8-10 CM
- 60-90 second contractions
- 2-3 minutes between contractions (deceleration phase)
- Early or latent
Leopold Maneuvers
- Consist of 4 steps
- Situation, fetal presentation. The superior surface of the fundus is palpated to determine consistency shape and mobility.
- Fetal position. Both sides of the uterus are palpated to determine which direction the fetal back is facing.
- Degree of fetal fitting. Determines the part of the fetus at the inlet and its mobility.
- Fetal attitude. Determines the fetal attitude and degree of fetal extension into the pelvis.
- Vertex presentation, known as the occiput anterior position, is the commonest presentation and associates the greatest ease of vaginal birth.
- There are variations in presentation which include face, brow, breech and shoulder positions.
Second Stage - Expulsion
- Second stage of labour begins when the patient is fully dilated and has complete effacement.
- The second stage involves cardinal movements of labour
- Engagement
- Descent: Downward movement of fetus to pelvic inlet
- Flexion: Chin against chest; resistance from pelvic floor
- Internal rotation: Fetal shoulders internally rotate 45°
- Extension: Head emerges from vagina
Fetal Positions
- Types of Fetal Positions include:
- Right Occiput Anterior (ROA)
- Left Occiput Anterior (LOA)
- Right Occiput Transverse (ROT)
- Left Occiput Transverse (LOT)
- Right Occiput Posterior (ROP)
- Left Occiput Posterior (LOP)
- Occiput Anterior Position (OA) and Occiput Posterior Position (OP) both involve head first.
- Modified Ritgen Maneuver is for protection of the perineum, avoiding muscle tears.
- Delayed cord clamping (waiting 30 to 60 seconds) is associated with higher haemoglobin levels after delivery and greater iron stores in the first several months of life.
- Placing the child "skin-to-skin" brings optimum warmth for the newborn, early maternal-neonatal bonding, and facilitation of early breastfeeding.
- The cord is doubly clamped and cut between the clamps.
Third Stage - Placenta Delivery
- The third stage involves the delivery of the placenta.
- The placenta delivers food and oxygen to the fetus through the umbilical cord during pregnancy.
- The contractions start 5-10 minutes after birth.
- Placenta separation from the uterine wall.
- The placenta separates from uterine wall and carefully removed.
- Two sides of the placenta include fetal surface ("Shiny Schultz") and maternal surface (“Dirty Duncan")
- A missing placental cotyledon or a membrane defect suggestive of a missing succenturiate lobe may suggest retention of a portion of the placenta which would prompt further clinical evaluation.
- Brandt-Andrews Maneuver and Dublin Maneuver are examples of assisted delivery.
- The contractions for delivery of the placenta usually can last 30 minutes.
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