Questions and Answers
What characterizes the latent phase of the first stage of labor?
How does the duration of the transition phase differ between nullipara and multipara?
What is the primary physiological change that happens during the second stage of labor?
In the context of the third stage of labor, what leads to the separation of the placenta?
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Which statement correctly describes the contracting frequency during the first stage of labor?
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What is a common maternal experience during the transition phase of labor?
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What is the average dilation rate for a multiparous woman during the first stage of labor?
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During the latent phase of labor, how often should the fetal heart rate be monitored for low-risk mothers?
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In the active phase of labor, what is the expected frequency of uterine contractions?
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When should maternal vital signs be checked during the transition phase of labor?
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What is the maximum time a placenta can take to separate before being classified as retained?
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What physiological changes are expected during the fourth stage of labor?
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What monitoring is necessary if there is an increased gush or trickling of blood during labor?
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What should be monitored more frequently for high-risk mothers during the second stage of labor?
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What is one of the primary purposes of establishing a birth plan?
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During the third stage of labor, how often should vital signs be checked?
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What does progressive relaxation primarily focus on during labor?
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What is the main focus of visualization techniques in labor?
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What technique involves performing gentle massage and applying gentle pressure on the skin?
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Which monitoring aspect is recommended during the second stage of labor in addition to uterine contractions?
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What is a recommended intervention if a mother cannot urinate during the labor stages?
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Which of the following agents is least likely to provide adequate pain relief when used alone for epidural analgesia?
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What is the primary benefit of using a Kobak needle or Iowa trumpet during the transvaginal approach for nerve block?
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In which situation is it recommended to delay the administration of an epidural catheter during labor?
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What potential complication must be closely monitored when administering repeated doses of epidural opioids?
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Which of the following is a common practice for the placement of a lumbar epidural catheter?
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What is the most appropriate position for a mother in labor if she prefers the supine position?
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Which of the following interventions is not advisable if the membranes have ruptured?
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How frequently should the perineal pad be changed during labor?
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Which opioid is most commonly used during the early stages of labor?
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What is the primary concern with administering opioids during labor?
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What is the primary goal of vocalization during contractions?
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Which of the following methods can encourage the mother to empty her bladder effectively?
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What effect can repeated doses of opioids such as Butorphanol cause?
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Which area is usually the first to be addressed in touch relaxation?
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What is a common method to alleviate discomfort during labor while sitting on a birthing ball?
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In dissociation relaxation, what is the main purpose of creating discomfort?
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What is the preferred position for visualization exercises?
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Which of the following is a potential risk associated with straight catheterization during labor?
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What is a key indicator that a mother in labor might need to change her position frequently?
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Which aspect is least emphasized during visualization techniques?
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What sequence typically follows in touch relaxation after the initial tightening and relaxing session?
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What common mistake might a woman in labor make regarding visualization?
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Which technique involves a coach for effective practice?
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What is the initial muscle focus in the dissociation relaxation technique?
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What technique is suggested to help maintain focus during visualization?
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Study Notes
Stages of Labor and Delivery
- Labor stages vary among women, influenced by parity (multipara vs. nullipara).
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First Stage: Onset of labor marked by regular contractions until full cervical dilation (10 cm).
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Latent Phase:
- Nullipara: up to 8.5 hours; Multipara: up to 5.3 hours.
- Cervical dilation (≤3 cm), mild to moderate contractions (25-40 mm Hg IUPC), 3-30 minutes apart.
- Mother can manage discomfort with mild anxiety.
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Active Phase:
- Nullipara: up to 4.5 hours; Multipara: up to 2.5 hours.
- Cervix dilates to 4-7 cm (1.2 cm/hr for nullipara, 1.5 cm/hr for multipara); contractions every 1-5 minutes, lasting 40-60 seconds.
- Moderate to strong contraction intensity (50-70 mm Hg IUPC), increasing pain and anxiety.
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Transition Phase:
- Nullipara: up to 3.6 hours; Multipara: ≤1 hour.
- Full dilation (8-10 cm), frequent contractions every 1.5-2 minutes lasting 60-90 seconds.
- Very strong intensity (70-90 mm Hg IUPC); high anxiety, intense pain, and urge to push.
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Latent Phase:
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Second Stage: Begins at full dilation, ends with delivery; lasts about 2 hours for nullipara, 15 minutes for multipara.
- Frequent contractions every 1.5-2 minutes; very strong contraction intensity (70-100 mm Hg IUPC).
- Intense urge to bear down as fetal head descends, marked by severe perineal pain and bulging.
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Third Stage:
- Starts after infant delivery, ends after placenta delivery; strong contractions help detach the placenta.
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Fourth Stage:
- Period from 1-4 hours post-birth during maternal physiological readjustment with potential blood loss (250-400 ml).
Assessments During Labor
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First Stage Assessments:
- Initial admission exam includes monitoring contractions, cervical exam (dilation and effacement), and fetal descent.
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Latent Phase:
- Vital signs (VS) checked every hour if stable, every 15 minutes if unstable.
- Monitor uterine contractions and fetal heart rate (FHR) based on risk levels.
- Active Phase: Similar monitoring frequency; focus on maternal comfort and coping mechanisms.
- Transition Phase: VS checked every 30 minutes; increased monitoring of contractions and bladder distention.
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Second Stage Assessments:
- VS every 5-15 minutes; continuous contraction monitoring and regular FHR checks.
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Third Stage Assessments:
- VS checked every 5 minutes; continuous monitoring until placenta is delivered.
Support Available During Labor
- Birth plans can reduce stress by outlining preferences for labor, delivery, and postpartum care.
- Key elements can include preferences on ambulation, pain management, interventions, and newborn care.
Relaxation Techniques
- Progressive Relaxation: Tighten muscles then relax, focusing on sensations.
- Touch Relaxation: Massage to relieve tension, performed in a specific sequence.
- Dissociation Relaxation: Relax various muscles while applying discomfort to distract from pain.
- Visualization: Focus on calming imagery to help maintain relaxation during labor.
Positioning, Hydrotherapy, and Comfort
- Mothers encouraged to ambulate, unless fetal monitoring necessitates bed rest.
- Warm showers or bathing can ease discomfort. Baths should be avoided if membranes have ruptured.
- Continuous support, positioning, and comfort measures enhance labor experience.
Medications in Labor
- Opioids and sedatives (e.g., meperidine, fentanyl) can cross the placenta, affecting the fetus.
- Neuraxial blocks are commonly utilized for pain relief with specific considerations for delivery methods.
- Epidural and Intrathecal Analgesia: Use of local anesthetics combined with opioids, tailored to pain management needs and fetal monitoring.
Special Considerations
- Retained placenta: Considered if separation hasn’t occurred within 30 minutes post-delivery.
- Monitoring bladder distention is critical, and catheterization may be necessary if urination is not possible.### Commonly Used Agents for Pain Management
- Morphine, 0.25-0.5 mg, is commonly administered for pain relief.
- Meperidine, dosed at 10-15 mg, is another option for analgesia.
- Fentanyl can be given in doses of 12.5-15 µg.
- Sufentanil is also utilized, but specific dosing is not provided.
Continuous Fetal Heart Rate Monitoring
- Electronic fetal monitoring (EFM) offers continuous tracking of fetal heart rate (FHR).
- FHR can be assessed via auscultation or ultrasound through an abdominal transducer.
- Intermittent monitoring occurs every 15 minutes during the first stage of labor and every 5 minutes during the second.
- Internal monitoring requires at least 2 cm cervical dilation to attach an electrode to the fetal presenting part.
- Internal scalp electrodes are contraindicated in cases of maternal communicable diseases (e.g., HIV) and with preterm infants.
- Telemetry options include ultrasound or ECG transducers, alongside external uterine pressure transducers for FHR monitoring.
- FHR is typically evaluated at a baseline rate of 110-160 bpm; bradycardia is defined as a rate below 110 bpm.
Fetal Scalp Sampling and Stimulation
- Fetal scalp sampling involves incision in the fetal scalp to collect a blood sample for oxygen assessment.
- Purpose includes evaluating fetal oxygenation, platelet levels, and ruling out acidosis.
- Factors limiting sampling include insufficient cervical dilation, elevated fetal head, intact membranes, and potential sampling errors.
- Test results are classified: normal (>7.25), pre-pathological (7.20 to 7.25), and pathological (<7.20). Tests should be repeated every 20-30 minutes.
- Fetal scalp stimulation is performed by gently massaging the scalp for 15 seconds to assess fetal response.
- A positive response is an increase in FHR of 10-15 bpm over baseline for 10-15 seconds; failure to respond indicates possible acidosis.
Premature Labor
- Preterm labor is defined as occurring between 20-37 weeks gestation.
- Premature rupture of membranes (PROM) can initiate preterm labor; common causes include infections and manual examinations.
- To estimate the delivery date, one can calculate from the last menstrual period (LMP) using Naegele's rule.
- Fetal viability is minimal before 23 weeks; survival rates improve by 10% if delivery is delayed by 2 days at 25 weeks gestation.
- Tocolytic drugs are often used to delay labor for glucocorticoid administration, enhancing fetal lung maturity, particularly between 24-36 weeks.
Tocolysis
- Tocolysis is the suppression of preterm labor to potentially administer glucocorticoids.
- Indomethacin (an NSAID) is effective up to 32 weeks gestation but can reduce amniotic fluid and cause premature closure of the ductus arteriosus.
- Nifedipine, a calcium channel blocker, is preferred for its safety and effectiveness, indicated for 24-34 weeks gestation and may increase FHR.
- Terbutaline, a beta-adrenergic agent, may also raise FHR and is used as second-line therapy between 32-34 weeks.
- Magnesium sulfate acts similarly to terbutaline but requires close monitoring due to potential maternal side effects and neonatal respiratory depression. Concurrent tocolytic use is discouraged.
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Description
Explore the stages of labor and delivery in this quiz, focusing on the intrapartal period. Understand the differences in labor presentation between multipara and nullipara women, and learn about the phases of the first stage of labor. Test your knowledge on cervical dilation and contraction patterns during labor.
