Obstetrics First Stage of Labor

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Questions and Answers

What is the definition of normal labor?

  • Expulsion of an immature fetus.
  • Spontaneous expulsion of a mature fetus. (correct)
  • Expulsion of a fetus that is 42 weeks or older.
  • Induced labor before 37 weeks.

At what gestational age is a fetus considered mature for the context of normal labor?

  • Between 34 and 36 completed weeks.
  • Over 42 completed weeks.
  • Under 37 completed weeks.
  • Between 37 and 42 completed weeks. (correct)

Which of the following best describes the first stage of labor?

  • The stage where the fetus is expelled.
  • The stage involving cervical dilation and effacement. (correct)
  • The stage where contractions cease.
  • The stage where a mature fetus is not involved.

Why is spontaneous expulsion important in defining normal labor?

<p>It distinguishes normal labor from induced labor. (C)</p> Signup and view all the answers

Which option is NOT a characteristic of normal labor?

<p>Requires continuous medical supervision. (C)</p> Signup and view all the answers

What is the cervical mucus plug commonly referred to in the context of pregnancy?

<p>Mucous (C)</p> Signup and view all the answers

What causes the blood mentioned in the content?

<p>Rupture of small vessels (A)</p> Signup and view all the answers

During which condition is the cervical mucus plug particularly significant?

<p>Early pregnancy (B)</p> Signup and view all the answers

What does the separation of the bag of membrane from the lower uterine segment lead to?

<p>Bleeding from small vessel ruptures (A)</p> Signup and view all the answers

Which of the following statements is true concerning the cervical mucus plug?

<p>It serves as a barrier to protect the fetus. (B)</p> Signup and view all the answers

Flashcards

Normal Labor Definition

Spontaneous delivery of a mature fetus (37-42 weeks gestation).

Mature Fetus

Fetus with a gestational age of 37 completed weeks to 42 completed weeks.

Spontaneous expulsion

Delivery of a baby without medical intervention.

First Stage of Labor

The initial phase of childbirth, including contractions and dilation of the cervix.

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Gestational Age

The time elapsed since conception, measured in weeks.

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Cervical Mucus Plug

The mucus that seals the cervix during pregnancy.

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Rupture of Small Vessels

Bleeding caused by separation of the membranes from the uterus.

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Lower Uterine Segment

The bottom part of the uterus, crucial for labor.

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Bag of Membranes

The sac (amniotic sac) surrounding the baby.

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Labor Bleeding

Bleeding during labor caused by membrane separation.

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Study Notes

Part 1: Area 2 (2024)

  • This section is about obstetric practice.
  • Images of a baby and a fetus are shown.

First Stage of Labor

  • Definition of Normal Labor:

    • Spontaneous expulsion of a mature fetus (37-42 weeks).
    • Single viable fetus.
    • Vertex occipitoanterior position (left or right).
    • Within a reasonable time (3-24 hours).
    • No surgical intervention (except episiotomy).
    • No complications for the mother or baby.
  • Stages of Normal Labor:

    • First Stage: Cervical dilatation and effacement.
      • Start: True labor pain.
      • End: Full cervical dilatation.
      • Duration: 12-16 hours (primigravida), 6-8 hours (multipara)
    • Second Stage: Delivery of the pelvic.
      • Start: Full cervical dilatation.
      • End: Delivery of the fetus.
      • Duration: 1-2 hours (primigravida), 0.5-1 hour (multipara)
    • Third Stage: Delivery of the placenta.
      • Start: Delivery of the fetus.
      • End: Delivery of the placenta.
      • Duration: 5-30 minutes
    • Fourth Stage: Observe complications after full labor.
      • Duration: 2 hours
  • Prodromal Phase:

    • Lightening
    • Increased urinary frequency
    • Labour pains

Procedure

  • Handwashing
  • Preparing equipment
  • Ensuring privacy
  • Assisting patient if complications exist (bleeding, PROM, high BP, cardiac issues)
  • Determining if the woman is in labor.

True Labor Pain vs. False Labor Pain

  • True Labor Pain:

    • Regular, increasing frequency and duration as labor progresses.
    • Begins in the lower abdomen, radiating to the back.
    • Accompanied by cervical dilatation and bulging of the membranes.
    • Not relieved by analgesics.
  • False Labor Pain:

    • Irregular, decreasing frequency and duration.
    • Begins in the lower abdomen.
    • Not accompanied by cervical dilatation or bulging of the membranes.
    • Relieved by analgesics.

Uterine Contractions

  • Latent Phase:
    • Frequency: 1 contraction every 10 minutes.
    • Duration: 20 seconds.
    • Intensity: Uterus can be dented.
  • Active Phase:
    • Frequency: 3 contractions every 10 minutes.
    • Duration: 40-60 seconds.
    • Intensity: Uterus is felt hard.

Membranes

  • Ask if woman experienced fluid leakage.
  • If uncertain, use litmus paper or smell the fluid to rule out urine.
  • Record rupture time.

Cervical Changes

  • Shortening and dilation of the cervix.
  • Latent Phase: Cervical dilation less than 3 cm.
  • Active Phase: Cervical dilation from 3-10 cm
  • Primigravida: Cervix dilates about 1.2 cm/hr.
  • Multigravida: Cervix dilates about 1.5 cm/hr

Cervical Effacement

  • Caused by uterine contraction and retraction.
  • Prostaglandin release due to pressure on the cervix before membrane rupture.

Nursing Management Steps (First Stage)

  • History taking (personal, medical, family, obstetric, menstrual, contraceptive history).
  • General examination (abdominal).

Investigations

  • Urine sample (protein and sugar testing—mid-void sample after vaginal swab, before enema).
  • Complete blood count (CBC).
  • HIV test.
  • Hepatitis B test.
  • Kidney and liver function tests.
  • Blood group and Rh factor

Vaginal Examination

  • Internal examination of vagina and cervix.
  • Indications:
    • Assessing the cervix (dilatation, consistency, position).
    • Assessing the fetus (engagement, position, lie, presentation, station).
  • Contraindications:
    • Specific conditions; consult doctors
  • Useful for assessing cervical condition and fetal positioning.

Contraindications for Vaginal Exam

  • Specific patient conditions

Placenta, Vasa Previa, Early Rupture of Membranes

  • Placenta Praevia: Placenta covers the cervix opening
  • Vasa Previa: Fetal vessels run across the cervix.
  • Early Rupture of Membranes (PROM): Rupture before labor onset.

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