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Questions and Answers

What are the four essential components of labor?

The four essential components of labor are Passageway (pelvis), Passenger (fetus), Powers (uterine contractions), and Psyche.

Describe the phases of the first stage of labor.

The first stage of labor is divided into the latent phase, lasting up to 7 hours for nullipara, and the active phase, which progresses from 4 cm to 10 cm dilation at a rate of 1-2 cm per hour.

What is a partogram and its significance in labor?

A partogram is a graphical representation used to monitor the progress of labor, helping healthcare providers track contractions and cervical dilation.

What roles do oxytocin and prostaglandins play in initiating labor?

<p>Oxytocin stimulates uterine contractions, while prostaglandins prepare the cervix and also promote uterine contractions.</p> Signup and view all the answers

What is the time frame for the delivery of the placenta after the baby is born?

<p>The placenta is typically delivered within 20-30 minutes after the delivery of the baby.</p> Signup and view all the answers

Explain the differences between the latent and active phases of the first stage of labor.

<p>The latent phase is prolonged, lasting up to 7 hours with gradual dilation, while the active phase is rapid, characterized by faster dilation from 4 cm to 10 cm.</p> Signup and view all the answers

What should healthcare providers monitor for during the fourth stage of labor?

<p>During the fourth stage of labor, providers should watch for signs of postpartum hemorrhage and the involution of the uterus.</p> Signup and view all the answers

What are the two main stages of labor besides the first stage?

<p>The two main stages of labor besides the first stage are the second stage, which involves descent and pushing to deliver the baby, and the third stage, which is the delivery of the placenta.</p> Signup and view all the answers

What stage of labor is the 26-year-old lady in based on her cervical dilatation and contractions?

<p>The lady is in the first stage of labor.</p> Signup and view all the answers

Identify the negative finding from the pelvic examination in this case.

<p>The negative finding is the head being at -3 station.</p> Signup and view all the answers

How is labor defined in the context of this case?

<p>Labor is defined as the act of uterine contractions combined with cervical change and dilation.</p> Signup and view all the answers

What does the term 'presentation' refer to during childbirth?

<p>Presentation refers to the part of the fetus that is felt during vaginal examination.</p> Signup and view all the answers

Explain the significance of the term 'station' in obstetrical assessment.

<p>Station indicates the level of descent of the presenting part in relation to the ischial spine.</p> Signup and view all the answers

What is the purpose of an amniotomy during labor?

<p>Amniotomy is performed to artificially rupture the membranes to augment labor.</p> Signup and view all the answers

Describe 'caput succedaneum' and its common occurrence during labor.

<p>Caput succedaneum is edema over the presenting part of the head, commonly seen in prolonged labor.</p> Signup and view all the answers

What does 'moulding' refer to in the context of fetal delivery?

<p>Moulding refers to the change in the fetal skull to adapt to the maternal pelvis during its passage.</p> Signup and view all the answers

What is the significance of the sutures in fetal skull development during labor?

<p>The sutures allow some movement between the individual bones, facilitating the molding of the fetal skull during passage through the birth canal.</p> Signup and view all the answers

Define the term ' cephalo-pelvic disproportion' in the context of labor.

<p>Cephalo-pelvic disproportion refers to a situation where the fetal head is too large to fit through the maternal pelvis, often indicated by severe molding.</p> Signup and view all the answers

What is the normal position for a cephalic presentation during labor?

<p>The normal position for a cephalic presentation is occipito-anterior (OA).</p> Signup and view all the answers

List the series of positional changes the fetus undergoes during labor.

<p>Engagement, descent, flexion, internal rotation, restitution and external rotation, extension, and delivery of shoulders and fetal body.</p> Signup and view all the answers

What does the first stage of labor encompass?

<p>The first stage of labor encompasses the onset of labor until complete dilation of the cervix.</p> Signup and view all the answers

What role does emotional support play during the management of labor?

<p>Emotional support helps improve the mother’s experience and comfort during labor.</p> Signup and view all the answers

What is the typical duration of the active management of the third stage of labor?

<p>The active management of the third stage of labor typically lasts about 30 minutes.</p> Signup and view all the answers

How does monitoring fetal well-being contribute to labor management?

<p>Monitoring fetal well-being ensures that the fetus is tolerating labor and helps identify any complications early.</p> Signup and view all the answers

What is the recommended timing for administering 10 IU of oxytocin during delivery?

<p>It should be administered during the delivery of the anterior shoulder or immediately after the baby's delivery.</p> Signup and view all the answers

What are three methods used when the placenta does not expel during controlled cord traction?

<p>Repeat controlled cord traction after 10 minutes, manual evacuation under anesthesia, or injection of oxytocin into the umbilical vein.</p> Signup and view all the answers

What is one key sign of placental separation during controlled cord traction?

<p>Signs include lengthening of the cord protruding through the vulva.</p> Signup and view all the answers

What risks arise from improper management during the third stage of labor?

<p>Complications may include retained placenta, postpartum hemorrhage, and infection.</p> Signup and view all the answers

What is the normal fetal heart rate range during labor?

<p>The normal range is between 110 and 160 beats per minute.</p> Signup and view all the answers

What is continuous fetal monitoring, and why is it preferred?

<p>Continuous fetal monitoring tracks the fetus's heart rate throughout labor, providing more information than intermittent monitoring.</p> Signup and view all the answers

What does analgesia refer to in the context of labor pain management?

<p>Analgesia refers to the loss of pain perception, which can be achieved locally or systemically.</p> Signup and view all the answers

What factors are assessed when monitoring maternal wellbeing during childbirth?

<p>Monitoring includes BP, pulse rate (PR), and temperature.</p> Signup and view all the answers

What percentage of women are likely to start labor within 2 weeks before or after their expected due date?

<p>80%</p> Signup and view all the answers

What characterizes the onset of labor?

<p>Regular uterine contractions, effacement and dilatation of the cervix, and fetal descent.</p> Signup and view all the answers

What is the major distinction between preterm labor and normal labor?

<p>Preterm labor occurs before 37 completed weeks of gestation.</p> Signup and view all the answers

What is still unclear about the initiation of human labor?

<p>The precise mechanism of initiation is still obscure.</p> Signup and view all the answers

How does the clinical course differ among the stages of labor?

<p>The clinical course varies by the progression of cervical dilation, uterine contractions, and fetal descent.</p> Signup and view all the answers

Define 'active management of the third stage of labor'.

<p>It refers to interventions to prevent complications during the delivery of the placenta.</p> Signup and view all the answers

What key factors affect cervical effacement and dilation during labor?

<p>Factors include uterine contractions, hormonal changes, and the position of the fetus.</p> Signup and view all the answers

What event marks the beginning of the second stage of labor?

<p>The full dilation of the cervix.</p> Signup and view all the answers

What constitutes normal labor (eutocia)?

<p>Normal labor involves spontaneous onset at term, vertex presentation, minimal assistance during delivery, and no health complications for the mother or baby.</p> Signup and view all the answers

What initiates the synthesis of prostaglandins leading to labor?

<p>The synthesis is initiated by a rise in estrogen levels, glucocorticoids, and mechanical stretching in late pregnancy.</p> Signup and view all the answers

How can uterine distension affect the onset of labor?

<p>Uterine distension can activate the fetal hypothalamic-pituitary-adrenal axis, leading to increased production of hormones such as cortisol that facilitate labor.</p> Signup and view all the answers

What is the difference between normal delivery and labor?

<p>Delivery refers to the physical expulsion of the fetus, while labor is the series of physiological changes and contractions leading up to that expulsion.</p> Signup and view all the answers

How does the ratio of estrogen to progesterone influence the onset of labor?

<p>An alteration in the estrogen to progesterone ratio, rather than just a decrease in progesterone, is linked to the synthesis of prostaglandins, which facilitates labor.</p> Signup and view all the answers

Where are the major sites for prostaglandin synthesis located?

<p>The major sites for prostaglandin synthesis are the amnion and chorion near term.</p> Signup and view all the answers

What is considered abnormal labor (dystocia)?

<p>Abnormal labor occurs when there is a deviation from the defined parameters of normal labor, such as non-vertex presentation or complications affecting labor progression.</p> Signup and view all the answers

What role does intracellular calcium play in myometrial contraction during labor?

<p>Intracellular calcium activates calmodulin, which in turn activates MLCK, leading to phosphorylated myosin and actin, resulting in myometrial contraction.</p> Signup and view all the answers

What role do estrogen and oxytocin play in labor?

<p>Estrogen increases the release of oxytocin and enhances myometrial receptor synthesis, while oxytocin stimulates uterine contractions crucial for labor progression.</p> Signup and view all the answers

What factors can lead to a decrease in progesterone levels before labor?

<p>Factors include increased fetal production of DHEA-S and cortisol, which inhibit the conversion of fetal pregnenolone to progesterone.</p> Signup and view all the answers

How does abnormal fetal presentation impact labor?

<p>Abnormal fetal presentation can complicate the labor process, potentially leading to prolonged labor or necessitating interventions like cesarean delivery.</p> Signup and view all the answers

What is the effect of prostaglandins on the myometrial cells?

<p>Prostaglandins increase the excitability of myometrial cells and enhance gap junction formation.</p> Signup and view all the answers

What physiological changes occur in the uterus during labor?

<p>During labor, there is an increase in gap junction proteins, myometrial oxytocin receptors, and contraction-associated proteins due to uterine stretch.</p> Signup and view all the answers

Why is the termination of labor considered natural in normal labor?

<p>Natural termination in normal labor occurs spontaneously with minimal aid, reflecting a healthy progression of the labor process.</p> Signup and view all the answers

How does infection affect the process of labor initiation?

<p>Infection can lead to an increase in cytokines, which can trigger the processes necessary for labor initiation.</p> Signup and view all the answers

What mechanical changes in late pregnancy contribute to the onset of labor?

<p>Mechanical stretching of the uterus and cervix in late pregnancy induces biochemical changes that promote labor.</p> Signup and view all the answers

What role do a-adrenergic and β-adrenergic receptors play in the myometrium?

<p>α-receptors decrease cyclic AMP and promote uterine contraction, while β-receptors increase cyclic AMP, leading to uterine relaxation.</p> Signup and view all the answers

How does oxytocin affect prostaglandin synthesis during labor?

<p>Oxytocin stimulates the synthesis and release of prostaglandins E2 and F2α from the amnion and decidua.</p> Signup and view all the answers

What is the significance of receptor sensitivity and number changes for oxytocin during pregnancy?

<p>The number of oxytocin receptors increases throughout pregnancy, peaking during labor, enhancing the uterus's response to oxytocin.</p> Signup and view all the answers

What factors can lead to false labor pains, especially in primigravidae?

<p>False labor pains occur due to the stretching of the cervix and lower uterine segment, often seen more in first-time mothers.</p> Signup and view all the answers

Describe the Ferguson reflex and its influence on oxytocin levels.

<p>The Ferguson reflex is the maternal response to vaginal examination and amniotomy, causing a rise in plasma oxytocin levels.</p> Signup and view all the answers

What is prelabor and how does it relate to the onset of true labor?

<p>Prelabor, or the premonitory stage, can begin 2–3 weeks prior to true labor and may include signs of approaching delivery.</p> Signup and view all the answers

Explain the role of calcium ions in myometrial contraction.

<p>An increase in local free calcium ions enhances uterine contraction by activating myosin light chain kinase.</p> Signup and view all the answers

How do prostaglandins contribute to labor, especially during the expulsion of the placenta?

<p>Prostaglandins activate lysosomal enzyme systems, aiding in the expulsion of the placenta and controlling postpartum hemorrhage.</p> Signup and view all the answers

What is the main neurological factor involved in initiating labor?

<p>Labor may be initiated through nerve pathways involving adrenergic receptors in the myometrium.</p> Signup and view all the answers

What occurs to the presenting part of the fetus when lightening happens?

<p>The presenting part sinks into the true pelvis, signifying the incorporation of the lower uterine segment into the uterus wall.</p> Signup and view all the answers

What are the characteristics of a ripe cervix before the onset of labor?

<p>A ripe cervix is soft, 80% effaced, and is a key indicator of impending labor.</p> Signup and view all the answers

What impact does the engaged presenting part have on the mother’s urinary and digestive system?

<p>It may lead to increased frequency of micturition or constipation due to pressure on the bladder and bowel.</p> Signup and view all the answers

Which proteins are primarily involved in the uterine contractile system?

<p>The primary components are actin and myosin, which facilitate muscle contraction in the uterus.</p> Signup and view all the answers

What happens to the myometrial contractile response just before labor onset?

<p>The contractile response is initiated through alpha receptors located around the cervix and lower uterus.</p> Signup and view all the answers

How does the lower pole of the uterus react as labor approaches?

<p>The lower pole is actively pulled up around the presenting part, leading to cervical and uterine changes.</p> Signup and view all the answers

What role does calcium play in the myometrial contractile system?

<p>Calcium is essential as it contributes to the contraction of the myometrial cells.</p> Signup and view all the answers

Study Notes

Defining Labor

  • Labor is defined as regular uterine contractions combined with cervical change & dilatation.
  • The fetus is gradually pushed through the birth canal (consisting of the cervix, vagina & perineum).
  • The placenta is extruded and the uterus involutes.

Stages of Labor

  • First stage: Labor onset to complete dilation (10cm)
    • Latent phase: Nullipara can last up to 7 hours (dilation 0-4cm)
    • Active phase: More rapid (1-2cm/hour) (dilation 4-10cm)
  • Second stage: Complete dilation to delivery of the infant
  • Third stage: Delivery of fetus to delivery of the placenta
  • Fourth stage: After delivery of the placenta
  • Active management of 3rd stage of labor: Reduces PPH risk (15-5%)
    • IM injection of 10 IU oxytocin
    • Early clamping and cutting of umbilical cord.
    • Controlled cord traction

Mechanism of Labor

  • Engagement: Widest diameter of fetal head passes the pelvic brim.
  • Descent: Presenting part moves down the birth canal.
  • Flexion: Fetal head flexes minimizing diameter.
  • Internal rotation: Fetal head rotates to align with the pelvic outlet.
  • Restitution and external rotation: Head rotates back to original position.
  • Extension: Head extends as it passes under the pubic arch.
  • Delivery of the shoulders and fetal body:

Factors Affecting Labor Progress

  • Passageway: The pelvis, must be adequate for fetal passage.
  • Passenger: The fetus, including size, position, and presentation.
  • Powers: The strength and frequency of uterine contractions.
  • Psyche: Psychological state of the mother.
  • Prolonged Latent Phase:
    • Possible causes: inadequate cervical dilation, lack of fetal descent, or variations in maternal anatomy.
    • Management: monitoring, hydration, pain relief, and considering augmentation of labor.

Terminology

  • Presenting part: The fetal part that enters the pelvic inlet first.
  • Vertex: The area of the fetal skull bounded by the 2 parietal eminences & the anterior & posterior fontanelles.
  • Lie: The relationship between the longitudinal axis of the fetus and the mother’s uterus.
  • Station: The level of descent of the presenting part assessed on vaginal examination.
  • Engagement: The widest diameter (BPD) of the fetal head has passed the pelvic brim.
  • Amniotomy: Artificial rupture of the membranes.
  • Attitude: The relationship of the different parts of the fetus to each other, usually flexion.
  • Caput succedaneum: Edema over the presenting part of the head, common in prolonged labor.
  • Moulding: Change in the fetal skull to adapt to the maternal pelvis during passage.
  • Position: Describes the fetal occiput's relation to the maternal pelvis.
    • OA- occipito-anterior: Normal.
    • OP- occipito-posterior: Can lead to prolonged labor.
    • OT- occipito-transverse: Lateral position.

Monitoring

  • External CTG (Cardiotocography): Abdominal probe for fetal heart rate and contractions.
  • Internal electrode: Placed on the fetal skull vaginally.

Partogram

  • Graphic record of labor:
    • Cervical dilation
    • Uterine contraction frequency, strength, and duration.
    • Descent of the head
    • State of the membranes
    • Maternal wellbeing: BP, PR, Temp.
    • Fetal assessment

Analgesia

  • Loss of pain perception.
  • Can be local or systemic.
  • Options: Hypnosis, regional anesthesia, or opioids.
  • Importance: Provides pain relief and improves the patient’s experience during labor.

Complications of 3rd Stage of Labor

  • Improper management can lead to postpartum hemorrhage (PPH).
  • Signs of placental separation:
    • Cord lengthening
    • Small gush of blood
    • Rising of the uterine fundus above the umbilicus
  • Methods to control PPH:
    • Controlled cord traction
    • Oxytocin infusion
    • Manual evacuation of placenta under anesthesia

Fetal Monitoring

  • Auscultation: Listening to the fetal heart rate. Normal range is 110-160bpm.
  • Fetal distress: Secondary to hypoxia, infection, or anemia.

Patient Presentation for Management

  • 26-year-old primi gravid (first pregnancy):
    • Presenting to labor room: Regular uterine cramps every 4 minutes lasting 35 seconds.
    • Pelvic examination: Cervical dilation of 5 cm, 70% effacement, head at -3 station.
  • Stage of labor: Active phase of the first stage of labor.
  • Negative finding: Head at station -3 indicating the fetus is not yet fully engaged in the pelvis.
  • Management:
    • Ongoing monitoring of labor progress.
    • Fetal monitoring (CTG or auscultation).
    • Pain management.
    • Hydration.
    • Consideration of augmentation of labor if progress is slow.

What is Labor?

  • It is the expulsion of the babies and placenta from the uterus and body.
  • Begins when uterine contractions occur, causing cervical dilation and fetal descent.
  • Occurs at 37 weeks or earlier, which is then called preterm labor.
  • Delivery is the extraction of a viable fetus from the womb. Delivery does not have to be labor; it can happen through a Cesarean section.

Why does Labor Start?

  • The precise mechanism involved in labor is still unclear. However, a few hypotheses exist, and they include:
    • Uterine Distension: This is when the uterus is stretched by the baby and amniotic fluid which triggers labor.
    • Fetoplacental Contribution: The baby’s hypothalamus, pituitary, and adrenal glands activate and release hormones (CRH, ACTH, Cortisol) before labor starts.
    • Estrogen's Roles: This hormone plays a role in releasing oxytocin, increasing receptors for hormones and prostaglandins, stimulating the production of proteins, and increasing excitability of the myometrium.
    • Progesterone's Role: The fetus’s production of DHEA-S and cortisol inhibits progesterone which supports an overall decrease in progesterone levels before labor.
    • Prostaglandin's Role: Prostaglandins (E2 and F2a) are essential for initiating and maintaining labor. They are produced by the fetal membranes, amnion, and chorion, which all help initiate contraction and release more prostaglandins.
    • Oxytocin and Myometrial Oxytocin Receptors: Oxytocin receptors are concentrated in the fundus of the uterus and increase in number and sensitivity before labor.
    • Neurological Factors: Labor can occur in denervated uteruses but also due to nerve pathways.

How does Myometrial Contraction occur?

  • The contractile system involves:
    • Actin
    • Myosin
    • ATP
    • Myosin Light Chain Kinase
    • Ca++
  • Calcium ions bind to the myosin light chain kinase causing phosphorylation of myosin light chains.
  • Phosphorylated myosin binds to actin causing contraction.
  • The decrease in calcium ions releases the actin and myosin, which then relaxes the uterus.

What is False Labor?

  • False labor, or spurious labor, is more common in first-time mothers than in mothers who have had children before.
  • It occurs a couple of weeks before actual labor starts.
  • Pains stem from stretching of the cervix and lower uterus causing irritation to the nearby ganglia.

What is Prelabor?

  • Prelabor (premonitory stage) starts 2-3 weeks before true labor in first-time mothers and a few days before in mothers who have had children before.
  • It can include:
    • Lightening: This occurs when the baby’s head drops down into the pelvis.
    • Cervical Changes: The cervix becomes ripe, meaning it softens and begins to prepare for dilation.

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Description

This quiz explores the definitions and stages of labor, including the mechanisms involved in the process. Test your knowledge on the active management techniques for the third stage of labor and understand the physiological changes occurring during delivery. Get ready to deepen your understanding of obstetric nursing practices.

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