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Questions and Answers
What are the four essential components of labor?
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.
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?
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?
What roles do oxytocin and prostaglandins play in initiating labor?
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What is the time frame for the delivery of the placenta after the baby is born?
What is the time frame for the delivery of the placenta after the baby is born?
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Explain the differences between the latent and active phases of the first stage of labor.
Explain the differences between the latent and active phases of the first stage of labor.
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What should healthcare providers monitor for during the fourth stage of labor?
What should healthcare providers monitor for during the fourth stage of labor?
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What are the two main stages of labor besides the first stage?
What are the two main stages of labor besides the first stage?
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What stage of labor is the 26-year-old lady in based on her cervical dilatation and contractions?
What stage of labor is the 26-year-old lady in based on her cervical dilatation and contractions?
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Identify the negative finding from the pelvic examination in this case.
Identify the negative finding from the pelvic examination in this case.
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How is labor defined in the context of this case?
How is labor defined in the context of this case?
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What does the term 'presentation' refer to during childbirth?
What does the term 'presentation' refer to during childbirth?
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Explain the significance of the term 'station' in obstetrical assessment.
Explain the significance of the term 'station' in obstetrical assessment.
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What is the purpose of an amniotomy during labor?
What is the purpose of an amniotomy during labor?
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Describe 'caput succedaneum' and its common occurrence during labor.
Describe 'caput succedaneum' and its common occurrence during labor.
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What does 'moulding' refer to in the context of fetal delivery?
What does 'moulding' refer to in the context of fetal delivery?
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What is the significance of the sutures in fetal skull development during labor?
What is the significance of the sutures in fetal skull development during labor?
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Define the term ' cephalo-pelvic disproportion' in the context of labor.
Define the term ' cephalo-pelvic disproportion' in the context of labor.
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What is the normal position for a cephalic presentation during labor?
What is the normal position for a cephalic presentation during labor?
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List the series of positional changes the fetus undergoes during labor.
List the series of positional changes the fetus undergoes during labor.
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What does the first stage of labor encompass?
What does the first stage of labor encompass?
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What role does emotional support play during the management of labor?
What role does emotional support play during the management of labor?
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What is the typical duration of the active management of the third stage of labor?
What is the typical duration of the active management of the third stage of labor?
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How does monitoring fetal well-being contribute to labor management?
How does monitoring fetal well-being contribute to labor management?
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What is the recommended timing for administering 10 IU of oxytocin during delivery?
What is the recommended timing for administering 10 IU of oxytocin during delivery?
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What are three methods used when the placenta does not expel during controlled cord traction?
What are three methods used when the placenta does not expel during controlled cord traction?
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What is one key sign of placental separation during controlled cord traction?
What is one key sign of placental separation during controlled cord traction?
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What risks arise from improper management during the third stage of labor?
What risks arise from improper management during the third stage of labor?
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What is the normal fetal heart rate range during labor?
What is the normal fetal heart rate range during labor?
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What is continuous fetal monitoring, and why is it preferred?
What is continuous fetal monitoring, and why is it preferred?
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What does analgesia refer to in the context of labor pain management?
What does analgesia refer to in the context of labor pain management?
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What factors are assessed when monitoring maternal wellbeing during childbirth?
What factors are assessed when monitoring maternal wellbeing during childbirth?
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What percentage of women are likely to start labor within 2 weeks before or after their expected due date?
What percentage of women are likely to start labor within 2 weeks before or after their expected due date?
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What characterizes the onset of labor?
What characterizes the onset of labor?
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What is the major distinction between preterm labor and normal labor?
What is the major distinction between preterm labor and normal labor?
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What is still unclear about the initiation of human labor?
What is still unclear about the initiation of human labor?
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How does the clinical course differ among the stages of labor?
How does the clinical course differ among the stages of labor?
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Define 'active management of the third stage of labor'.
Define 'active management of the third stage of labor'.
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What key factors affect cervical effacement and dilation during labor?
What key factors affect cervical effacement and dilation during labor?
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What event marks the beginning of the second stage of labor?
What event marks the beginning of the second stage of labor?
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What constitutes normal labor (eutocia)?
What constitutes normal labor (eutocia)?
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What initiates the synthesis of prostaglandins leading to labor?
What initiates the synthesis of prostaglandins leading to labor?
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How can uterine distension affect the onset of labor?
How can uterine distension affect the onset of labor?
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What is the difference between normal delivery and labor?
What is the difference between normal delivery and labor?
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How does the ratio of estrogen to progesterone influence the onset of labor?
How does the ratio of estrogen to progesterone influence the onset of labor?
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Where are the major sites for prostaglandin synthesis located?
Where are the major sites for prostaglandin synthesis located?
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What is considered abnormal labor (dystocia)?
What is considered abnormal labor (dystocia)?
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What role does intracellular calcium play in myometrial contraction during labor?
What role does intracellular calcium play in myometrial contraction during labor?
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What role do estrogen and oxytocin play in labor?
What role do estrogen and oxytocin play in labor?
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What factors can lead to a decrease in progesterone levels before labor?
What factors can lead to a decrease in progesterone levels before labor?
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How does abnormal fetal presentation impact labor?
How does abnormal fetal presentation impact labor?
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What is the effect of prostaglandins on the myometrial cells?
What is the effect of prostaglandins on the myometrial cells?
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What physiological changes occur in the uterus during labor?
What physiological changes occur in the uterus during labor?
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Why is the termination of labor considered natural in normal labor?
Why is the termination of labor considered natural in normal labor?
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How does infection affect the process of labor initiation?
How does infection affect the process of labor initiation?
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What mechanical changes in late pregnancy contribute to the onset of labor?
What mechanical changes in late pregnancy contribute to the onset of labor?
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What role do a-adrenergic and β-adrenergic receptors play in the myometrium?
What role do a-adrenergic and β-adrenergic receptors play in the myometrium?
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How does oxytocin affect prostaglandin synthesis during labor?
How does oxytocin affect prostaglandin synthesis during labor?
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What is the significance of receptor sensitivity and number changes for oxytocin during pregnancy?
What is the significance of receptor sensitivity and number changes for oxytocin during pregnancy?
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What factors can lead to false labor pains, especially in primigravidae?
What factors can lead to false labor pains, especially in primigravidae?
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Describe the Ferguson reflex and its influence on oxytocin levels.
Describe the Ferguson reflex and its influence on oxytocin levels.
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What is prelabor and how does it relate to the onset of true labor?
What is prelabor and how does it relate to the onset of true labor?
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Explain the role of calcium ions in myometrial contraction.
Explain the role of calcium ions in myometrial contraction.
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How do prostaglandins contribute to labor, especially during the expulsion of the placenta?
How do prostaglandins contribute to labor, especially during the expulsion of the placenta?
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What is the main neurological factor involved in initiating labor?
What is the main neurological factor involved in initiating labor?
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What occurs to the presenting part of the fetus when lightening happens?
What occurs to the presenting part of the fetus when lightening happens?
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What are the characteristics of a ripe cervix before the onset of labor?
What are the characteristics of a ripe cervix before the onset of labor?
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What impact does the engaged presenting part have on the mother’s urinary and digestive system?
What impact does the engaged presenting part have on the mother’s urinary and digestive system?
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Which proteins are primarily involved in the uterine contractile system?
Which proteins are primarily involved in the uterine contractile system?
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What happens to the myometrial contractile response just before labor onset?
What happens to the myometrial contractile response just before labor onset?
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How does the lower pole of the uterus react as labor approaches?
How does the lower pole of the uterus react as labor approaches?
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What role does calcium play in the myometrial contractile system?
What role does calcium play in the myometrial contractile system?
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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
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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
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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.
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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.
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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
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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).
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Signs of placental separation:
- Cord lengthening
- Small gush of blood
- Rising of the uterine fundus above the umbilicus
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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
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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.
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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.