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Questions and Answers
What is NOT a criterion for normal labour?
What is NOT a criterion for normal labour?
The first phase of labour is characterized by the uterus being responsive.
The first phase of labour is characterized by the uterus being responsive.
False
What hormone does the fetal hypothalamus release to initiate labour?
What hormone does the fetal hypothalamus release to initiate labour?
Corticotropin releasing hormone (CRH)
During the Myometrial Activation phase, there is a functional withdrawal of ______.
During the Myometrial Activation phase, there is a functional withdrawal of ______.
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Match the phases of labour with their descriptions:
Match the phases of labour with their descriptions:
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What characterizes true labour pain in comparison to false labour pain?
What characterizes true labour pain in comparison to false labour pain?
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Cervical ripening involves the hardening of the cervix due to reduced water content.
Cervical ripening involves the hardening of the cervix due to reduced water content.
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What is the primary purpose of the Bishop score in relation to labour?
What is the primary purpose of the Bishop score in relation to labour?
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The first stage of labour is characterized by true labour pains that lead to full dilation of the cervix to _____ cm.
The first stage of labour is characterized by true labour pains that lead to full dilation of the cervix to _____ cm.
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Match each stage of labour with its description:
Match each stage of labour with its description:
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What is considered an adequate uterine contraction?
What is considered an adequate uterine contraction?
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The measurement of uterine contractions should be observed over a 20-minute period every 30 minutes.
The measurement of uterine contractions should be observed over a 20-minute period every 30 minutes.
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What is the range of intrauterine pressure considered normal during uterine contractions?
What is the range of intrauterine pressure considered normal during uterine contractions?
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Adequate uterine contractions involve measuring ________ for a duration of 10 minutes.
Adequate uterine contractions involve measuring ________ for a duration of 10 minutes.
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Match the following uterine contraction terms with their definitions:
Match the following uterine contraction terms with their definitions:
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Which of the following is NOT a recommended practice to prevent perineal tears during the second stage of labour?
Which of the following is NOT a recommended practice to prevent perineal tears during the second stage of labour?
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Fetal heart rate auscultation should be documented every hour during labor.
Fetal heart rate auscultation should be documented every hour during labor.
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What is the recommended interval for monitoring uterine contractions during labor?
What is the recommended interval for monitoring uterine contractions during labor?
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In the event of ruptured membranes, temperature should be monitored every _____
In the event of ruptured membranes, temperature should be monitored every _____
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Match the monitoring time intervals with the risk level during the first and second stages of labor:
Match the monitoring time intervals with the risk level during the first and second stages of labor:
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What is the normal baseline fetal heart rate (FHR)?
What is the normal baseline fetal heart rate (FHR)?
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Fetal heart rate deceleration includes early, late, and variable deceleration.
Fetal heart rate deceleration includes early, late, and variable deceleration.
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What is the recommended position for a mother during labor according to the WHO labor care guide?
What is the recommended position for a mother during labor according to the WHO labor care guide?
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Abnormal FHR, defined as above ______ bpm, should be monitored as per WHO guideline.
Abnormal FHR, defined as above ______ bpm, should be monitored as per WHO guideline.
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Match the fetal position with its description:
Match the fetal position with its description:
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What does a yellow alert indicate in terms of cervical dilatation on the partogram?
What does a yellow alert indicate in terms of cervical dilatation on the partogram?
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In the partogram, the upper section is dedicated to maternal condition.
In the partogram, the upper section is dedicated to maternal condition.
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What does G₂P₁ indicate?
What does G₂P₁ indicate?
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Amniotic fluid molding is represented in the partogram as __________, along with other vital signs.
Amniotic fluid molding is represented in the partogram as __________, along with other vital signs.
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Match the partogram sections with their focus:
Match the partogram sections with their focus:
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What is the adequate number of contractions in 10 minutes during labor?
What is the adequate number of contractions in 10 minutes during labor?
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Tachysystole is characterized by fewer than 5 contractions in 10 minutes.
Tachysystole is characterized by fewer than 5 contractions in 10 minutes.
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What is the normal range of intrauterine pressure during the second and third stages of labor?
What is the normal range of intrauterine pressure during the second and third stages of labor?
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The predominant contraction site in the uterus during labor is the ______.
The predominant contraction site in the uterus during labor is the ______.
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Match the uterine contraction metrics with their corresponding values:
Match the uterine contraction metrics with their corresponding values:
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What is tracked in the alert column of the partogram?
What is tracked in the alert column of the partogram?
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Oral fluid and solid food intake is advisable during the supportive care section of labor.
Oral fluid and solid food intake is advisable during the supportive care section of labor.
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What does the 'yes/no' field under the companion section indicate?
What does the 'yes/no' field under the companion section indicate?
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The section of the partogram that includes baseline FHR is called the ______ section.
The section of the partogram that includes baseline FHR is called the ______ section.
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Match the following supportive care parameters with their descriptions:
Match the following supportive care parameters with their descriptions:
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Which of the following is NOT included in the care of woman section of the partogram?
Which of the following is NOT included in the care of woman section of the partogram?
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Urine analysis for protein and acetone is a part of monitoring the woman's care during labor.
Urine analysis for protein and acetone is a part of monitoring the woman's care during labor.
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What is recorded in the partogram during the progress of labor?
What is recorded in the partogram during the progress of labor?
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What does the alert action line in a partogram indicate?
What does the alert action line in a partogram indicate?
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The active phase of labor begins at 5 cm dilatation of the cervix according to the modified WHO partogram.
The active phase of labor begins at 5 cm dilatation of the cervix according to the modified WHO partogram.
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During labor, it is important to monitor the woman's _____ rate as part of her care.
During labor, it is important to monitor the woman's _____ rate as part of her care.
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Match the types of vital signs with their respective units of measure:
Match the types of vital signs with their respective units of measure:
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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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The Friedman curve is characterized by a __________ shape.
The Friedman curve is characterized by a __________ shape.
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Match the partogram components with their descriptions:
Match the partogram components with their descriptions:
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Study Notes
Pre-Labour State
- Lightening occurs when the fetal head descends into the pelvis, leading to a decrease in fundal height.
- False labor pains are irregular and non-progressive, and do not lead to cervical dilatation.
- Cervical ripening involves softening and dilation of the cervix due to prostaglandins. This involves changes in connective tissue, including decreased cross-linking of fibers, increased water content, and increased hyaluronic acid.
- The Bishop score is used to assess cervical readiness for induction of labor.
True vs. False Labour Pain
- True labor pains are regular, rhythmic, and progressive, increasing in intensity and frequency.
- False labor pains are irregular, non-progressive, and do not lead to cervical dilatation.
- True labor pains radiate to the back of the thigh, while false labor pains do not.
- A show, which is a mixture of mucosal blood and the mucus plug, is present in true labor but absent in false labor.
- The bag of membranes is present in true labor and not felt in false labor.
- Sedation, an enema, and rest do not alleviate true labor pains but may alleviate false labor pains.
Stages of Labour
- The first stage of labor begins with true labor pains and ends with full cervical dilation (10cm).
- The second stage of labor involves the delivery of the baby.
- The third stage of labor involves the delivery of the placenta.
- The fourth stage of labor is a 1-2 hour observation period after the delivery of the placenta.
Criteria for Normal Labour
- Normal labor includes spontaneous onset, term gestation (32-42 weeks), vertex presentation, uncomplicated delivery, and vaginal delivery.
Phases of Labour
- Uterine Quiescence: The uterus is unresponsive, the cervix is soft, and progesterone is the main hormone.
- Myometrial Activation/Preparatory Phase: Progesterone levels decrease, estrogen levels increase, and there is an increase in oxytocin and prostaglandin receptors. This phase also includes an increase in gap junctions and cervical ripening.
- Phase of Uterine Stimulation/Contraction: All stages of labor are included in this phase.
- Post-partum phase: This phase occurs after delivery.
Onset of Labour
- The fetal hypothalamus releases corticotropin-releasing hormone (CRH).
- The fetal pituitary gland releases adrenocorticotropic hormone (ACTH).
- The fetal adrenal gland releases dehydroepiandrosterone sulfate (DHEA-sulfate).
- The placenta converts DHEA-sulfate to estrogen.
- Estrogen causes uterine contractions.
Monitoring During Labour
- Maternal pulse and blood pressure are monitored hourly.
- Temperature is monitored hourly if the membranes have ruptured.
- Uterine contractions are monitored every 30 minutes.
- Pelvic examination is performed every 4 hours.
- Fetal heart rate (FHR) is auscultated and documented every 30 minutes.
Management of the Second Stage of Labour
- Recommended practices for preventing perineal tears include applying a warm compress to the perineum, performing a perineal massage, controlled delivery of the fetal head, and using the modified Ritgen maneuver.
- Routine episiotomy and fundal pressure are not recommended practices.
Pain Relief
- Pain relief during labor is recommended.
- A companion of choice is permitted during labor.
Monitoring Time Intervals
- For low-risk pregnancies, monitoring intervals during the first stage of labor are every 30 minutes, and during the second stage every 15 minutes.
- For high-risk pregnancies, monitoring intervals during the first stage of labor are every 15 minutes, and during the second stage every 5 minutes.
Who Labor Care Guide
- The baseline fetal heart rate should be within the normal range of 110-160 bpm.
- Abnormal FHR (less than 110 or greater than 160 bpm) should be monitored according to the WHO guidelines and documented every 30 minutes.
Partogram
- The partogram is a labor and delivery progress chart with sections for different aspects of patient care.
- It includes tracking sections for ruptured membranes, supportive care, the baby, the woman, and the progress of labor.
Types of Partograms
- Friedman Curve: The first partogram, featuring a sigmoid curve.
- Alert Action Line: Introduced by Phillpott & Castle, it indicates the expected minimum dilation during the active phase (1cm/hr).
- Modified WHO Partogram: Based on previous WHO recommendations, it includes the active phase (first and second phases of labor).
Modified WHO Partogram Details
- Fetal HR: Normally 110-160 bpm and recorded every 30 minutes.
- Amniotic Fluid: Intact membranes, colorless fluid, meconium stained fluid, or blood stained fluid.
- Moulding: Overlapping of cranial bones, with 0/x indicating no moulding, and +1, +2, +3 indicating increasing levels of moulding.
Uterine Contractions
- Uterine contractions originate in the corpus of the uterus and travel at a speed of 2cm/sec.
- The entire uterus takes 15 seconds to depolarize.
- The fundus is the predominant contraction site.
- Adequate contractions occur at least 3 times in 10 minutes, last for 45 seconds, and increase intrauterine pressure by 65-75 mmHg.
Strength of Contractions
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Palpable contractions are felt at 10 mmHg.
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Painful contractions occur at 15 mmHg.
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Cervical dilatation occurs at 20-25 mmHg.
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The first stage of labor requires 40-50 mmHg, while the second and third stages require 100-120 mmHg.
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The basal tone is 10-20 mmHg.
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Contractions should be monitored every 30 minutes.
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Note: 1 mvu = Strength of uterine contractions (in mmHg) x Number of contractions in 10 minutes.
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Blood flow to the uterus decreases during contractions.
Tachysystole
- Tachysystole involves more than 5 contractions in 10 minutes.
- Misoprostol is the most common cause of tachysystole, followed by oxytocin.
- Tachysystole can lead to fetal distress due to reduced blood supply.
- Management includes stopping oxytocin, turning the mother to the left lateral position, providing oxygen inhalation by mask, administering IV fluids if needed, and administering terbutaline (a uterine relaxant).
Hypotonic Contractions
- Hypotonic contractions lead to prolonged or slow labor progress.
- Management involves augmentation of labor through artificial rupture of membranes or oxytocin administration.
Precipitate Labor
- Precipitate labor is a rapid labor, with the entire process completed in less than 3 hours.
Labor and Puerperium
- The upper uterine segment is formed by the entire uterus and contracts during labor.
- The lower uterine segment is formed by the isthmus and passively dilates during labor.
- During the first stage of labor, the cervix effaces and becomes incorporated into the lower uterine segment.
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Description
Test your knowledge on the pre-labour state and distinctions between true and false labour pains. Understand key concepts such as cervical ripening, the Bishop score, and the characteristics of labour pain. This quiz is essential for anyone studying obstetrics or looking to refresh their knowledge on these vital topics.
