Obstetrics: Stages of Labor and Monitoring

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Questions and Answers

What is the normal range for fetal heart rate monitoring?

100-120 beats per minute

160-180 beats per minute

120-160 beats per minute (correct)

80-100 beats per minute

Which stage of labor refers to the delivery of the placenta?

3rd stage (correct)

1st stage

2nd stage

4th stage

Which sign is considered the most reliable indicator of placental separation?

Uterine contraction

Lengthening of the umbilical cord (correct)

Amount of blood escapes from the vagina

Fundus of the uterus rises

What is the typical measurement range for a newborn's head circumference?

33 cm - 35 cm Signup and view all the answers

In boys, which of the following is NOT a characteristic change during puberty?

Breast development Signup and view all the answers

Which hormone is primarily responsible for triggering pubertal development?

Gonadotropin-releasing hormone (GnRH) Signup and view all the answers

What common intervention is applied during late deceleration due to utero-placental insufficiency?

Left lateral position Signup and view all the answers

What is indicated by a measurement of less than 30 cm for the chest circumference of a newborn?

Sign of prematurity Signup and view all the answers

What is one purpose of conducting an internal examination during pregnancy?

To confirm the process of pregnancy Signup and view all the answers

Which of the following signs are assessed during an internal examination to confirm early pregnancy?

Chadwick’s, Goodell’s, and Hegar’s Sign Signup and view all the answers

During a pelvic examination, which of the following is NOT typically assessed?

Blood pressure and heart rate Signup and view all the answers

What is the primary role of FSH in the menstrual cycle?

Maturation of the ovum Signup and view all the answers

Why is estimating pelvic size particularly important in the third trimester?

To determine if a Cesarean section is likely needed based on CPD Signup and view all the answers

What triggers ovulation during the menstrual cycle?

Surge of LH from the pituitary gland Signup and view all the answers

Which assessment is NOT included in evaluating pelvic adequacy?

Fetal heartbeat rate Signup and view all the answers

What phase of the menstrual cycle is characterized by the shedding of the thickened endometrium?

Menstrual phase Signup and view all the answers

What is the primary purpose of a CBC during the initial visit in pregnancy?

To detect anemia Signup and view all the answers

What is produced by the graafian follicle?

Estrogen and follicular fluid Signup and view all the answers

When is the CBC typically repeated during pregnancy?

At 28-32 weeks gestation Signup and view all the answers

When does the endometrium become very thin?

Immediately after menstrual flow begins Signup and view all the answers

What happens if conception occurs after ovulation?

The corpus luteum remains throughout most of the pregnancy Signup and view all the answers

Which blood test specifically screens for syphilis during pregnancy?

Serologic test Signup and view all the answers

What term describes the first phase of the menstrual cycle following menstruation?

Proliferative phase Signup and view all the answers

Which hormone primarily influences the growth of the uterine lining during the second half of the menstrual cycle?

LH Signup and view all the answers

What is the predominant appearance of linea nigra in pregnant individuals?

A black line in the midline of the abdomen from the sternum or umbilicus to the symphysis pubis Signup and view all the answers

When is chloasma typically observed during pregnancy?

After the sixteenth week of pregnancy Signup and view all the answers

What sign indicates significant uterine changes within the first trimester?

Hegar's sign Signup and view all the answers

What is a common cause of fatigue among pregnant individuals during the first trimester?

Anemia, infection, emotional stress, or malignant disease Signup and view all the answers

What is ballottement, and when is it typically observed?

A gentle tapping felt when the fetus floats upwards during a bimanual examination at 16 to 20 weeks Signup and view all the answers

What does an increase in the size of the uterus suggest during pregnancy?

It may correlate with the duration of the pregnancy Signup and view all the answers

What characterizes the probable signs of pregnancy?

Signs commonly noted by health providers during examination Signup and view all the answers

When does the uterus typically rise above the symphysis pubis during pregnancy?

By the twelfth week Signup and view all the answers

Which of the following describes the characteristics of an introvert?

Prefers alone time and struggles with emotional expression Signup and view all the answers

What is a common psychological task for mothers during pregnancy?

Seeking acceptance of the child by others Signup and view all the answers

During the first trimester, what percentage of pregnancies are reported as unintended, unwanted, or mistimed?

50% Signup and view all the answers

What emotional responses may partners experience during the first trimester?

Pride, happiness, jealousy, or loss Signup and view all the answers

Which sign of pregnancy is considered a positive (diagnostic) sign?

Fetal heartbeat detected by a healthcare provider Signup and view all the answers

What primary focus does the mother have in the third trimester?

Nest building and preparing for parenthood Signup and view all the answers

What is a potential emotional experience for the partner during the second trimester?

Experiencing confusion due to the mother's mood swings Signup and view all the answers

What is often referred to as a second turning point in the second trimester of pregnancy?

Quickening Signup and view all the answers

Study Notes

Acronyms

EDC: Expected Date of Confinement
EDD: Expected Date of Delivery
AOG: Age of Gestation
LMP: Last Menstrual Period

Fetal Heart Rate Monitoring

Normal fetal heart rate is 120-160 beats per minute

Stages of Labor

1st Stage: Dilatation of the cervix
2nd Stage: Delivery of the baby
3rd Stage: Delivery of the placenta
4th Stage: First 2 hours of recovery (postpartum)

Placental Examination

Cotyledons are the contents inside the placenta and there are typically 15-20
Beware of:
- Spurt of blood
- Placenta Cord – cut off
Signs of Placental Separation:
- Uterine contraction (Calkin Sign) *globular and hard
- The fundus of the uterus rises in the abdomen
- Lengthening of the umbilical cord (most reliable)
- An amount of blood suddenly escapes from the vagina

Internal Vaginal Examination

Effacement (thickness): Measured in percentage (%)
Dilatation (opening): Measured in centimeters (cm)
Bag of Water: BOW
Station: (+)(-)
Presentation: Cephalic/Breach

Anthropometric Measurement

Head: 33cm - 35cm
Chest: 30.5cm - 33cm (measure at the level of the nipple)
- Less than 30cm is indicative of prematurity
Abdomen: 30.5cm - 33cm
Length: 45cm – 55cm (head to heel, follow contours)

Late Deceleration

Indicates utero-placental insufficiency
Considered an emergency requiring strict monitoring
Interventions:
- Position the patient, left lateral
- Change to plain IV if there is oxytocin drip
- Put oxygen

Variable Deceleration

Indicates cord prolapse (rupture of the bag of water)
Considered serious
Interventions:
- Position the patient, left lateral
- Change to plain IV if there is oxytocin drip
- Put oxygen

Pubertal Development

Puberty is the stage of life where secondary sex changes begin
The hypothalamus synthesizes and releases gonadotropin-releasing hormone (GnRH) which stimulates the anterior pituitary to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

Puberty Changes in Girls

Growth spurt
Increase in transverse diameter of the pelvis
Breast development
Growth of pubic hair
Onset of menstruation
Growth of axillary hair
Vaginal secretions

Puberty Changes in Boys

Increase in weight
Growth of testes
Growth of face, axillary, and pubic hair
Voice changes
Penile growth
Increase in height
When estrogen (produced by the ovaries) rises, release of the hormone is repressed, and menstrual cycles do not occur (this is the principle that birth control pills use to eliminate menstrual flow)

Pituitary Gland

The anterior lobe of the pituitary gland produces two hormones that influence the menstrual cycle:
- Follicle-stimulating hormone (FSH) responsible for maturation of the ovum
- Luteinizing hormone (LH) responsible for ovulation (release of the mature egg cell from the ovary) and growth of the uterine lining during the second half of the menstrual cycle
FSH and LH are called gonadotropic hormones as they cause growth (trophy) in the gonads (ovaries)
One ovarian primordial follicle is activated by FSH to begin to grow and mature
The follicle produces follicular fluid, containing a high concentration of estrogen (mainly estradiol) and some progesterone
The mature follicle is called a graafian follicle
On day 14, the ovum divides by mitotic division
LH from the pituitary and prostaglandins cause the graafian follicle to rupture, resulting in ovulation
If fertilization occurs, the corpus luteum remains throughout most of the pregnancy (approximately 16 to 20 weeks)

First Phase of Menstrual Cycle (Proliferative)

Immediately after a menstrual flow (days 1-5 of a cycle), the endometrium (uterine lining) is very thin
This phase is also termed interchangeably the proliferative, estrogenic, follicular, or postmenstrual phase
The follicular phase is characterized by menstruation, when the thickened endometrium is shed because no egg was fertilized or implanted

Skin Changes

Linea Nigra:
- A black line in the midline of the abdomen that may run from the sternum or umbilicus to the symphysis pubis
- Appears on the primigravida by the third month and keeps pace with the rising height of the fundus
- The entire line may appear on the multigravida before the third month
- May be a probable sign of pregnancy if the patient has never been pregnant
Chloasma:
- Called the “Mask of Pregnancy”
- A bronze type of facial coloration seen more on dark-haired women
- Seen after the sixteenth week of pregnancy
Fingernails:
- Some patients note marked thinning and softening by the sixth week

Fatigue

Common complaint during the first trimester
Can also be caused by anemia, infection, emotional stress, or malignant disease

Positive Home Pregnancy Tests

Not always accurate but can be effective if performed correctly

Probable Signs of Pregnancy

Signs commonly noted by health providers upon examination of the client and include uterine changes; abdominal changes; cervical changes; basal body temperature; a positive pregnancy test and fetal palpation

Uterine Changes

By the twelfth week, the uterus rises above the symphysis pubis and should reach the xiphoid process by the 36th week of pregnancy
The uterus increases in width and length approximately five times its normal size; its weight increases from 50 grams to 1,000 grams
Hegar's Sign: Softening of the lower uterine segment just above the cervix, noted by the sixth to eighth week of pregnancy
Ballottement: Demonstrated during the bimanual examination done at the 16th to 20th week. The fetus floats upwards, then sinks back and a gentle tap is felt on the finger

Abdominal Changes

Correspond to changes in the uterus. As the uterus grows, the abdomen gets larger.
Abdominal enlargement alone is not a sign of pregnancy.

Assessment of Systems

General appearance and mental status:
- Posture
- Manner of dressing
- Manner of speaking
- Facial expression
- Presence of bandages and dressings

Prenatal Assessment

Measurement of Fundal Height & Fetal Heart Sounds
Internal Examination (IE) or Vaginal Examination:
- Confirms the process of pregnancy
- Cervix size
- Pelvic abnormalities
- Detects early pregnancy and gestations Chadwick’s, Goodell’s, and Hegar’s Sign
- After 34 weeks: assesses consistency of the cervix, length and dilatations, fetal presenting part, bony architecture of pelvis, anomalies of the vagina and perineum
Pelvic Examination and Estimating Pelvic Size:
- Done in the third trimester to determine CPD (cephalopelvic disproportion)
- Reveals information on the health of both external and internal reproductive organs
- Pelvic Examination:
  - External genitalia:
    - HSV 2
    - Skene’s and Bartholin’s glands infection
    - Rectocele
    - Cystocele
  - Internal Genitalia:
    - Position and color of cervix, pap smear
    - Signs of infection
    - Abnormal appearance
    - Position, contour, consistency, and tenderness of pelvic organs
    - Strength and irregularity of posterior vaginal wall
- Estimating Pelvic Size:
  - Assessment of Pelvic Adequacy (clinical pelvimetry):
    - Diagonal conjugate
    - True conjugate or conjugate vera
    - Ischial tuberosity diameter

Laboratory Assessment

Blood studies:
- CBC:
  - Initial visit
  - Repeated at 28-32 weeks
  - To detect anemia
- Genetic screening
- Serologic test for syphilis
- Blood typing (including RH factor)

Psychological Tasks of the Mother

Ensuring safe passage through pregnancy, labor and birth
Seeking acceptance of this child by others
Seeking of commitment & acceptance of self as mother to the infant (binding in)
Learning to give of one’s self on behalf of one’s child

First Trimester: Accepting the pregnancy

50% of all pregnancies are unintended, unwanted or mistimed.
Women sometimes experience disappointment, anxiety or ambivalence
Partner may go through some changes also
Partner should give emotional support
May feel proud, happy, jealous or loss

Second Trimester: Accepting the baby

Second turning point is often quickening (feeling fetal movement)
Proof of the child’s existence
Anticipatory role playing
May accept at conception, at birth or later
How well she follows prenatal instructions
Partner may feel left out, he may increase his work, he may have misinformation
Educate both partners

Third Trimester: Preparing for Parenthood

“Nest building” (preparing for the baby's arrival)
Attending prenatal classes or parenting classes
Reworking developmental tasks
Working through previous life experiences
Woman’s relationship with her parents, particularly her mother
Dealing with fear of dying
Needs confidence in health care providers
Men may need to reconcile feelings toward fathers and learn a new pattern of behavior
Role-playing and fantasizing
Second step in preparing of parenthood
Spend time with other mothers to learn how to be a mother. Needs good role models

Signs of Pregnancy

Presumptive (Subjective)
Probable (Objective)
Positive (Diagnostic)

Presumptive Signs of Pregnancy

Breast changes
Amenorrhea (absence of menstruation)
Nausea and vomiting
Urinary frequency
Fatigue
Quickening (feeling fetal movement)
Skin changes (linea nigra, chloasma)
Positive home test

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Description

This quiz covers key concepts related to obstetrics, including acronyms, fetal heart rate monitoring, stages of labor, placental examination, and internal vaginal examination. Test your knowledge of these essential terms and procedures in childbirth management.