Physiology of Normal Labor
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Which of the following factors primarily influences the relationship of body parts in a fetus during labor?

  • Fetal lie (correct)
  • Fetal station
  • Fetal position
  • Fetal attitude

What is the purpose of molding in the fetal head during delivery?

  • To facilitate fetal engagement
  • To decrease the size and shape of the fetal head (correct)
  • To improve fetal attitude
  • To enhance fetal presentation

At what age does the anterior fontanelle typically close?

  • 2 years
  • 6-8 weeks (correct)
  • 3-4 months
  • 12-18 months

Which suture is located between the two frontal bones in a fetal skull?

<p>Frontal suture (A)</p> Signup and view all the answers

In primipara patients, when does engagement typically occur in relation to labor?

<p>10-14 days before labor (C)</p> Signup and view all the answers

What is the function of sutures in the fetal skull?

<p>To allow for flexibility during birth (D)</p> Signup and view all the answers

Which fetal position refers to the relationship of the presenting part to the maternal pelvis?

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

What is the shape of the posterior fontanelle in a fetal skull?

<p>Triangular-shaped (C)</p> Signup and view all the answers

What is the primary method used for placental separation during labor?

<p>Schultze’s mechanism (C)</p> Signup and view all the answers

What is the typical duration for placental separation in both primipara and multipara?

<p>10-30 minutes (B)</p> Signup and view all the answers

During placental delivery, what is the outcome associated with Duncan’s mechanism?

<p>Higher blood loss and risk of retained fragments (D)</p> Signup and view all the answers

What is a critical observation during the fourth stage of labor?

<p>Monitoring for uterine relaxation and bleeding (A)</p> Signup and view all the answers

What is the role of controlled cord traction during placental expulsion?

<p>To apply gentle pressure on the uterine fundus (B)</p> Signup and view all the answers

What is the cervical dilatation range during the latent phase of the first stage of labor?

<p>1-3 cm (C)</p> Signup and view all the answers

Which characteristic best describes the maternal behavior during the active phase of the first stage of labor?

<p>Irritable and uncooperative (A)</p> Signup and view all the answers

What is the typical frequency of uterine contractions during the transitional phase of the first stage of labor?

<p>5/10 to 6/10 minutes (B)</p> Signup and view all the answers

How long do uterine contractions last during the active phase of the first stage of labor?

<p>31-60 seconds (A)</p> Signup and view all the answers

What degree of effacement is typically reached during the transitional phase?

<p>100% (B)</p> Signup and view all the answers

What is a primary characteristic of uterine contractions during the second stage of labor?

<p>They last longer and are more frequent. (B)</p> Signup and view all the answers

When does the rupture of the bag of water typically occur during labor?

<p>By the end of the first stage (A)</p> Signup and view all the answers

What change in maternal behavior commonly occurs during the second stage of labor?

<p>Involuntary bearing down (A)</p> Signup and view all the answers

Which statement best describes the concept of 'lightening' in the context of pregnancy?

<p>It is the descent of the fetal head into the true pelvis, observed by the sinking of the uterus. (B)</p> Signup and view all the answers

What is the primary purpose of the intermittent nature of uterine contractions?

<p>To allow for rest and restoration of utero-placental circulation. (D)</p> Signup and view all the answers

In what way does effacement of the cervix differ between primiparas and multiparas?

<p>Multi-para women may have dilation proceed before effacement is complete. (D)</p> Signup and view all the answers

What does 'retraction' refer to in the context of uterine contractions?

<p>The retention of some muscle shortening after contractions. (A)</p> Signup and view all the answers

What indicates the true dilation of the cervix?

<p>Cervix measures 0 cm in length. (B)</p> Signup and view all the answers

Which of the following best describes the characteristics of Braxton Hicks contractions?

<p>They can be mistaken for true labor contractions and are often irregular. (A)</p> Signup and view all the answers

Which segment of the uterus is described as 'passive' during labor?

<p>The lower segment, which effaces the cervix. (A)</p> Signup and view all the answers

At what point does the first stage of labor end?

<p>When the cervix becomes fully dilated. (B)</p> Signup and view all the answers

How is 'fetal station' defined in obstetrics?

<p>The relationship between the presenting part and the maternal pelvic ischial spines. (A)</p> Signup and view all the answers

What does the term 'effacement' refer to in pregnancy?

<p>The shortening of the cervical canal from its original length. (B)</p> Signup and view all the answers

During which stage of labor is the fetus expelled from the uterus?

<p>Second stage (D)</p> Signup and view all the answers

What is the expected duration of the fourth stage of labor?

<p>1-2 hours (C)</p> Signup and view all the answers

What is the significance of the 'show' in the context of labor?

<p>It refers to the expulsion of the mucus plug streaked with blood. (A)</p> Signup and view all the answers

What is the effect of contractions in the upper segment of the uterus?

<p>They promote thickening and shortening of that segment. (B)</p> Signup and view all the answers

What change is observed in the cervix as it progresses toward labor?

<p>It softens and becomes butter-soft at term. (A)</p> Signup and view all the answers

What occurs during the third stage of labor?

<p>The expulsion of the placenta and membranes. (B)</p> Signup and view all the answers

What happens to the anal orifice during the displacement of the pelvic floor?

<p>It gapes until the opening is 2.5 cm in diameter. (A)</p> Signup and view all the answers

During the second stage of labor, which of the following is NOT a sign observed?

<p>Cervical dilation of less than 5 cm. (A)</p> Signup and view all the answers

What does the term 'descent' refer to during labor?

<p>The progress of the presenting part through the pelvis. (A)</p> Signup and view all the answers

What occurs to the fetal head during the internal rotation process?

<p>It rotates about 45 degrees anteriorly to the midline. (C)</p> Signup and view all the answers

Which force is NOT responsible for the descent during labor?

<p>Maternal breathing techniques. (C)</p> Signup and view all the answers

What is the significance of flexion during labor?

<p>It leads to the change in presenting skull diameter. (D)</p> Signup and view all the answers

What emotional state may a woman exhibit during the second stage of labor?

<p>Apprehension and irritability. (A)</p> Signup and view all the answers

Which option describes the initial shape of the introitus during labor?

<p>An antero-posterior slit. (C)</p> Signup and view all the answers

Flashcards

Fetal Head Bones

The skull bones of a fetus (2 frontal, 2 parietal, 2 temporal, 1 occipital).

Sutures

Fibrous bands connecting the fetal skull bones.

Fontanelles

Junction points of fetal skull sutures with gaps.

Anterior Fontanelle

Largest diamond-shaped fontanelle between frontal and parietal bones.

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Posterior Fontanelle

Small triangular fontanelle between parietal and occipital bones.

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Molding

Overlapping of fetal skull bones during delivery, reducing size.

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Engagement

Fetal presenting part reaching the pelvis's ischial spines.

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Engagement in Primipara

Engagement occurs 10-14 days before labor begins.

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Fetal Station

The relationship of the presenting part of the fetus to the level of the maternal ischial spines, measured in centimeters.

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Floating Presenting Part

When a presenting part of the fetus is not engaged (not touching the ischial spines).

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Dipping Presenting Part

A presenting part that is descending but has not yet reached the ischial spines.

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Lightening

The sinking of the uterus, noticeable by a descent of the abdomen, often the setting of the fetal head in the true pelvis.

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Cervical Ripening

A change in the cervix leading up to labor, becoming softer. (Goodell's sign, at term butter-soft, tips forward)

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Braxton Hicks Contractions

Irregular, painless contractions that occur in the weeks leading up to labor.

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Show

The expulsion of the mucus plug, possibly streaked with blood, during labor.

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Uterine Contractions: Intermittent

Uterine contractions are rhythmic but have periods of relaxation between them. This allows for rest of the muscles, restoration of blood flow to the placenta, and fetal oxygenation.

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Uterine Retraction

During labor, uterine muscles don't fully relax between contractions. They retain some shortening, known as retraction. This helps push the fetus down and out.

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Uterine Polarity

The uterus divides into two segments during labor: the upper segment contracts and retracts to expel the fetus, while the lower segment thins out and helps the cervix open.

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Upper Uterine Segment

The upper part of the uterus that contracts and retracts, becoming thicker and expelling the fetus.

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Lower Uterine Segment

The lower part of the uterus that thins out and helps the cervix to open during labor.

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Placental Separation Mechanisms

There are two primary ways the placenta detaches from the uterine wall: Schultze's mechanism (central separation, fetal side presenting) and Duncan's mechanism (separation at the lower pole, maternal side presenting).

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Schultze's Mechanism

The placenta separates centrally, delivering like an inverted umbrella with the fetal surface presenting followed by membranes and a placental clot.

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Duncan's Mechanism

The placenta separates at its lower pole, delivering sideways with the maternal surface presenting and a potential for more blood loss and retained fragments.

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Placental Expulsion

The placenta is usually expelled through a combination of natural maternal bearing-down effort, gentle pressure on the contracted uterus by a physician, and controlled cord traction.

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Fourth Stage of Labor

The recovery period after delivery lasting 1-2 hours. It's crucial to monitor the mother's condition for uterine relaxation and bleeding.

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Pelvic Floor Displacement

The bladder moves up into the abdomen during labor, providing more space in the pelvis for the baby's head to pass through.

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Pressure on Rectum

The descending baby's head puts pressure on the rectum, causing a feeling of needing to defecate.

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Anal Gap

During labor, the anus opens up to a maximum of 2.5 centimeters in diameter.

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Leg Cramps

Leg cramps can occur during labor due to pressure on the sacral nerve from the descending baby.

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Head Visible Then Disappears

During contractions, the baby's head might appear at the vaginal opening, but then disappear between contractions.

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Perineum Bulging

The perineum area between the vagina and anus stretches and bulges out as the baby descends.

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Introitus Shape Change

The vaginal opening changes shape during labor, gradually widening from a slit to an oval and finally a circle.

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Descent of the Presenting Part

The baby's head or buttocks (the presenting part) descends through the pelvis during labor.

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Dilatation

The widening of the cervix, measured in centimeters, during labor. It typically progresses from 1-3 cm (latent phase), 4-7 cm (active phase), and 8-10 cm (transitional phase).

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Uterine Contractions Frequency

How often uterine contractions occur during labor. Frequency is measured in contractions per 10 minutes, ranging from 1-2 (latent phase), 3-4 (active phase), and 5-6 (transitional phase).

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Uterine Contraction Duration

The length of time each uterine contraction lasts during labor. It typically increases from 15-30 seconds (latent phase), 31-60 seconds (active phase), to 60-90 seconds (transitional phase).

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Uterine Contraction Intensity

The strength of uterine contractions during labor, described as mild (latent phase), moderate (active phase), and severe (transitional phase).

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Involuntary Bearing Down

The uncontrollable urge to push that occurs during labor, especially during the second stage. This is driven by the contractions of the abdominal muscles and diaphragm.

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Rupture of the Bag of Water

The breaking of the amniotic sac, releasing amniotic fluid during labor. It typically occurs towards the end of the first stage but can happen earlier.

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Second Stage of Labor

The stage of labor where the baby is pushed out of the birth canal through contractions and physical pushing actions.

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Study Notes

Physiology of Normal Labor

  • Labor is the process of regular uterine contractions causing cervical changes, resulting in the delivery of a viable fetus and placenta.
  • Viability is the chance of a fetus surviving outside the uterus, usually after 28 weeks of pregnancy.
  • Normal labor is a complete and spontaneous delivery of a full-term, single, viable fetus through the natural birth canal, within 24 hours of the onset of true labor pains, without complications to the mother or newborn.
  • Duration of Normal Labor:
    • Primigravida (first pregnancy): 12-18 hours
    • Multigravida (subsequent pregnancies): 6-10 hours
  • Types of Labor (abnormal):
    • Prolonged labor: lasts longer than 24 hours
    • Precipitate labor: lasts less than 3 hours
    • Premature labor: occurs before 28-37 weeks of gestation

Content Outline

  • Definitions: Terms related to labor and viability.
  • Causes of Labor Onset (theories): Progesterone withdrawal, prostaglandin production, uterine distention, placental ischemia, and oxytocin stimulation.
  • Factors Affecting Labor (5Ps):
    • Passenger: Fetus, placenta, membranes, umbilical cord, blood, and amniotic fluid (size, position, attitude, and presentation of the fetus).
    • Passage: Birth canal and bony pelvis structure.
    • Power: Uterine contractions (frequency, intensity, and duration).
    • Position: The mother’s position during labor can affect the contractions
    • Psyche: The mother’s psychological state
  • Signs of True Labor: Show (expulsion of mucous plug streaked with blood), dilation of cervix, formation of the bag of waters, rupture of membranes, and true labor pains (increasing in frequency, duration, & intensity).
  • Signs of False Labor: Braxton Hicks contractions, irregular contractions, no significant cervical changes.
  • Nature of Uterine Contraction:
    • Uterine contraction phases: Increment, Acme, Decrement
    • Measurement of contraction intensity (mm Hg).
    • Fundal dominance during contractions. -Polarity of uterine segments (active vs. passive)
  • Stages of Labor and Phases of First Stage:
    • First Stage: Cervical changes (effacement and dilation), Latent phase, Active phase and the Transitional phase.
    • Second Stage: Expulsion of fetus.
    • Third Stage: Delivery of placenta.
    • Fourth Stage (Recovery Stage): Recovery after delivery of the placenta and fetus.
  • Mechanisms of Placental Separation:
    • Schultze mechanism (central placental separation)
    • Duncan mechanism (placental separation along the lower margin)
  • Definitions of anatomical Landmarks:
    • engagement, station, flexion, extension, restitution, rotation, etc

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Description

This quiz explores the physiological aspects of normal labor, including definitions related to labor and viability, as well as the duration and types of labor. Understand the key concepts that define a typical delivery process and recognize the factors influencing labor onset.

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