Module 2

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Questions and Answers

What is the duration that defines a prolonged latent phase for a nulliparous client?

Greater than 16 hours

Greater than 12 hours

Greater than 8 hours

Greater than 20 hours (correct)

Which factor does NOT contribute to a prolonged latent phase of labour?

Unfavourable cervix

Occiput posterior position

Frequent contractions (correct)

Transverse position

What are common consequences of a lengthy and protracted latent phase?

Lower blood pressure

Exhaustion and dehydration (correct)

Increased fetal heart rate

Enhanced cervical dilation

According to Friedman, what constitutes the longest normal time for a multipara in the latent phase?

Greater than 14 hours Signup and view all the answers

Which of the following statements is TRUE regarding clients with a prolonged latent phase?

They may experience discouragement and fatigue. Signup and view all the answers

What is characterized by contractions that are building in frequency, duration, and intensity?

The latent phase of labour Signup and view all the answers

Which of the following management techniques is least likely to be applied during a prolonged labour?

Increased monitoring without intervention Signup and view all the answers

What is a common coping strategy during a prolonged latent phase of labor?

Resting and hydrating Signup and view all the answers

What role does a midwife play in cases of prolonged labour?

To identify abnormal labour and provide support and management Signup and view all the answers

What is the likely outcome for clients who experience a prolonged latent phase but later achieve normal dilation?

Similar risk of arrest disorders as those with a normal latent phase Signup and view all the answers

What may indicate a diagnosis of dystocia during labor?

Cervical dilatation of less than 0.5 cm per hour for four hours Signup and view all the answers

What is the recommended monitoring duration after administering narcotics for therapeutic rest?

30 minutes Signup and view all the answers

What is one of the four Ps associated with the etiology of dystocia?

Psyche Signup and view all the answers

What management strategy should be reserved for cases diagnosed with dystocia during labor?

Augmenting labor with oxytocin Signup and view all the answers

What effect does induction of labor have on the incidence of dystocia?

Increases the incidence of dystocia Signup and view all the answers

Which symptom suggests the active first stage of labor has begun?

Cervix fully effaced and four centimeters dilated Signup and view all the answers

What factor does NOT influence the length of latent labor?

Environmental noise levels Signup and view all the answers

How often should the fetal head's position and growth be assessed during labor?

As needed based on labor progress Signup and view all the answers

What percentage of clients treated with therapeutic rest may not be in labor at all?

10% Signup and view all the answers

What is necessary for diagnosing true cephalopelvic disproportion (CPD)?

Well-flexed head cannot pass through pelvis despite adequate uterine contractions. Signup and view all the answers

Which anatomical features may impede the passage of the fetus during labor?

Prominent ischial spines, sacral promontory, and a narrow pubic arch. Signup and view all the answers

How can a full bladder affect labor?

It competes for space with the fetal head and may prevent descent. Signup and view all the answers

What hormones are released by maternal fear and anxiety during labor?

β-endorphin, adrenocorticotropic hormone, cortisol, and epinephrine. Signup and view all the answers

What effect do stress hormones have on labor contractions according to the content?

Contractions may become weaker, shorter, and further apart. Signup and view all the answers

Which of the following factors is NOT directly mentioned as an influencer on labor?

The physical size of the fetus. Signup and view all the answers

What role does maternal anxiety play during labor?

Leads to the release of hormones that weaken labor contractions. Signup and view all the answers

Why is it essential to empty the bladder regularly during labor?

To create more space in the pelvis for the fetal head. Signup and view all the answers

Which of the following conditions does not contribute to cephalopelvic disproportion?

Well-flexed head presentation. Signup and view all the answers

What effect does a decrease in blood flow during labor have?

Contractions become weaker and less effective. Signup and view all the answers

Study Notes

Prolonged Labour

Majority of childbearing clients anticipate normal labour, vaginal birth.
Some experience abnormally prolonged labour in first stage (latent/active) or second stage, leading to increased interventions, cesarean births.
Prolonged labour is challenging for clients & partners.
Midwives support clients through abnormal labour, recognize abnormalities, apply management techniques, maximize vaginal birth, minimize interventions.

Prolonged Latent First Stage of Labour

Latent phase: Contractions increase in frequency, duration, intensity; cervical changes (effacement, dilation 0-4 cm).
Friedman definition: >20 hours (nulliparous), >14 hours (multiparous) = prolonged latent phase. This represents longest normal times & 95th percentile for spontaneous labour.
Factors influencing prolonged latent phase: unfavorable cervix, transverse/occiput posterior positions.
Clients with prolonged latent phase achieving eventual normal pattern of dilation/descent aren't more likely to develop arrest disorders than clients with normal latent phase. Perinatal mortality is not increased.
Lengthy latent phase can be worrisome/tiring for clients, partners, & family. Exhaustion, dehydration can impede active labour progress.
Client may feel discouraged, anxious: fear inability to endure remaining labour; friends/family worry if labour is normal.
Prenatal education critical: variation in normal latent phase length; coping strategies; hydration; rest.
Midwife assessment for reassurance, education on latent phase, active labour signs/symptoms.
Coping strategies: normal activities (walking, showering), distractions, rest.
Dimenhydrinate (antihistamine) may promote rest/sleep if client unable to rest.
Therapeutic rest (narcotic, e.g., morphine): 85% of clients wake in active labour, 10% were not in labour, 5% persistent dysfunctional pattern.
30-minute monitoring period after narcotic administation is common. Decision to remain in hospital or discharge for rest considers fetal well-being, narcotic effects, distance from hospital, available driver.
Majority of clients with prolonged latent phase enter active labour spontaneously if managed expectantly.
Preventing labour augmentation (e.g., artificial rupture of membranes, oxytocin) is crucial; it increases complications (e.g., cesarean). Dystocia diagnosis requires established active labour.

Prolonged Active First Stage of Labour

Active first stage: Regular, painful contractions; progressive cervical changes.
Traditionally defined by cervix fully effaced, four cm dilated; recent evidence suggests active labour may not commence until greater dilation.
Accurate diagnosis of active labour phase critical for assessment/management.
Spontaneous labour studies (no oxytocin/epidural): Mean active labour duration: 7.7 hours (nullipara), 5.6 hours (multipara).
Progress below 5th percentile when dilation < 1 cm/ hour.
Dystocia: Inadequate labour progress: dilation < 0.5 cm/hour for four hours active first stage, descent < 1 cm/hour second stage.
Dystocia associated with maternal morbidity (stress, dehydration, infection, pelvic floor injury, uterine rupture, postpartum hemorrhage) & fetal complications (meconium stained fluid, abnormal fetal heart patterns, hypoxia).
Induction of labour increases risks of dystocia, especially in nulliparous clients with unfavorable cervix.
Normal labour/vaginal birth relies on fetal/pelvic factors, uterine contractions, & pushing. Aetiology of dystocia involves four Ps: Powers, Passenger, Passage, Psyche.

Powers

Contractions (hypotonic, ineffective, uncoordinated, infrequent).
Palpating uterus to assess contraction strength; caput/molding assessment (no caput/molding shows poor contraction quality).

Passenger

Fetal size, position, attitude.
Adequate contractions can correct malposition; inadequate can lead to persistence.
Contraction power can help overcome issues with normal-sized infant with poorly flexed/asynclytic head.
Relative disproportion may occur if malposition/deflexed/asynclytic fetal head appears to not fit pelvis. True Cephalopelvic Disproportion (CPD) is when well-flexed head cannot pass through pelvis despite adequate uterine contractions.

Passage

Pelvic structure, space available.
Prominent ischial spines, sacral promontory, narrow pubic arch can impede passage.
Full bladder competes for space with fetal head, preventing descent; regular bladder emptying is crucial.

Psyche

Labouring client's emotional status (fear, anxiety).
Maternal fear/anxiety produces stress hormones; this weakens uterine contractions.

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Description

This quiz explores prolonged labour, focusing on the latent first stage and its implications for midwifery care. Participants will learn about the definitions, influencing factors, and management techniques for clients experiencing abnormal labour. Enhance your understanding of supporting clients through these challenging situations.