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Questions and Answers
What does the acronym ROM stand for in relation to the process of childbirth?
What does the acronym ROM stand for in relation to the process of childbirth?
Rupture of Membranes
What is the term for the process of the fetal skull changing shape during labor?
What is the term for the process of the fetal skull changing shape during labor?
Molding
Which of the following is NOT a cardinal movement of labor?
Which of the following is NOT a cardinal movement of labor?
What is the term used to describe the relationship between the long axis of the fetal body and the long axis of the woman's body?
What is the term used to describe the relationship between the long axis of the fetal body and the long axis of the woman's body?
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What is NOT one of the four 'P's' that are considered to be essential components of a successful labor process?
What is NOT one of the four 'P's' that are considered to be essential components of a successful labor process?
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What does the acronym 'LOP' stand for in relation to fetal position?
What does the acronym 'LOP' stand for in relation to fetal position?
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What is the name given to the topmost part of the fetal skull?
What is the name given to the topmost part of the fetal skull?
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Which type of fetal presentation occurs most frequently during childbirth?
Which type of fetal presentation occurs most frequently during childbirth?
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The term 'sinciput' refers to the area over the occipital bone in the fetal skull.
The term 'sinciput' refers to the area over the occipital bone in the fetal skull.
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The fetal head is typically wider in its anteroposterior diameter than in its transverse diameter.
The fetal head is typically wider in its anteroposterior diameter than in its transverse diameter.
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Which of the following is a potential complication associated with a breech presentation?
Which of the following is a potential complication associated with a breech presentation?
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The term 'decrescendo' describes the phase of a contraction when the intensity is the strongest.
The term 'decrescendo' describes the phase of a contraction when the intensity is the strongest.
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The 'physiologic retraction ring' is considered a danger sign during labor.
The 'physiologic retraction ring' is considered a danger sign during labor.
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Which of the following is NOT a method commonly used to determine the fetal position, presentation, and Lie?
Which of the following is NOT a method commonly used to determine the fetal position, presentation, and Lie?
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What is the name of the primary power of labor?
What is the name of the primary power of labor?
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The anterior shoulder of the baby is typically born first during labor.
The anterior shoulder of the baby is typically born first during labor.
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What is the name of the point in the fetal skull that is found at the junction of the coronal and sagittal sutures?
What is the name of the point in the fetal skull that is found at the junction of the coronal and sagittal sutures?
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What is the term for a type of fetal presentation in which the baby's buttocks or feet are positioned first to enter the birth canal?
What is the term for a type of fetal presentation in which the baby's buttocks or feet are positioned first to enter the birth canal?
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Which of the following describes the 'attitude' of the fetus in a 'good attitude' position?
Which of the following describes the 'attitude' of the fetus in a 'good attitude' position?
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A fetus is considered 'engaged' when the presenting part has reached the level of the ischial spines.
A fetus is considered 'engaged' when the presenting part has reached the level of the ischial spines.
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A 'floating' presentation refers to a presenting part that is descending but has not yet reached the ischial spines.
A 'floating' presentation refers to a presenting part that is descending but has not yet reached the ischial spines.
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The 'vertex' presentation is also known as the 'ideal' presentation?
The 'vertex' presentation is also known as the 'ideal' presentation?
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What is the name of the position where the fetal head is hyperextended with the chin as the presenting part?
What is the name of the position where the fetal head is hyperextended with the chin as the presenting part?
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The 'Frank' breech presentation is where the baby's knees are flexed and the buttocks present to the cervix.
The 'Frank' breech presentation is where the baby's knees are flexed and the buttocks present to the cervix.
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A 'shoulder presentation' is generally considered to be more frequent than a 'breech presentation'.
A 'shoulder presentation' is generally considered to be more frequent than a 'breech presentation'.
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The 'left occipitoanterior' (LOA) fetal position is considered to be the most common fetal position.
The 'left occipitoanterior' (LOA) fetal position is considered to be the most common fetal position.
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The 'cardinal movements of labor' are generally considered to be most active during the first stage of labor.
The 'cardinal movements of labor' are generally considered to be most active during the first stage of labor.
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What is the term used to describe the downward movement of the baby's head through the pelvic inlet?
What is the term used to describe the downward movement of the baby's head through the pelvic inlet?
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What is the anatomical landmark that defines the position of the presenting part in relation to the pelvis?
What is the anatomical landmark that defines the position of the presenting part in relation to the pelvis?
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A 'crowning' presentation typically occurs when the presenting part is at +3 or +4 stations.
A 'crowning' presentation typically occurs when the presenting part is at +3 or +4 stations.
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Which of the following is a potential risk faced by the mother if labor is prolonged?
Which of the following is a potential risk faced by the mother if labor is prolonged?
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It is generally recommended that a woman use abdominal muscles to bear down with full force even before the cervix is fully dilated.
It is generally recommended that a woman use abdominal muscles to bear down with full force even before the cervix is fully dilated.
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The 'pacemaker' point of the uterus is located near one of the uterotubal junctions.
The 'pacemaker' point of the uterus is located near one of the uterotubal junctions.
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In the later stages of labor, the lower uterine segment becomes thicker and active to help expel the fetus.
In the later stages of labor, the lower uterine segment becomes thicker and active to help expel the fetus.
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A 'Bandl's Ring'is an example of a physiologic retraction ring.
A 'Bandl's Ring'is an example of a physiologic retraction ring.
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Effacement of the cervix involves shortening and thinning of the cervical canal.
Effacement of the cervix involves shortening and thinning of the cervical canal.
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Dilatation of the cervix is measured by the number of centimeters the opening has widened.
Dilatation of the cervix is measured by the number of centimeters the opening has widened.
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The psychological state of a woman during labor is considered to be one of the most important factors for a successful birth.
The psychological state of a woman during labor is considered to be one of the most important factors for a successful birth.
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A 'fetal kick count' is a common method used to assess the baby's well-being during labor.
A 'fetal kick count' is a common method used to assess the baby's well-being during labor.
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A woman's perception of her labor experience is generally not considered a significant factor in her overall well-being.
A woman's perception of her labor experience is generally not considered a significant factor in her overall well-being.
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Study Notes
Theories of Labor Onset
- Labor is a series of processes where the mature or almost mature products of conception are expelled from the mother's body. Also called childbirth, accouchement, parturition, or travail.
- The trigger that changes random, painless Braxton Hicks contractions into strong, coordinated, productive labor contractions is unknown.
- Factors influencing labor involve a combination of maternal and fetal contributions.
Factors Influencing Labor Onset
- Uterine muscle stretching releases prostaglandins (Uterine Stretch Theory).
- Pressure on the cervix stimulates oxytocin release from the posterior pituitary (Oxytocin Theory).
- Oxytocin and prostaglandins work together to initiate contractions.
- Changes in the estrogen-to-progesterone ratio stimulate uterine contractions.
- Placental age triggers contractions at a set point.
- Thrombosis in the venous sinus of the placenta impairs circulation, aging the placenta and reducing hormone and nutrient delivery to the fetus, potentially leading to termination of pregnancy.
- Rising fetal cortisol levels reduce progesterone and increase prostaglandin formation (Progesterone Deprivation Theory).
- Fetal membranes produce prostaglandins to stimulate contractions.
Preliminary Signs of Labor
- Lightening (descent of the fetal presenting part into the pelvis) - more noticeable in primiparas than in multiparas.
- It can occur 10-14 days before labor.
- Changes in abdominal contour, reduced discomfort in the diaphragm, and shortness of breath.
- Slight weight loss (1-3 pounds) as body fluids are excreted through urine.
- Increased vaginal discharge and urinary frequency.
- Shooting pains in legs due to pressure on nerves through the pelvis.
- Braxton Hicks contractions - strong contractions in the latest weeks of pregnancy, sometimes mistaken for labor contractions.
Signs of True Labor
- Involve uterine and cervical changes
- Knowledge of true labor signals is helpful in preventing preterm birth and providing reassurance during labor.
- Uterine contractions are involuntary and can be intense in early labor.
- Breathing exercises offer a sense of well-being during labor.
- Show (bloody show): a pink tinged mucus plug, resulting from blood leaking as a result of pressure from the fetus.
- Rupture of membranes (ROM): amniotic fluid released from the vagina, either as a sudden gush or a slow seep.
Difference between True and False Labor
- False labor contractions begin and remain irregular, are felt first in the abdomen and groin, and often stop with ambulation or sleep.
- True labor contractions begin irregularly but become regular and predictable. They are often felt first in the lower back, sweeping around to the abdomen and continue regardless of activity level.
Ripening of the Cervix
- An internal sign noticeable only through pelvic examination.
- Goodell's sign: softening and forward tipping of cervix at term.
Passenger (Fetus)
- The fetus (the passenger) that includes the head (the widest uterine diameter) is the most likely part to not pass through the pelvic ring.
- Whether the fetal skull passes depends on its structure (bones, fontanelles, and suture lines) and its alignment with the pelvis.
Structure of the Fetal Skull
- Fetal skull is composed of 8 bones: frontal (2), parietal (2), occipital, temporal (2), sphenoid, and ethmoid.
- Cranial bones are connected by suture lines.
- Fontanelles are membrane-covered spaces found at the junction of the main suture lines. These are important areas of expansion during birth.
- Fetal skull molding: overlap of cranial bones to assist in passage through the birth canal. This is not permanent and will return to normal shape and size post-birth.
Diameters of the Fetal Skull
- Suboccipitobregmatic diameter: the smallest anteroposterior diameter of the skull, around 9.5cm.
- Occipitofrontal diameter: an anteroposterior diameter measuring around 12cm.
- Occipitomental diameter: the widest anteroposterior diameter, measuring approximately 13.5cm.
- The anteroposterior head diameter presents to the birth canal determined by degree of flexion (full, moderate, or poor ).
Fetal Attitude
- The position of the head, including the position of the fetal head and degree of head flexion relative to the body.
- Good attitude: complete flexion with chin on chest
- Moderate flexion: chin not on chest, but in an alert or "military" position
- Poor flexion: head extension, presenting the occipitomental diameter.
Fetal Lie
- The relationship between the fetal long axis and the mother's long axis.
- Longitudinal lie (99% of births) – fetal long axis is parallel or aligned to the mother's long axis.
- Transverse or horizontal lie - fetal long axis is perpendicular to the mother's long axis.
Fetal Presentation
- The fetal body part that will first contact the cervix is the presenting part
- Longitudinal lie is classified as vertex, face, or breech
- Vertex: the top of the fetal head (the occiput) presents first
- Face: the chin/mentum presents first.
- Breech: buttocks or feet present first.
- Shoulder: one shoulder presents first.
Station
- Relationship of the presenting fetal part to the level of the ischial spines in the mother.
- 0 station: presenting part at the level of the ischial spines.
- Positive (above) or negative (below) station values are expressed in cm.
Engagement
- The presenting part is at or below the level of the ischial spines. A fetus that is engaged will have difficulty moving above the ischial spines.
Mechanisms of Labor
- Descent, flexion, internal rotation, extension, and external rotation. These movements help the fetus move through the birth canal.
Powers of Labor
- Uterine contractions are the primary force that moves the fetus through the birth canal. They are rhythmic and progressive in intensity.
- Abdominal muscle contractions can assist during the pushing phase of labor.
Cervical Changes
- Effacement: The thinning and shortening of the cervix.
- Cervical dilatation: The opening and widening of the cervix to allow passage of the fetus. (measured 0-10cm)
- Dilatation is associated with increased vaginal secretions.
Role of Psyche
- Woman's emotional state during labor is a strong determinant of childbirth.
- Support from family members, partner, and other care providers is important for the woman.
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Description
Explore the various theories and factors that influence the onset of labor in childbirth. This quiz delves into hormonal influences, uterine muscle dynamics, and maternal contributions to the labor process. Test your knowledge of the mechanisms behind labor contractions and their triggers.
