[15] MIDTERM | INTRAPARTUM PART 3A (1ST STAGE OF LABOR)

Question 1

• regular progression of uterine contractions
• effacement and progressive dilatation of the cervix
• progress in descent of the presenting part

Answer 1

NORMAL LABOR

Question 2

1ST STAGE OF LABOR

• stage of ____
• begins with the onset of regular ____ and ends with complete ____
• Factors affecting the length of labor: ____, maternal & fetal position, ____, and level of ____

Answer 2

• stage of dilatation
• begins with the onset of regular uterine contractions and ends with complete dilation of the cervix
• Factors affecting the length of labor: analgesia, maternal & fetal position, woman’s body size, and level of physical fitness

Question 3

1ST STAGE OF LABOR

LATENT PHASE
* Contractions are mild to moderate intensity and short, lasting ____ seconds.

• may start as mild contractions lasting ____ seconds with a frequency of ____ minutes and progress to moderate lasting ____ seconds with a frequency of ____ minutes
• w/ effacement & cervix dilates ____ cm
• Duration: Nullipara: ____ hrs. ; Multipara: ____ hours
• ____ contractions an hour is considered a meaningful signal that spontaneous birth is beginning or imminent.
• Prolonged latent phase: exceeding ____ hours in nullipara & ____ hours in multipara

Answer 3

LATENT PHASE
* Contractions are mild to moderate intensity and short, lasting 20 to 40 seconds.

• may start as mild contractions lasting 20 to 30 seconds with a frequency of 10 to 30 minutes and progress to moderate lasting 30 to 40 seconds with a frequency of 5 to 7 minutes
• w/ effacement & cervix dilates 0-3 cm
• Duration: Nullipara: 6 hours ; Multipara: 4.5 hours
• Twelve contractions an hour is considered a meaningful signal that spontaneous birth is beginning or imminent.
• Prolonged latent phase: exceeding 20 hours in nullipara & 14 hours in multipara

Question 4

ACTIVE PHASE
* Cervical dilatation occurs more rapidly, increasing from ____ cm ( ____ cm/hr in nulliparas and ____ cm/hr in multiparas)

• Fetal descent is ____
• Contractions become more frequent (every ____ minutes) and longer in duration lasting ____ seconds, and are ____ intensity

Answer 4

ACTIVE PHASE
* Cervical dilatation occurs more rapidly, increasing from 4 to 7 cm (1.2 cm/hr in nulliparas and 1.5 cm/hr in multiparas)

• Fetal descent is progressive
• Contractions become more frequent (every 3-5 minutes) and longer in duration lasting 40 to 60 seconds, and are moderate to strong intensity

Question 5

ACTIVE PHASE: WHO, 2018
* The duration of active first stage (from ____ cm until full cervical dilatation) usually does not extend beyond ____ hours in first labors, and usually does not extend beyond ____ hours in subsequent labors.

• A minimum cervical dilatation rate of ____ cm/hour throughout active first stage is unrealistically fast for some women and is therefore not recommended for identification of normal labor progression.
• A slower than ____ cm/hour cervical dilatation rate alone should not be a routine indication for obstetric intervention.

Answer 5

ACTIVE PHASE: WHO, 2018
* The duration of active first stage (from 5 cm until full cervical dilatation) usually does not extend beyond 12 hours in first labors, and usually does not extend beyond 10 hours in subsequent labors.

• A minimum cervical dilatation rate of 1 cm/hour throughout active first stage is unrealistically fast for some women and is therefore not recommended for identification of normal labor progression.
• A slower than 1-cm/hour cervical dilatation rate alone should not be a routine indication for obstetric intervention.

Question 6

ACTIVE PHASE
* Duration: nulliparas ____ hrs and ____ hrs in multiparas

• Show and perhaps spontaneous ____ may occur
• By the end of the active phase, contractions have a frequency of ____ min, duration of ____ seconds, and ____ intensity

Answer 6

ACTIVE PHASE
* Duration: nulliparas 3 hrs and 2 hrs in multiparas

• Show and perhaps spontaneous rupture of the membranes may occur
• By the end of the active phase, contractions have a frequency of 2 -3 min, duration of 60 seconds, and strong intensity

Question 7

TRANSITION PHASE
* contractions reach their peak of intensity which is ____, occurring every ____ min with duration of ____ seconds and causing maximum dilatation of ____ cm.

• By the end of this phase, both ____ and complete ____ have occurred

Answer 7

TRANSITION PHASE
* contractions reach their peak of intensity which is strong, occurring every 2-3 min with duration of 60-70 seconds and causing maximum dilatation of 8-10 cm.

• By the end of this phase, both full dilatation (10 cm) and complete cervical effacement (obliteration of the cervix) have occurred

Question 8

TRANSITION PHASE
Characteristics of this phase:
hiccupping, belching, nausea, or vomiting
beads of perspiration on the upper lip or brow
increasing rectal pressure and feeling the urge to bear down