9 - Labor

Question 1

Labor definition:

Answer 1

Products of conception expelled outside the uterus

Question 2

Labor duration:

Answer 2

At least 5 minutes and last 30–60 seconds

Question 3

Labor types:

Answer 3

1– Lightening
2– false labor
3– Cervical effacement

Question 4

Lightening definition and associated symptoms:

Answer 4

— 2 or more weeks before labor with upper abdomen flattened with a prominent lower abdomen

— Less SOB and increased urination

Question 5

False labor AKA Braxton Hicks:

Answer 5

Irregular, painless contractions occurring in the last 4–8 weeks

[Every 10–20 minutes]

Question 6

False VS true labor:

Answer 6

True:
1– Regular, get stronger and closer together with time
2– Continue despite changing position
3– Starts in the lower back to the abdomen front
4– Relieved with analgesia

[False is exactly the opposite but it is felt in the front abdomen or pelvis only]

Question 7

Cervical Effacement:

Answer 7

Cervix getting softer as a result of increased water content and collagen lysis

Question 8

Onset of labor major sign:

Answer 8

Passage of blood tinged mucus from the vagina

Question 9

Hormones that cause labor:

Answer 9

1– Progesterone starts inhibiting prostaglandin [Inhibiting the connection b/w the MYOMETRIAL cells and preventing oxytocin release]

2– Estrogen opposing progesterone

3– Dermatan sulphate replaced by HYALURONIC ACID —> More water —> Cervical effacement —> Contractions

Question 10

Pelvis 3 imaginary lines:

Answer 10

1– Inlet
2– Midpelvis
3– Outlet

Question 11

Pelvic shapes:

Answer 11

1– Gynecoid pelvis [Classical]
2– Android pelvis
3– Anthropoid pelvis
4– Platypelloid pelvis

Question 12

Gynecoid pelvis features:

Answer 12

1– Cylindrical shape
2– Fetal head is occipito-anterior
3– Most favorable

Question 13

Android pelvis features:

Answer 13

1– Funneling
2– Fetal head is occipito-anterior
3– Typical male pelvis

Question 14

Anthropoid pelvis features:

Answer 14

1– Fetal head is occipito-posterior

Question 15

Platypelloid pelvis features:

Answer 15

1– Oval
2– Fetal head is in the transverse diameter
3– Highest risk for obstructed labor

Question 16

Fetal skull components:

Answer 16

1– Vault [AKA cranium]: Occipital + 2 parietal + 2 frontal + 2 temporal

2– Base: Ossified united bones

Question 17

Fetal skull fontanels:

Answer 17

1– Ant: Closes at 18 mth, [Diamond shaped]

2– Post: Closes at 6–8 wks, [T-Shaped]

Question 18

Fetal skull diameters and significance:

Answer 18

1– Suboccipito-Bregmatic diameter [Well flexed]

2– Occipito-frontal diameter [Less well flexed]

3– Occipito-mental diameter AKA brow presentation [Extended]

4– Submento-bregmatic diameter[ [Hyperextended]

Question 19

Labor stages:

Answer 19

1– Labor onset until full cervical dilation [10cm]

2– Full cervical dilation until baby delivery

3– Baby delivery until placenta delivery

4– 6 Hrs after placental delivery

Question 20

Primipara VS multipara:

Answer 20

1– Primipara 1st stage requires [6–18 hrs] vs 2–10 for multi

2– Primipara 2nd stage requires [30 min — 3 hrs] vs 5–30 min for multi

Question 21

Labor’s first stage is divided into:

Answer 21

1– Latent phase: From labor onset until cervix dilation [4cm]

2– Active phase: Time b/w the end of latent and full dilatation [10cm]

Question 22

Labor’s second stage is divided into

Answer 22

1– Passive: Time b/w full dilation and INVOLUNTARY expulsive contractions

2– Active second stage: Maternal urge to push the fetal head VOLUNTARY

Question 23

The 7 mechanisms of labor that changes the position and attitude of the fetus till the birth canal and their description:

Answer 23

1– Engagement [Head is facing across the pelvis]
2– Descent [Voluntary uterine action]
3– Flexion [Head flex in mid-cavity]
4– Internal rotation [Sagittal sutures lies in AP diameter of the pelvic outlet]
5– Extension [Head beyond pubis symphysis into vulva in this order: Bregma —> Face —> Chin]
6– External rotation [Shoulders rotate in AP plane]
7– Expulsion [Anterior shoulder is beyond pubis symphysis then posterior follow suit]

Question 24

Episiotomy:

Answer 24

Perineum incision to enlarge the vagina [Only if the head passed the pelvic cavity]

Question 25

Episiotomy indications:

Answer 25

``` 1– Large baby 3– Fetal malposition [Occipito-posterior] 4– Previous pelvic floor surgery 5– Rigid perineum muscles 6– Serious risk of a tearing ```

Question 26

Shoulder delivery maneuver:

Answer 26

1– Pull the head downwards and forwards —> Ant. Shoulder appears beneath the pubis 2– Lift the head [Post. Shoulder appears over the perineum] 3– Baby swept upwards to deliver the rest

Question 27

Shoulder dystocia:

Answer 27

Difficulty delivering the shoulders

Question 28

Valsalva maneuver in 2nd stage:

Answer 28

Deep breath, hold it, then forcefully exhaled against the closed airway

Question 29

The placental separation signs that happen in 3rd stage:

Answer 29

``` 1– Cord lengthening 2– Cord protrudes from the vulva 3– Blood gushing 4– Fundus rise above the umbilicus 5– Fundus becomes hard ```

Question 30

Management of each respective stage:

Answer 30

— 1st: Mobilization, observation, pain relief and hydration [To prevent ketosis] — 2nd: Valsalva maneuver [As mom is feeling an urge to push] — 3rd: AKA active management by giving OXYTOCIN as the ant. Shoulder is delivered, cutting umbilical cord to reduce POSTPARTUM HEMORRHAGE [PPM] —4th: Keep checking HR and BP for tachycardia and low BP [As PPM commonly occurs]

Question 31

Causes of PPM:

Answer 31

1– Unrepaired lacerations 2– Uterine relaxation 3– Retained pieces of placenta 4– Hematoma