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