Book facts

Question 1

What was Friedman’s most important contribution?

Answer 1

His separation of the latent phase from the active phase of the first stage of labor. pg. 397

Question 2

What is primary dysfunctional labor?

Answer 2

If a woman’s cervix fails to dilate at the appropriate rate during the active phase of labor.

Question 3

If cervical dilation ceases during a 2-hour period in the active phase of labor what has occured?

Answer 3

Secondary arrest of dilation.

Question 4

True/false: During the latent phase of labor, it is not known with certainty whether a woman is in true or false labor.

Answer 4

True.

Question 5

Primary dysfunctional labor and arrest of dilation during the active phase may also indicate ___ ____

Answer 5

Cephalopelvic disproportion

Question 6

Is a condition that occurs when the size or shape of the fetus doesn’t match the size or shape of the mother’s pelvis and soft tissue, making it difficult or impossible for the baby to pass through the pelvis during vaginal delivery.

Answer 6

Fetopelvic dysproportion aka cephalopelvic dysproportion

Question 7

True/False: Newer data suggests early amniotomy (at cervical dilation less than 4 cm or soon after cervical ripening with Foley ballon) decreases the time to complete dilation and vaginal delivery, especially in nulliparous women, without an increase in adverse perinatal outcomes.

Answer 7

True pg. 399

Question 8

During early labor, the contractions may occur every __ to __ minutes, last __ to ___ seconds, and develop intrauterine pressures (intensity) of 20 to 30 mm Hg above basal tone (10 to 15 mm Hg).

Answer 8

5 to 7 minutes, last 30-40 seconds.

Question 9

Late in the first stage of labor, contractions typically occur every __ to ___ minutes, last __ to __ seconds, and are 40 to 60 mm Hg in
intensity.

Answer 9

2 to 3 minutes; 50 to 70

Question 10

The higher intensity of contractions reflects a more widespread propagation of the contraction, with the recruitment of more ___ cells.

Answer 10

myometrial

Question 11

Is a vaginal delivery possible if the lie of the fetus is transverse or oblique?

Answer 11

Only if the fetus is very immature. Otherwise only when baby is in longitudinal lie can a vaginal delivery be possible. (Lie = the relationship of the long axis of the fetus to the long axis of the mother)

Question 12

During the first trimester, amniotic fluid consists mostly of water and electrolytes and contains minimal ___.

Answer 12

protein

Question 13

Neutrophils are usually absent from the amniotic fluid of a healthy fetus, and their presence typically signifies an ____ or ____ process.

Answer 13

Inflammatory or infectious

Question 14

The umbilical cord blood glucose uptake is approximately ___ at normal maternal arterial plasma glucose concentrations.

Answer 14

5mg/kg/min

Question 15

The Bishop Score helps quantitate the favorability of the cervix; __ the score the shorter the labor and the less likely induction will fail.

Answer 15

higher

Question 16

What are the 5 components of the Bishop score?

Answer 16

Dilation, Effacement, Station, Consistency, Position.

Out of these dilation is the most critical. Effacement (or length), station, and consistency are each half as important, and position has little effect.

Question 17

A __ Bishop score indicates that the cervix is ready to dilate with uterine contractions.

Answer 17

high

Question 18

Prostaglandins should not be administered to induce labor in women with a prior cesarean delivery, because their use is associated with an increased risk of _ _

Answer 18

Uterine rupture.

Question 19

What are the cervical ripening medications/mechanisms to induce labor?

Answer 19

Prostaglandin E analogues ie: misoprostol/Foley catheter bulb (16 or 20 French, filled with 30-60mL saline. Chestnut pg 404

Question 20

Women with DM Are predisposed to __ __, not only because fetal macrosomia is more common but also because the fetus of a mother with DM has a shoulder circumference that is disproportionately large relative to the head circumference.

Answer 20

shoulder dystocia

Question 21

The most significant complication of preterm premature rupture of membranes (PROM) is __ birth.

Answer 21

preterm

Question 22

What maneuver is it called when the mother’s thighs are removed from their supports and are hyper-flexed alongside her abdomen in the presence of shoulder dystocia?

Answer 22

The McRobert’s maneuver, elevates the symphysis in a cephalad direction and often frees the impacted shoulder and allows easy delivery.

Question 23

Assuming that the fetus is tolerating labor satisfactorily, the most important obstetric determination is where the patient is in the ___ or the ___ phase of the first stage of labor.

Answer 23

latent or active

Question 24

Newer data suggest early amniotomy (amniotomy at cervical dilation less than a 4 cm or soon after cervical ripening with Foley balloon) decreases the time to complete dilation and vaginal delivery, especially in nulliparous women, without an increase in adverse perinatal outcomes.

Question 25

___ ___ is the most frequently performed major surgery in the United States.

Answer 25

Cesarean delivery.

Question 26

___ ___ fetal heart rate monitoring represents the best means of detecting uterine rupture.

Answer 26

Continuous electronic

Question 27

If the leading bony point is at the level of the spines, the vertex is said to be at ___ station.

Answer 27

zero

Question 28

If the leading bony point is 1 cm above the level of the spines, the station is designated as ___

Answer 28

-1

Question 29

+1, +2, +3 indicate that the leading bony point is 1,2 and 3 cm ___ the ischial spines, respectively.

Answer 29

below

Question 30

___ ___ is the primary cause of pain during the 1st stage of labor.

Answer 30

Cervical distention

Question 31

Labor pain, anxiety, and emotional stress increase ___ release and inhibit the segmental and suprasegmental reflexes of GI and urinary motility. This is turn results in an increase in gastric ___ and volume and a delay in bladder emptying.

Answer 31

gastrin

acidity

Question 32

Labor pain exists and is severe in many women, which a close correlation between ___ ___ and pain during the 1st stage of labor.

Answer 32

cervical dilation

Question 33

There are large individual difference in pain perception, which likely reflect difference at ___ sites. The activation of these sites in the PRIMARY mechanism of action for distraction methods of analgesia

Answer 33

suprathalamic

Question 34

Emotional support provided by the doulas ___ the use of analgesics, the duration of labor, and the incidence of operative deliveries in selected patient populations.

Answer 34

reduces

Question 35

There is little evidence that any individual opioid confers significant benefit over ___ when administered as a bolus.

Answer 35

Meperidine

Question 36

What was the first opioid to be used for PCA during labor?

Answer 36

Meperidine

Question 37

True/False. Gastric emptying is not altered during pregnancy.

Answer 37

True

Question 38

Where does uterine artery arise from?

Answer 38

The anterolateral abdominal aorta

Question 39

Examination of the cervix is deferred in patients with __ ___ in the second half of the pregnancy, unless placenta previa has been ruled out by ultrasound, to avoid exacerbation of bleeding.

Answer 39

Vaginal bleeding

Question 40

To prevent infection, cervical examination may also be deferred in patients with ___ ___ __ ___ and no labor.

Answer 40

Premature rupture of membranes