Labor

Question 1

At what dilation can you define labor as active phase?

Answer 1

<6 cm

Question 2

Early decelerations

Answer 2

Mirror image of uterine contractions

Question 3

Definition of accelerations

Answer 3

FHR increases 15 bpm for at least 15 seconds

Question 4

What are the 3 Ps of labor?

Answer 4

Powers, passenger, and pelvis

Question 5

How long does latent phase last (nullipara versus multipara)?

Answer 5

Nullipara <18-20 hours

Multipara <14 hours

Question 6

How long does the active phase of labor last (nullipara versus multipara)?

Answer 6

Nullipara <3 hours or <4 hours with epidural

Multipara <2 hours or <3 hours with epidural

Question 7

How long does the third stage of labor last?

Answer 7

<30 minutes

Question 8

Arrest of active phase criteria

Answer 8

No cervical dilation for 4 hours in the active phase with ROM and adequate contractions

Question 9

When the powers are thought to be holding up the second stage of labor, what should you give?

Answer 9

Oxytocin

Question 10

Adequate uterine contractions

Answer 10

Contractions every 2-3 minutes, firm on palpation, and lasting for at least 40-60 seconds.

Question 11

Montevideo unit (how many are considered adequate)

Answer 11

Each mmHg rise during uterine contractions.

Examine total Montevideo units during over 10 minute window.

Question 12

FHR normal, well oxygenated fetus

Answer 12

Baseline 110-160, accelerations present, with variability

Question 13

Early decelerations

Answer 13

Fetal head compression, benign

Question 14

Late decelerations

Answer 14

“Offset” from uterine contractions, suggest fetal hypoxia

Question 15

What should you suspect if late decelerations occur with >50% of uterine contractions, along with decreased variability?

Answer 15

Acidemia

Question 16

Category I fetal heart rate pattern

Answer 16

Normal baseline and variability

Question 17

Category II fetal heart rate pattern

Answer 17

Has some aspect that is concerning, but not ominous (tachycardia without decelerations)

Question 18

Category III fetal heart rate pattern

Answer 18

Ominous and indicates a high likelihood of severe fetal hypoxia or acidosis (absent baseline variability with recurrent late or variable bradycardia)

Question 19

Criteria for cesarean for active phase arrest

Answer 19

> 6 cm dilated, failure to progress despite 4 hours of adequate uterine activity, or >6 hours of oxytocin with inadequate uterine activity and no cervical change.

Question 20

Scalp stimulation inducing acceleration

Answer 20

Highly correlates to normal umbilical pH (>7.20)

Question 21

At what gram weight should you perform cesarean to prevent birth trauma/shoulder dystocia?

Answer 21

> 5,000 grams in non-diabetic mother

>4,500 grams in diabetic mother

Question 22

Tachysystole

Answer 22

> 5 uterine contractions over 10 minutes, averaged over 30 minutes

Question 23

How do you treat tachysystole

Answer 23

Decrease or stop oxytocin, or administer beta-mimetic agent