MIDTERM CH 13: Labor and Birth Flashcards
Match the correct definition to one of the 5 P’s of Labor.
Fetus, fetal presentation, and position.
a) Passenger
b) Powers
c) Psych
d) Passageway
e) Position
f) Presentation
a) Passenger
Match the correct definition to one of the 5 P’s of Labor.
Contractions and maternal efforts.
a) Passenger
b) Powers
c) Psych
d) Passageway
e) Position
f) Presentation
b) Powers
Match the correct definition to one of the 5 P’s of Labor.
Psychological responses to labor.
a) Passenger
b) Powers
c) Psych
d) Passageway
e) Position
f) Presentation
c) Psych
Match the correct definition to one of the 5 P’s of Labor.
The birth canal.
a) Passenger
b) Powers
c) Psych
d) Passageway
e) Position
f) Presentation
d) Passageway
Match the correct definition to one of the 5 P’s of Labor.
Maternal positioning during labor.
a) Passenger
b) Powers
c) Psych
d) Passageway
e) Position
f) Presentation
e) Position
Match the correct definition to one of the 5 P’s of Labor.
The part of the fetus entering the birth canal.
a) Passenger
b) Powers
c) Psych
d) Passageway
e) Position
f) Presentation
f) Presentation
Which feature of the fetal skull allows for molding during labor?
a) The rigidity of the skull bones
b) The presence of fontanels and sutures
c) The size of the anterior fontanel only
d) The development of the occipital bone
b) The presence of fontanels and sutures
Rationale: Fontanels and sutures in the fetal skull allow the bones to overlap and adapt to the birth canal during labor, a process known as molding. This flexibility helps facilitate vaginal delivery.
What is the clinical significance of the posterior fontanel closing within 6–8 weeks after birth?
a) It allows for brain growth and development postpartum.
b) It protects the skull from trauma during delivery.
c) It indicates that the skull is fully ossified at birth.
d) It helps determine fetal position during labor.
d) It helps determine fetal position during labor.
Rationale: During labor, the posterior fontanel is a landmark used by healthcare providers to assess fetal position. Its closure after birth does not affect brain growth, as the anterior fontanel remains open longer for this purpose.
How can fetal anomalies such as hydrocephalus or macrosomia affect labor?
a) They make vaginal delivery easier due to a larger pelvis.
b) They increase the risk of complications, such as cephalopelvic disproportion.
c) They ensure faster descent of the fetal head through the pelvis.
d) They reduce the likelihood of fetal molding.
b) They increase the risk of complications, such as cephalopelvic disproportion.
Rationale: Hydrocephalus (enlarged head due to fluid accumulation) and macrosomia (excessively large fetus) can lead to cephalopelvic disproportion, where the fetal head is too large to pass through the maternal pelvis, increasing the risk of prolonged labor or the need for a cesarean delivery.
What is the purpose of assessing the size of the fetal head during labor?
a) To determine fetal oxygenation levels
b) To identify potential birth injuries
c) To evaluate its relationship to the maternal pelvis
d) To assess fetal lung maturity
c) To evaluate its relationship to the maternal pelvis
Rationale: The size of the fetal head is assessed to ensure it can adequately fit through the maternal pelvis. Disproportion can lead to complications such as prolonged labor or obstructed delivery.
What role does the anterior fontanel play in assessing fetal well-being during labor?
a) It provides a reference for fetal heart rate monitoring.
b) It indicates the degree of molding during delivery.
c) It serves as a landmark for determining fetal position.
d) It reflects the progression of fetal brain development.
c) It serves as a landmark for determining fetal position.
Rationale: The anterior fontanel is a key landmark used during vaginal exams to determine the orientation and position of the fetus in the birth canal. This aids in assessing labor progression.
What happens to the fetal skull during the molding process?
a) The cranial bones overlap to adapt to the birth canal.
b) The sutures fuse to stabilize the skull.
c) The fontanelles expand to facilitate vaginal delivery.
d) The skull shrinks to reduce its circumference.
a) The cranial bones overlap to adapt to the birth canal.
Rationale: Molding occurs during labor as the cranial bones overlap to adjust the shape of the fetal skull. This adaptation decreases the skull dimensions, allowing it to pass through the maternal pelvis.
Which condition involves edema of the scalp at the presenting part and crosses suture lines?
a) Cephalohematoma
b) Caput succedaneum
c) Hydrocephalus
d) Macrosomia
b) Caput succedaneum
Rationale: Caput succedaneum is characterized by swelling of the scalp that crosses suture lines and resolves within 3–4 days after birth. This is different from cephalohematoma, which does not cross suture lines.
Which of the following describes the anterior fontanelle?
a) It is triangular and closes within 8–12 weeks after birth.
b) It is the widest diameter of the fetal skull.
c) It fuses during the molding process in labor.
d) It is diamond-shaped and remains open for 12–18 months.
d) It is diamond-shaped and remains open for 12–18 months.
Rationale: The anterior fontanelle, commonly referred to as the “soft spot,” is diamond-shaped and allows for brain growth. It closes by 12–18 months postpartum.
Which conditions might alter the shape of the fetal skull during delivery? (Select all that apply)
a) Caput succedaneum
b) Cephalohematoma
c) Hydrocephalus
d) Shoulder dystocia
e) Macrosomia
a) Caput succedaneum
b) Cephalohematoma
c) Hydrocephalus
Rationale: Caput succedaneum and cephalohematoma are common conditions that affect the shape of the fetal skull during delivery, while hydrocephalus, an abnormal enlargement of the head, can also distort skull dimensions. Shoulder dystocia (d) and macrosomia (e) do not directly affect the skull shape but may complicate delivery.
Which fetal presentation is most favorable for vaginal delivery?
a) Frank breech
b) Complete breech
c) Cephalic presentation
d) Shoulder presentation
c) Cephalic presentation
Rationale: The cephalic presentation, where the fetus’s head is the presenting part, is the most favorable for vaginal delivery because it aligns well with the maternal pelvis. This is the most common one as well.
Which of the following describes the relationship between the fetal spine and the mother’s spine in a longitudinal lie?
a) The fetal spine is parallel to the mother’s spine.
b) The fetal spine is perpendicular to the mother’s spine.
c) The fetal spine is at an angle to the mother’s spine.
d) The fetal spine is positioned posteriorly to the mother’s pelvis.
a) The fetal spine is parallel to the mother’s spine.
Rationale: In a longitudinal lie, the fetus’s spine is parallel to the mother’s spine. This is typical for cephalic or breech presentations and is most conducive to vaginal delivery.
What distinguishes a complete breech presentation from a frank breech presentation?
a) The hips and knees are flexed in a complete breech, while only the hips are flexed in a frank breech.
b) The feet are extended below the buttocks in a complete breech, while the feet are tucked in a frank breech.
c) The head presents first in a complete breech, while the buttocks present first in a frank breech.
d) The shoulders present in a complete breech, while the legs present in a frank breech.
a) The hips and knees are flexed in a complete breech, while only the hips are flexed in a frank breech.
Rationale: In a complete breech presentation, both the hips and knees are flexed, positioning the fetus in a seated position. In a frank breech presentation, the hips are flexed but the knees are extended, with the legs straight up along the body.
Which of the following fetal presentations is associated with a transverse lie?
a) Cephalic presentation
b) Breech presentation
c) Shoulder presentation
d) Footling presentation
c) Shoulder presentation
Rationale: In a transverse lie, the fetal spine is perpendicular to the mother’s spine, and the presenting part is typically the shoulder, making vaginal delivery difficult or impossible without repositioning.
What is the clinical significance of an oblique fetal lie during labor?
a) It is a normal variation and rarely requires intervention.
b) It typically resolves to a longitudinal or transverse lie as labor progresses.
c) It necessitates immediate cesarean delivery.
d) It results in the cephalic presentation without complications.
b) It typically resolves to a longitudinal or transverse lie as labor progresses.
Rationale: An oblique lie, where the fetal spine is at an angle to the mother’s spine, is often temporary and may resolve spontaneously into a longitudinal or transverse lie during labor. Persistent oblique lie may require intervention.
What is the presenting part in a vertex cephalic presentation?
a) Brow of the fetal head
b) Occipital portion of the fetal head
c) Scapula
d) Buttocks
b) Occipital portion of the fetal head
Rationale: In a vertex cephalic presentation, the occiput is the presenting part, which allows for the smallest diameter of the fetal skull to navigate through the maternal pelvis.
Which fetal presentation is associated with the highest risk of complications during vaginal delivery?
a) Cephalic presentation
b) Vertex presentation
c) Occipital presentation
d) Breech presentation
d) Breech presentation
Rationale: Breech presentations, where the pelvis or lower extremities present first, are associated with increased risks of complications such as umbilical cord prolapse, birth trauma, and asphyxia during vaginal delivery.
Which variation of cephalic presentation is least favorable for vaginal delivery?
a) Vertex presentation
b) Military presentation
c) Brow presentation
d) Occipital presentation
c) Brow presentation
Rationale: In a brow presentation, the widest diameter of the fetal head enters the pelvis, increasing the risk of cephalopelvic disproportion and obstructed labor, making it less favorable for vaginal delivery compared to other cephalic presentations.
What is the most common fetal lie at term in singleton pregnancies?
a) Transverse lie
b) Oblique lie
c) Longitudinal lie
d) Variable lie
c) Longitudinal lie
Rationale: By term, the majority of singleton pregnancies have a longitudinal lie, with the fetal spine parallel to the maternal spine, often resulting in a cephalic presentation.
Which of the following is a key risk associated with breech presentations?
a) Premature rupture of membranes
b) Fetal skull entrapment in the pelvis
c) Umbilical cord prolapse before delivery
d) Excessive cervical dilation during labor
b) Fetal skull entrapment in the pelvis
Rationale: In breech presentations, the fetal skull is the last part to be delivered, increasing the risk of entrapment in the pelvis. This poses a significant challenge during vaginal delivery.
Why are the fetal buttocks less effective than the head as a cervical dilator during labor?
a) The buttocks are smaller in diameter than the head.
b) The buttocks fail to descend into the maternal pelvis.
c) The buttocks are soft and less rigid compared to the fetal skull.
d) The buttocks block the umbilical cord from exiting first.
c) The buttocks are soft and less rigid compared to the fetal skull.
Rationale: The soft tissue of the buttocks does not apply the same pressure on the cervix as the hard fetal skull, making cervical dilation less effective during breech presentations.
Which breech presentation has the highest likelihood of resulting in a vaginal birth?
a) Frank breech
b) Complete breech
c) Footling breech
d) Incomplete breech
a) Frank breech
Rationale: In a frank breech, the buttocks present first with legs extended upward, which is more favorable for vaginal delivery compared to other breech presentations that typically require cesarean delivery.
What maternal conditions are associated with breech presentations? (Select all that apply)
a) Prematurity
b) Placenta previa
c) Multiparity
d) Uterine abnormalities such as fibroids
e) Gestational diabetes
a) Prematurity
b) Placenta previa
c) Multiparity
d) Uterine abnormalities such as fibroids
Rationale: Breech presentations are more common in cases of prematurity, placenta previa, uterine abnormalities, multiparity, and certain fetal anomalies. Gestational diabetes (e) is not directly associated with breech presentation.
Why is molding less likely to occur in breech presentations?
a) The fetal head does not pass through the cervix first.
b) The maternal pelvis restricts fetal head movement.
c) The umbilical cord prevents compression of the head.
d) The fetal head is smaller in breech presentations.
a) The fetal head does not pass through the cervix first.
Rationale: In breech presentations, the head is delivered last, reducing the opportunity for molding, which typically occurs when the head is subjected to pressure during its descent through the birth canal.
What is the primary reason that a cesarean birth is often necessary for breech presentations other than frank breech?
a) The risk of umbilical cord prolapse increases significantly.
b) The cervix is unable to fully dilate during breech labor.
c) Fetal head entrapment and birth trauma are more likely.
d) The maternal pelvis cannot accommodate the breech position.
c) Fetal head entrapment and birth trauma are more likely.
Rationale: In complete, footling, and incomplete breech presentations, cesarean delivery is preferred to reduce the risk of head entrapment and birth trauma, which are higher compared to frank breech presentations.
What is the typical fetal lie associated with a shoulder presentation?
a) Transverse lie
b) Longitudinal lie
c) Oblique lie
d) Variable lie
a) Transverse lie
Rationale: In a shoulder presentation, the fetus is typically in a transverse lie, meaning the fetal spine is perpendicular to the maternal spine, and the shoulder presents first in the birth canal.
Which clinical finding during Leopold maneuvers is indicative of a shoulder presentation?
a) A longitudinal lie and a vertex presentation
b) A transverse lie with the shoulder as the presenting part
c) A breech presentation with the feet palpated near the cervix
d) A head-down position with a well-flexed fetal head
b) A transverse lie with the shoulder as the presenting part
Rationale: During Leopold maneuvers, a transverse lie with the shoulder palpated in the birth canal is a key indicator of shoulder presentation, necessitating further evaluation and likely cesarean delivery.
What is the most favorable fetal attitude for vaginal birth?
a) Complete extension of all joints
b) Partial extension with the chin away from the chest
c) Complete flexion of all joints
d) Neutral attitude with no flexion or extension
c) Complete flexion of all joints
Rationale: The most favorable fetal attitude for vaginal birth is complete flexion, where the fetal back is rounded, the chin is tucked to the chest, and the legs and thighs are flexed. This position presents the smallest fetal skull diameters to the pelvis.
How does an abnormal fetal attitude affect the labor process?
a) It facilitates a faster descent of the fetus through the pelvis.
b) It reduces the risk of cephalopelvic disproportion.
c) It ensures proper alignment of the fetal head with the maternal pelvis.
d) It increases the diameter of the presenting part, complicating the birth process.
d) It increases the diameter of the presenting part, complicating the birth process.
Rationale: An abnormal fetal attitude, such as partial or complete extension, increases the diameter of the presenting part, making it harder for the fetus to navigate through the maternal pelvis and increasing the risk of labor complications.
What does the fetal attitude describe?
a) The posturing of fetal joints and the relationship of fetal parts to one another
b) The position of the fetal spine in relation to the maternal spine
c) The alignment of the fetal presenting part with the maternal pelvis
d) The degree of molding of the fetal skull during labor
a) The posturing of fetal joints and the relationship of fetal parts to one another
Rationale: Fetal attitude refers to the degree of flexion or extension of the fetal joints and the relationship of fetal parts to each other. This influences the presenting diameter of the fetal head during labor.
What is the significance of the suboccipitobregmatic diameter during labor?
a) It measures the widest transverse diameter of the fetal skull.
b) It determines the smallest anteroposterior diameter of the fetal skull.
c) It identifies the distance between the two parietal bones.
d) It measures the circumference of the fetal head.
b) It determines the smallest anteroposterior diameter of the fetal skull.
Rationale: The suboccipitobregmatic diameter, approximately 9.5 cm in a well-flexed fetal head, represents the smallest anteroposterior diameter and is crucial for successful passage through the maternal pelvis during labor.
Which fetal attitude is most favorable for vaginal delivery?
a) General flexion
b) Partial extension
c) Neutral position
d) Complete extension
a) General flexion
Rationale: General flexion, where the arms are crossed, thighs are flexed on the abdomen, and legs are flexed at the knees, allows the fetus to present the smallest diameters of the fetal skull for passage through the pelvis.
What does the biparietal diameter represent?
a) The smallest diameter of the fetal head
b) The widest part of the fetal head entering the pelvic outlet
c) The measurement from the occiput to the anterior fontanel
d) The largest anteroposterior diameter of the fetal skull
b) The widest part of the fetal head entering the pelvic outlet
Rationale: The biparietal diameter, approximately 9.25 cm at term, is the widest transverse diameter of the fetal skull and is crucial for determining whether the head can fit through the pelvic outlet.
Which position of the fetal head is required for the suboccipitobregmatic diameter to be the presenting part?
a) Full flexion
b) Partial flexion
c) Neutral position
d) Complete extension
a) Full flexion
Rationale: Full flexion of the fetal head ensures the suboccipitobregmatic diameter, the smallest anteroposterior diameter, is presented, facilitating easier passage through the maternal pelvis.
Why is the biparietal diameter critical in labor?
a) It is the largest circumference of the fetal head.
b) It helps determine the degree of fetal molding.
c) It measures the widest transverse diameter of the fetal skull, which must fit through the maternal pelvis.
d) It prevents cephalopelvic disproportion during labor.
c) It measures the widest transverse diameter of the fetal skull, which must fit through the maternal pelvis.
Rationale: The biparietal diameter is the widest transverse measurement of the fetal skull and plays a key role in assessing whether the fetal head can pass through the maternal pelvis.
Which presenting part designates a vertex presentation?
a) Mentum (M)
b) Sacrum (S)
c) Occiput (O)
d) Acromion process (A)
c) Occiput (O)
Rationale: A vertex presentation is characterized by the occiput as the presenting part. This position typically allows for the smallest diameter of the fetal head to pass through the maternal pelvis.
Which fetal position is described when the occiput is directed toward the right anterior quadrant of the maternal pelvis?
a) ROA
b) ROP
c) LOA
d) LOT
a) ROA
Rationale: ROA stands for right occiput anterior, indicating that the occiput is the presenting part and is directed toward the right anterior quadrant of the maternal pelvis.
