Module 3 & 4 Practice Questions

Question 1

A visually apparent, symmetrical, gradual decrease and return of the FHR, delayed in its onset relative to the onset of a uterine contraction with the FHR nadir occurring after the peak of the contraction, and with its return typically occurring after the end of the contraction.

Answer 1

Late deceleration

Question 2

The mean FHR rounded to increments of 5 beats per minute during a 10-minute segment, excluding periodic or episodic changes is

Answer 2

Baseline

Question 3

A visually apparent abrupt increase in the FHR with a peak of 15 beats per minute or more above baseline and a duration of 15 seconds or more

Answer 3

Acceleration

Question 4

A visually apparent decrease in the FHR, at least 15 beats per minute below the baseline, that continues for at least 2 minutes but less than 10 minutes.

Answer 4

Prolonged deceleration

Question 5

With IA, categorizing fetal assessment as Category I or Category II is based on:

Answer 5

presence of decelerations
baseline rate
baseline rhythm

Question 6

According to the ACOG bulletin on FHR monitoring, for a pregnant person without complications, what is the best choice for fetal assessment?

Answer 6

Either continuous electronic fetal monitoring or intermittent auscultation is acceptable

Question 7

The presence of accelerations in the FHR generally indicates

Answer 7

The fetus is not acidemic

Question 8

What are examples of effective intrauterine resuscitation techniques:

Answer 8

Lateral positioning, d/c Pitocin, IVF bolus, O2 admin (possibly-no current recommendations)

Question 9

Continuous electronic fetal heart rate monitoring is associated with

Answer 9

Increased cesarean births

Question 10

A fetal heart rate in the 170s for 15 minutes should be described as:

Answer 10

Tachycardia

Question 11

Recurrent decelerations occur:

Answer 11

With at least 50% of contractions in a 20-minute period.

Question 12

If a Category II based on IA findings, what is an appropriate action?

Answer 12

Change the birthing person’s position and increase frequency of ausculation

Question 13

The presence of early decelerations means:

Answer 13

head compression

Question 14

When a patient is having variable decels the FIRST action should be:

Answer 14

Reposition the patient

Question 15

A common cause of late decelerations noted after an epidural is:

Answer 15

hypotension

Question 16

Susie has an EFM with FHR baseline 145, moderate variability, no accelerations but repetitive decelerations noted to have smooth gradual descent to 130 starting with contraction and smooth gradual ascent to baseline by the end of the contraction. What category is this strip?

Answer 16

Cat I

Question 17

Admission to the hospital in the latent phase of labor may result in:

Answer 17

An increased rate of intrapartum interventions

Rationale: Latent phase labor can be a long process with very little measureable progress. Its appropriate management requires patience. When a woman is admitted to the hospital in this phase, prior to active labor, there is a tendency for care providers and family members to want to see progress and to demonstrate impatience, both leading to increased interventions. The evidence shows that increased interventions are associated with hospital admission in latent phase, including increased use of pain medication and more cesarean births. Perinatal outcomes are not improved.

Question 18

According to Friedman, active labor begins when the:

Answer 18

Rate of dilatation changes abruptly

Rationale: Responses ‘a’, ‘b’, and ‘c’ are loosely associated with the onset of active labor but, according to Friedman, the distinguishing characteristic of active labor onset is the significant increase in the rate of dilatation.

Question 19

A G1 P0 is in active labor. At 1600 her cervical exam is 7cm/100%/0 station. Two hours later her VE reveals 8cm/100%/+1 station. According to Friedman’s criteria, her labor progress is:

Answer 19

Protracted

Question 20

A G1 P0 in active labor. At 1600 her cervical exam is 7cm/100%/0 station. Two hours later her cervical exam is 8cm/100%/+1. According to contemporary research, her labor progress is:

Answer 20

Normal

Rationale: Contemporary research shows that the upper limit of active phase length is about twice as long as Friedman’s findings from ~50 years ago. Some researchers recommend a rate of .5cm/hr as the criterion for normal progress. In this scenario, Michelle’s progress is .5cm/hr so this would be considered normal progress using this alternative criterion.

Question 21

What was the outcome for most women diagnosed with a secondary arrest of dilatation in Friedman’s research?

Answer 21

Vaginal birth without intervention

Question 22

Researchers have found the following maternal outcome(s) to be associated with a longer duration of second stage:

Answer 22

Increased cesarean birth
Increased operative vaginal birth
Increased third and fourth degree lacerations

Rationale: Although a longer second stage was not shown to result in increased perinatal complications, the research did consistently show an increase in cesarean birth, operative vaginal birth, and third and fourth degree lacerations.

Question 23

A G2 P1001 is in active labor. Her cervical exam is 10cm/100%/0 station. She has no urge to push. According to Friedman’s criteria, the phase of labor is

Answer 23

Second stage

Rationale: Friedman defines second stage based on cervical dilatation alone. Complete dilatation = second stage, with or without an urge to push.

Question 24

A G2 P1001 is in active labor. Her cervical exam is 10cm/100%/0 station. She has no urge to push. A short time later, Nicki begins spontaneous bearing down efforts with each contraction. An hour later, Nicki’s cervical exam is 10cm/100%/+2 station. According to Friedman’s criteria, this labor progress is:

Answer 24

Normal

Rationale: Friedman’s criterion for normal progress in second stage is at least 2cm/hr descent for a multiparous woman. Nicki has made 2cm/hr progress in descent, which is normal.

Question 25

Which labor hormones are present in myometrial tissue throughout pregnancy?

Answer 25

Prostaglandin

Question 26

Active management of labor originating in Dublin in the 70’s included which parameters:

Answer 26

continuous labor support by a midwife

Question 27

Active management of labor originating in Dublin in the 70’s included which parameters:

Answer 27

continuous labor support by a midwife

Question 28

A G3 P2 is in active labor. She was 7 cm 80% -2 at 2 pm. At 4 pm her cervical exam was the same. According to Friedman, this is a

Answer 28

Secondary arrest of dilation

Question 29

A G1 P0 is in active labor. She has been 6 cm 80% -2 for the last 4 hours. Her contractions are every 4-6 minutes, moderate by palpation and 60-70 seconds long. The FHR monitor shows a category one tracing. What is the best next step?

Answer 29

Use shared decision making with the patient

Question 30

A G4 P2 is in active labor. At noon her cervical exam is 6 cm, 80%,-1. At 3 pm her cervical exam is 8 cm, 100% -1. According to contemporary research criteria, which accurately describes her labor progress

Answer 30

normal active phase

Question 31

ACOG recommends consideration of a cesarean birth when a woman

Answer 31

is greater than 6 cm with rupture membranes and no cervical change in 4 hours

Question 32

A G1 P0 has the urge to push at noon. She is 10 cm, 100%, -1. Two hours later she is 10cm, 100%, -1. According to Friedman, this is a/n

Answer 32

arrest of descent

Question 33

What is the most common reason for primary C/S?

Answer 33

Slow labor

Question 34

What term us currently being used for labors that are to slow?

Answer 34

Per ACOG/SMFM “abnormally progressing labor”

There are many terms that are used for this

Question 35

Per Friedman, what is labor protraction in active labor?

Answer 35

Progress occurring, but slower than normal

Friedman <1.5 cm/hr nullip, <1.2 cm/h multip
Contemporary <0.5 cm/h OR 0.5-0.7/0.5-1.3 cm/h (nullip/multip, with faster dilation as labor progresses)

Question 36

Per Friedman, what is labor arrest in active labor?

Answer 36

1) No progress for X hours
Friedman=2hrs
Updated=4hrs

2) Oxytocin with no progress in 4 hours (with adequate contractions) or 6 hours with inadequate contractions

Question 37

When should we intervene in labor according to Friedman?

Answer 37

Consider intervention for protraction or arrest of labor

Question 38

When should we intervene in labor according to contemporary recommendations?

Answer 38

ACOG: when first stage is protracted or arrested, oxytocin is recommended
Neal and Lowe: “at >5cm, oxytocin augment may be considered for a >4 hour delay in cervical change

Question 39

What other factors should be considered for abnormally slow labor?

Answer 39

-Maternal and Fetal Wellbeing
-Pt’s willingness or interest in other interventions

Question 40

What outcomes are associated with early intervention in arrested or protracted labor according to the evidence reviewed in Module 4?

Answer 40

There are no differences in outcomes regarding maternal and fetal wellbeing, labor is shortened.

Question 41

How should we intervene with abnormally slow labor?

Answer 41

-Shared Decision Making!!
-Oxytocin, amniotomy
-Doulas/cont. labor support
-Position changes/activity changes
-Assess fetal positioning
-Assess pain/coping
***Can start with least invasive options first if it is safe to do so and that is what the patient wants

Question 42

When is a cesarean indicated for abnormally slow labor alone?

Answer 42

**NOT indicated in latent labor or for slow but progressive labor

ACOG: Reserve for women at 6cm+ with ROM and failure to progress with 4 hours of adequate labor or 6 hours of Pitocin