Normal Labor

Question 1

stage I

Answer 1

onset of contractions until maximum dilation of cervix

two phases

Question 2

active phase

Answer 2

6-10cm

Question 3

latent phase

Answer 3

0-5.9cm
nullip - 20hrs
multip - generally around 14hrs

Question 4

stage II

Answer 4

complete dilation to delivery of baby
no maximum length of time
nullips - push for 3hrs
multips - push for 2hrs

Question 5

stage III

Answer 5

delivery of baby to delivery of placenta
requires uterine contraction
usually occurs within 30mins of delivery

Question 6

cervix changes

Answer 6

must change from thick and firm structure that is long to a thin and short structure

Question 7

how do cervical changes occur

Answer 7

achieved by breaking disulfide bonds between collagen and infusion of water - called cervical ripening
can lead to effacement (shortening of the cervix)

Question 8

stimulation of cervical changes

Answer 8

fetal head engagement
foley bulb
production of prostaglandin E2 (which is why indomethacin can be a tocolytic)

Question 9

what is fetal station

Answer 9

how far out baby is and how close baby is to coming out

• 5 to +5
• centimeters from vaginal opening
• 0 is the ischial spine

Question 10

what is fetal lie

Answer 10

orientation of te baby

Question 11

how is fetal lie determined

Answer 11

leopold maneuvers or ultrasound

Question 12

longitudinal fetal lie

Answer 12

axial skeleton parallel to mom’s

Question 13

transverse fetal lie

Answer 13

axial skeleton perpendicular to mom’s

Question 14

oblique fetal lie

Answer 14

axial skeleton neither parallel nor perpendicular

Question 15

what is the ‘right way’

Answer 15

longitudinal cephalic

Question 16

breech

Answer 16

any position other than longitudinal cephalic

indication for c-section

Question 17

external version

Answer 17

maneuver that can be attempted at 37wks where you flip the baby around from the outside

Question 18

frank breech

Answer 18

knees extended

hips flexed

Question 19

complete breech

Answer 19

knees flexed

hips flexed

Question 20

footlong breech

Answer 20

knees in any position

hips extended

Question 21

diameters of delivery

Answer 21

at the pelvic inlet, the largest diameter is transverse, causing the baby’s head to turn transverse to engage. the pelvic inlet is the pubic symphysis to sacral prominence
at mid-pelvis, it’s a 90degree change. largest diameter is at the anterior-posterior, causing a corkscrewing of the baby to get through

Question 22

fetal movements of delivery

Answer 22

1. engagement
2. descent
3. flexion
4. internal rotation
5. extension
6. external rotation
7. expulsion

Question 23

what is engagement

Answer 23

head (biparietal diameter) passes below the pelvic inlet

Question 24

what is flexion

Answer 24

flexion of the fetal head occurs passively due to the structure of the pelvis

Question 25

what is internal rotation

Answer 25

usually from OT position to an antero-posterior position

- also passive

Question 26

what is extension

Answer 26

extension occurs as baby’s head passes under the pubic symphysis

Question 27

what is external rotation

Answer 27

aka restitution

the turning of the baby’s head to again align with the rest of its body after its passed under the symphysis

Question 28

what is expulsion

Answer 28

anterior shoulder is delivered, posterior shoulder is delivered last