OB Lecture 4- Keppler

Question 1

What is a bishop score?

Answer 1

-Combined somewhat objective scoring system for determining a patient’s likelihood of
successful induction of labor
-Considers dilation, effacement, position and consistency of the cervix plus station of the fetal
presenting part

Question 2

Max score in bishop score?

Answer 2

13

Question 3

Labor progressing at a slower pace than “normal”

Answer 3

Protracted labor

Question 4

Either arrest of dilation after diagnosis of active labor, or failure of descent of the fetal head
during the second stage of labor

Answer 4

Arrested labor

Question 5

Less than 3 hours from onset of labor to delivery

Answer 5

Precipitous labor

Question 6

○ Green/brown staining of the amniotic fluid when the fetus defecates prior to delivery
○ Associated with adverse fetal outcomes including fetal intolerance of labor and respiratory
distress with aspiration

Answer 6

Meconium

Question 7

What is a Friedman’s curve?

Answer 7

Friedman’s Curve is a graph that care providers have traditionally used to define a “normal” length and pace of labor–giving first-time mothers about 14 hours to go from zero to ten cm and experienced mothers eight hours (Friedman 1955). If a cervix does not dilate according to this schedule, she may be assigned a diagnosis of Failure to Progress and taken to the operating room for a Cesarean.

Question 8

What are the 3 P’s you should remember in labor?

Answer 8

○ Pelvis
○ Passenger
○ Powers

Question 9

What degree laceration?

vaginal and perineal mucosa only, no disruption of muscles

Answer 9

1st degree

Question 10

What degree laceration?

1st degree plus superficial perineal muscles (transverse perineal and bulbocavernosus muscles)

Answer 10

2nd degree

Question 11

What degree laceration?

2nd degree plus anal sphincter(s)

Answer 11

3rd degree

Question 12

What degree laceration?

3rd degree plus anal mucosa

Answer 12

4th degree

Question 13

Is an episiotomy something that is commonly done?

Answer 13

No! Resist the urge

Question 14

_____ is the process of delivering a fetus and products of conception through coordinated uterine contractions combined with maternal expulsive efforts

Answer 14

Labor

Question 15

What stage of active labor is this?
Progressive dilation of the uterine cervix from entry to the active phase
to complete (10 cm) dilation

Answer 15

The first stage

Question 16

What stage of active labor is this?

Complete dilation and culminates with delivery of the neonate

Answer 16

The second stage

Question 17

What stage of labor is this?

The third stage starts at delivery of the newborn and culminates with delivery of the placenta

Answer 17

The third stage

Question 18

Why is fetal monitoring in labor important?

Answer 18

Fetal monitoring in labor is intended to confirm fetal wellbeing and guide interventions to decrease fetal harm in labor

Question 19

What are complications in labor?

Answer 19

Complications in labor are many and include bleeding, cord complications, protracted or arrested labor, and infection

Question 20

You are managing a patient in active labor. Her pain is controlled with an epidural and the fetal heart rate is being continuously monitored with a Category 1 tracing. Which of the following, if present, would change the fetal heart tracing to Category 2?
1. A baseline frequency of 165 beats per minute
2. Early decelerations
3. A temporary increase in the heart rate lasting 15 seconds, at least 15 beats per
minute above the baseline
4. Moderate variability

Answer 20

1. A baseline frequency of 165 beats per minute

Question 21

A 23 year old G1P0 at 39 weeks is admitted in active labor at 5 cm cervical dilation. In 3 hours her cervix is dilated to 7 cm dilation. After 6 hours, she is dilated to 8 cm. Which of the following best describes her labor progress?

1. Her labor is progressing normally
2. Her labor is protracted
3. Her labor is arrested
4. She is in the second stage of labor

Answer 21

2. Her labor is protracted

abnormally slow cervical dilation

Question 22

A 26 y/o G4P1021 at 41 0/7 weeks gestation presents for a post-dates induction of labor. You examine her cervix and note she’s 4 cm dilated, 50% effaced, at -1 station. Her cervix is soft and anterior. You calculate a Bishop score of 9. What is the significance of this finding?
1. She is guaranteed to have a vaginal delivery
2. Her induction is more likely to fail
3. Her induction is more likely to be successful using nipple stimulation
4. Her induction is as likely to result in a vaginal delivery as if she presented in
spontaneous labor

Answer 22

4. Her induction is as likely to result in a vaginal delivery as if she presented in
   spontaneous labor

Question 23

A patient has arrest in the active phase of labor. You are considering what factors are contributing to her stalled labor. Which of the following is not one of the three “Ps”?

1. Passenger
2. Powers
3. Pitocin
4. Pelvis

Answer 23

3. Pitocin

Question 24

Which of the following most accurately indicates that a patient admitted with contractions is in the first stage of active labor?

1. She is dilated to 5 cm
2. She is having enough pain to request an epidural
3. Her fetal heart rate pattern shows accelerations
4. The slope of cervical change over time is increasing

Answer 24

4. The slope of cervical change over time is increasing

Question 25

The orientation of the fetal head is assessed based on the location of which feature of the fetal cranium?

1. The parietal bones
2. The frontal suture
3. The occipital bone
4. The funny bone

Answer 25

3. The occipital bone

Question 26

Which of the following characteristics of a fetal heart rate being monitored in labor is not found in a category I tracing?

1. Late decelerations
2. Early decelerations
3. Accelerations
4. Moderate variability

Answer 26

1. Late decelerations

Question 27

Which of the following is not an indication for making an episiotomy?

1. Maternal exhaustion
2. Category 2 or 3 fetal heart rate tracing
3. Maternal history of cardiovascular disease
4. To decrease extension of a laceration to a more severe grade

Answer 27

4. To decrease extension of a laceration to a more severe grade