Pregnancy , Labour

Question 1

Rupture of membrane before the onset of labor at any stage of gestation is referred to as

Answer 1

premature rupture of the membranes

Question 2

Active labour is divided into 3 stages which are

Answer 2

stage of cervical effacement and dilatation.

stage of expulsion of the fetus.

stage of separation and expulsion of the placenta.

Question 3

Third stage of labour

Answer 3

The third stage of labor begins immediately after delivery of the fetus, and ends with the delivery of the placenta and fetal membranes.

Question 4

1st stage of labour

Answer 4

The first stage of labor begins when uterine contractions of sufficient frequency, intensity, and duration are attained to bring about effacement and progressive dilatation of the cervix. The first stage of labor ends when the cervix is fully dilated, that is, when the cervix is sufficiently dilated (about 10 cm) to allow passage of the fetal head

Question 5

phases of cervical dilation are ?

Answer 5

latent phase and the active phase

Question 6

The active phase of cervical dilatation is subdivided into?

Answer 6

acceleration phase, the phase of maximum slope, and the deceleration phase

Question 7

Phases of parturition

Answer 7

Phase 0,1,2,3

Question 8

Phase 1

Answer 8

There is uterine awakening

1. A striking increase in myometrial oxytocin receptors.
2. An increase in gap junctions (number and surface area) between myometrial cells.
3. Uterine irritability.
4. Responsiveness to uterotonins.
5. Transition from a contractile state characterized predominantly by occasional painless contractions to one in which more frequent contractions develop.
6. Formation of the lower uterine segment.
7. Cervical softening.

Question 9

Phase 2

Answer 9

Same with active labour
divided into the three stages of labor

The onset of labour is the transition between phase 1 and phase 2

Question 10

UTERINE PHASE 3 OF PARTURITION.

Answer 10

Phase 3 consists of the events of the puerperium maternal recovery from childbirth, maternal contributions to infant survival, and the restoration of fertility in the parturient

Question 11

Labour contractions are characterized by

Answer 11

strength, duration, and frequency

Question 12

At onset of labour , what is the frequency and duration of contraction

Answer 12

every 5 to 10 minutes and last for 20-25 seconds

Question 13

Labour forces are

Answer 13

Uterine contractions

Bearing down efforts( pushing )

Question 14

Bearing down effort is

Answer 14

is the periodic contractions of diaphragm, pelvic floor muscles and prelum abdominale which are added to the force of uterine contractions. It’s a voluntary expulsive force

Question 15

The minimal dilatation during the first stage is

Answer 15

for primiparous women: 1-1,2cm /hour and multiparous 1,2-1,5cm/hour.

Question 16

In patients with no significant obstetric risk factors, the fetal heart rate should be auscultated by what frequency

Answer 16

at least every 30 minutes in the first stage of labor and after each uterine contraction in the second stage of the labor

Question 17

Molding is ?

Answer 17

is the alteration of the relationship of the fetal cranial bones to each other as the result of the compressive forces exerted by the bony maternal pelvis.

Question 18

Duration of 2nd stage labour

Answer 18

from 30 minutes to 2 hours in primigravid women and from 10- 50 minutes in multigravid women. The median duration is 50 minutes in a primipara and slightly under 20 minutes in a multipara

Question 19

Clinical management of the second stage of labor.

Answer 19

When delivery is imminent, the patient is usually placed in the lithotomy position.

With each contraction, the mother should be encouraged to hold her breath and bear down with expulsive efforts.

As the perineum becomes flattened by the crowning head, an episiotomy may be performed, to prevent perineal lacerations.

Question 20

PERINEAL PROTECTIVE MANEUVERS

Answer 20

are performed to avoid injury of the fetus and laceration of the perineum

Question 21

What are the PERINEAL PROTECTIVE MANEUVERS

Answer 21

The first one is prevention of preterm fetal head extension (during pushing efforts the fetal head is flexed).

Second is the delivery of the fetal head by extension of vulvar muscles.

Third one is decreasing of perineal tension by borrowing of the tissues from the upper part of vulva ring to the lower.

Forth is regulations of voluntary maternal effort (pushing)

Fifth is the delivery of shoulders traction are indicated. first dow nward, later upward direction of

Question 22

The delivery of the placenta the placenta generally occurs within 2 to 10 minutes of the end of the second occurs during the third stage of labor.

Answer 22

Ya

Question 23

Shreder’s sign

Answer 23

the uterine fundus rises up, the uterus becomes firm and globular.

Question 24

KredeLasarevich ’s sign

Answer 24

doctor presses with his palm above the patient pubis , Before placental separation umbilical cord comes inside a vagina (sign is negative), after separation comes down (sign is positive).

Question 25

SIGNS OF PLACENTAL SEPARATION ARE FOLLOWS:

Answer 25

Alfeld ’s sign

Shredersign 

Krede- Lasarevich ’s sign

Question 26

Posterior asynclitism ?

Answer 26

When the saggital suture lies closer to symphysis and more of the posterior parietal bone presents

Question 27

anterior asynclitism

Answer 27

When the sagittal suture approaches the sacral promontory, more of the anterior parietal bone present s itself to the examining fingers

Question 28

Synclitism is

Answer 28

a position when the sagittal suture is in the transverse pelvic diameter.

Question 29

There are 2 kinds of the occiput presentations , what are they ?

Answer 29

anterior and posterior.

Question 30

The cardinal movements of labor in anterior occiput presentation are

Answer 30

flexion
internal rotation
Extension
Internal rotation of the head and external rotation of the body

Question 31

The cardinal movements of labor in posterior occiput presentation are:

Answer 31

Flexion 
Internal rotation 
Additional flexion
Extension 
Internal rotation of fetal head and external rotation of fetal body

Question 32

Molding describes

Answer 32

the change in fetal head shape from external compressive forces

Molding is associated with a shortened suboccipitobregmatic diameter and a lengthening of the mentovertical diameter.

Question 33

Contractions of True Labor are

Answer 33

Contractions occur at regular intervals Intervals gradually shorten
• Intensity gradually increases
• Discomfort is in the back and abdomen
• Cervix dilates
• Discomfort is not stopped by sedation

Question 34

Contractions of False Labor

Answer 34

• Contractions occur at irregular intervals
• Intervals remain long
• Intensity remains unchanged
• Discomfort is chiefly in lower abdomen
• Cervix does not dilate
• Discomfort is usually relieved by sedation

Question 35

VAGINAL EXAMINATION

What should you check for

Answer 35

1. Amnionic fluid. If there is a question of membrane rupture, a sterile speculum is carefully inserted, and fluid is sought in the posterior vaginal fornix. Any fluid is observed for vernix or meconium; if the source of the fluid remains in doubt, it is collected on a swab for further study, as described later.
2. Cervix. Softness, degree of effacement (length), extent of dilatation, and location of the cervix with respect to the presenting part and vagina are ascertained, as will be described. The presence of membranes with or without amnionic fluid below the presenting part often can be felt by careful palpation. The fetal membranes often can be visualized if they are intact and the cervix is dilated somewhat.
3. Presenting part. The nature of the presenting part should be positively determined and, ideally, its position
4. Station. The degree of descent of the presenting part into the birth canal is identified, as will be described. If the fetal head is high in the pelvis (above the level of the ischial spines), the effect of firm fundal pressure on descent of the fetal head is tested.
   5) Pelvic architecture - The diagonal conjugate, ischial spines, pelvic sidewalls, and sacrum are reevaluated for adequacy

Question 36

STATION

Answer 36

The level of the presenting fetal part in the birth canal is described in relationship to the ischial spines, which are halfway between the pelvic inlet and the pelvic outlet.

classification of station divides the pelvis above and below the spines into fifths.

These divisions represent centimeters above and below the spines

Question 37

If the presenting fetal part descends from the inlet toward the ischial spines, the designation is ?

Answer 37

-5, -4, -3, -2, -1 and 0 station

Question 38

Below the ischial spines, the presenting fetal part passes +1, +2, +3, +4, and +5 stations to delivery.

Question 39

If the leading part of the fetal head is at 0 station or below, it means

Answer 39

Fetal engagement of head has occurred

Question 40

Detection of ruptured membrane

Question 41

Rupture of the membranes is significant for three reasons which are ?

Answer 41

First, if the presenting part is not fixed in the pelvis, the possibility of prolapse of the umbilical cord and cord compression is greatly increased.

Second, labor is likely to occur soon if the pregnancy is at or near term.

Third, if delivery is delayed for 24 hours or more after membrane rupture, there is increasing likelihood of serious intrauterine infection

Question 42

You can detect rupture of membrane by

Answer 42

testing the pH of the vaginal fluid; the pH of vaginal secretions normally ranges between 4.5 and 5.5, whereas that of amnionic fluid is usually 7.0 to 7.5

A pH above 6.5 is consistent with ruptured membranes.

Detection of alphafetoprotein in the vaginal vault has been used to identify amnionic fluid