Quiz 8: Monitoring and managing the first stage of labour Flashcards
The latent phase of the first stage of labour is:
The period of time the cervix takes to dilate from 3 cm to full dilatation
The period of time from the onset of labour to full cervical dilatation
The period of time from the onset of labour to 3 cm cervical dilatation
The period of time during which the cervix becomes effaced
The period of time from the onset of labour to 3 cm cervical dilatation
What is the name given to the first oblique line on the program?
The action line
The alert line
The normal cervical dilatation line
The danger line
The alert line
If a patient’s cervix is 2 cm dilated, when should you perform the next vaginal examination?
When there are signs that the patient is in established labour with more regular and painful contractions
After 2 hours
After 8 hours
When the patient wants to bear down
When there are signs that the patient is in established labour with more regular and painful contractions
A patient presents in the latent phase of labour. After 12 hours she has not progressed to the active phase of labour despite regular contractions. Which of the following is the correct management?
She should be discharged home.
If there have been no cervical changes, the membranes should be ruptured.
If there has been slow dilatation and effacement of the cervix, it may be necessary to rupture the membranes.
An oxytocin infusion should be started.
If there has been slow dilatation and effacement of the cervix, it may be necessary to rupture the membranes.
A patient is admitted in established labour with regular contractions and ruptured membranes. On vaginal examination the cervix is 5 cm dilated. Where should her cervical dilatation be noted on the program?
On the alert line opposite 6 cm cervical dilatation
At the beginning of the latent phase of labour opposite 6 cm cervical dilatation
At the end of the latent phase of labour opposite 6 cm cervical dilatation
On the vertical line at the beginning of the active phase of labour opposite 6 cm cervical dilatation
On the alert line opposite 6 cm cervical dilatation
You should be satisfied with the progress of labour during the active phase when:
Cervical dilatation falls on or to the left of the alert line together with less fetal head palpable above the pelvis.
The cervix dilates at a rate of 2 cm per hour
Cervical dilatation falls on or to the left of the alert line together with improvement in the station of the presenting part as assessed on vaginal examination
There is progressive dilatation and effacement of the cervix
Cervical dilatation falls on or to the left of the alert line together with less fetal head palpable above the pelvis.
What should be your first step in the management of a patient who fails to progress in the active phase of the first stage of labour?
Make sure that the patient is in the active phase of the first stage of labour and that her membranes are ruptured.
Perform a pelvic assessment to determine whether she has a small pelvis.
Evaluate the patient by following the rule of the ‘4 Ps’.
Make sure that the patient has adequate analgesia.
Make sure that the patient is in the active phase of the first stage of labour and that her membranes are ruptured.
What should be your second step in the management of a patient who fails to progress in the active phase of the first stage of labour?
Determine whether the uterine contractions are adequate.
Start an oxytocin infusion.
Evaluate the patient by following the rule of the ‘4 Ps’.
Make sure that the patient is adequately hydrated.
Evaluate the patient by following the rule of the ‘4 Ps’.
When does a patient have adequate and effective uterine contractions?
If she has 2 or more contractions every 10 minutes with each contraction lasting 30 seconds or longer
If she has 3 or more contractions every 10 minutes with each contraction lasting 60 seconds or longer
If she progresses normally during labour
If she has pain with every contraction
If she progresses normally during labour
If a primigravida has poor progress in labour in spite of good, painful uterine contractions, without any moulding, your diagnosis should be:
Ineffective uterine contractions
Cephalopelvic disproportion
A small pelvis
Braxton Hicks contractions
Ineffective uterine contractions
A patient presents in labour at term with 2 contractions of 35 seconds each every 10 minutes. The cervix is 3 cm dilated and the membranes are bulging. The cervical dilatation is plotted on the alert line of the partogram. After 4 hours the cervix is 4 cm dilated while the other observations are unchanged. What is the correct management?
An oxytocin infusion should be started.
A Caesarean section should be done.
The patient’s membranes should be ruptured.
The doctor should be called to examine the patient.
The patient’s membranes should be ruptured.
What should you do if the cervical dilatation falls on the action line?
A Caesarean section should be done immediately.
The patient should be given the correct dose of oxytocin in an infusion.
The patient must be personally assessed by a doctor, and further management must be under the direction and responsibility of the doctor.
After making sure that the patient is in the active phase of the first stage of labour and her membranes are ruptured, she should be managed according to the rule of the ‘4 Ps’.
The patient must be personally assessed by a doctor, and further management must be under the direction and responsibility of the doctor.
Cephalopelvic disproportion due to a small pelvic inlet should be diagnosed when:
There is no further dilatation of the cervix
There is 3/5 or more of the fetal head palpable above the pelvic brim and 3+ or more moulding is present
There is 2/5 or less of the fetal head palpable above the pelvic brim and 1+ moulding is present
The measurements of the pelvic inlet are assessed as small during a pelvic examination
There is 3/5 or more of the fetal head palpable above the pelvic brim and 3+ or more moulding is present
A patient at term presents after having been in labour at home for some time. On admission, cephalopelvic disproportion is diagnosed. What is the correct further management of this patient?
An oxytocin infusion should be started.
A Caesarean section should be done.
The patient should be given pethidine and promethazine (Phenergan).
The patient should be reassured that she will labour and deliver normally.
A Caesarean section should be done.
A primigravida presents in labour at term. She is having 2 contractions of 35 seconds each every 10 minutes. The cervix is 5 cm dilated and the membranes have ruptured. Her cervical dilatation is plotted on the alert line. 4 hours later the cervix is 6 cm dilated and her other observations are unchanged. There are no signs of cephalopelvic disproportion. What is the correct management?
An oxytocin infusion should be started.
A Caesarean section should be done.
She should be given pethidine and hydroxyzine (Aterax).
The doctor should be called to examine the patient.
An oxytocin infusion should be started.
