Test 2 - Modules 4 & 5 Flashcards
T/F Most clinicians agree with Friedman view that the rate of progress is more important than the total length of labor.
True
Friedman observed thousands of labors and graphed their progress by plotting rates of ___________ and ___________ against elapsed time. This graphic representation of labor progress is now known as ____________ _________. He observed that the slope of the lines representing dilatation and descent change ____________ in most labors. Friedman divided labor into________ and ________ based on these observations.
dilatation and descent; Friedman’s curve.
predictably;
stages and phases
Friedman: The first stage of labor begins with the _______ of regular uterine contractions and ends with ________ dilation of the cervix.
onset; complete
Friedman: The second stage of labor is defined as beginning with ________dilation of the cervix and ending with the ________.
complete; birth.
One controversy is the onset of the active phase of first stage labor. Friedman defined this as the time when the _____ of dilation increases. In his original study, Friedman found that the median dilation at this point of faster progress was about ___centimeters (Friedman, 1954). Clinicians and researchers adopted this as the definition of onset of active labor, however ____________points out that is not accurate to define active labor based on a particular dilation as there is considerable variation among women .
rate; 3cm. Friedman
Contemporary research shows that many women are not in active labor until ____ or ____centimeters
5 or 6
Friedman First Stage, Latent phase (note that latent phase is calculated based on total duration, not rate of dilation per hour):
Nulliparas:_____________
Multiparas:_____________
Friedman First Stage, Active phase:
Nulliparas: At least ___________ dilatation
Multiparas: At least ___________dilatation
- 2 cm/hr;
1. 5 cm/hr
Friedman Second Stage
Nulliparas: _________ descent
Multiparas: _________ descent
1 cm/hr;
2cm/hr
Friedman: When progress occurs more slowly than the in time frames noted above, it is called a ________ disorder. _________ disorders are defined by Friedman as no progress in dilation for ___ hours during first stage, active phase labor, or no progress in descent for ____ during second stage.
protraction;
Arrest; two; one hour
Friedman determined the slowest ___% of labors are defined as abnormal.
T/F - Friedman acknowledges that this numerical point was chosen arbitrarily.
5%; True
In Friedman’s research, _____% of the women diagnosed with secondary arrest of dilatation subsequently gave birth vaginally (with / with no) intervention.
T/F: While this might lead one to question the accuracy of a diagnosis of labor abnormality based on two hours without progress, this criteria for abnormal labor and others were readily adopted by American obstetricians and are commonly used today.
52.5%; with no
True
Concerns about high rates of ___________ ________ and other treatments for slow labor have prompted a re-examination of the definition of normal labor progress.
cesarean sections
In 2010, Zhang et al. published an analysis of labor patterns based on a dataset called the “Consortium on Safe Labor.” The statistical analysis used in this study allowed for evaluation of rates of progress at each centimeter of dilation. The slowest yet normal dilation (based on 95th percentiles) was found to be __________ for nulliparas and __________ for multiparas, with _______ dilation as labor progresses.
0.5 - 0.7 cm/hr for nulliparas
0.5 - 1.3 cm/hr for multiparas
faster
“Safe Prevention of the Primary Cesarean” is an _________ __________ published jointly by _____________ and ____________.
expert opinion;
American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM)
Joint statement: “The Consortium on Safe Labor data do not directly address an optimal duration for the diagnosis of active phase protraction or labor arrest, but do suggest that neither should be diagnosed before ___ cm of dilation. Because they are contemporary and robust, it seems that the Consortium of Safe Labor data, rather than the standards proposed by Friedman, should inform ____________ __________ ____________”
6cm; evidence-based labor management
T/F - Criteria for arrested labor are discussed in the contemporary research.
False
In the ACOG/SMFM document, the term _____ ______ is used in reference to when a cesarean should be considered.
labor arrest
Contemporary research
_____to____ cm per hour
or
______________ cm per hour (nullips/multips, with faster dilation as labor progresses)
- 3 to 0.5 cm/hr
0. 5-0.7/0.5-1.3 cm/hr
Friedman asserts that labor disorders as
he defines them (with the exception of prolonged latent phase), are associated with a significant _________________________. This assertion is used to justify significant __________ in labor, including __________________. This issue is complicated by the fact that the_________used to treat the “disorder” may be what presents the risk to the_________.
increase in risk to the fetus.
intervention; cesarean section.
intervention; fetus.
Contemporary research: The findings of these studies were consistent. Perinatal complications (did / did not) increase with the length of the second stage. Rates of __________, __________ vaginal deliveries, and ______ and ______ lacerations did increase with the length of the second stage.
did not;
cesarean section, operative vaginal delivieries, and 3rd and 4th degree lacerations
T/ F - In the past, clear cut recommendations regarding when to intervene in slower labors were based on Friedman criteria for protracted and arrested labor. New evidence and recommendations make this less clear cut.
True
Joint statement (ACOG/SMFM): Recommendations in this document for criteria necessary prior to cesarean birth for non-progressive labor are cervical dilation of at least ___centimeters, _________membranes and no cervical change in __ hours with adequate uterine activity or at least __ hours of pitocin when unable to attain adequate uterine activity.
T/F - It is also clearly stated that “slow but progressive labor should not be an indication for cesarean section”.
6 cm, ruptured membranes, and no cervical change in 4 hours with adequate uterine activity, or at least 6 hours of pitocin when unable to attain adequate uterine activity.
True
Their most important physiologic function of prostaglandins is the ability to cause _________ or __________ of smooth muscle. This includes smooth muscle other than that of the cervix or uterus, and can have important implications regarding ___________ ______ ________of prostaglandins.
contraction or relaxation;
unitended side effects