Stages of labor

Stages of labor US Medical PG Question 1: Two days after vaginal delivery of a healthy newborn at term, a 32-year-old woman, gravida 2, para 2, is unable to breastfeed. Her labor was complicated by antepartum hemorrhage and she received two units of packed red blood cells. Her pulse is 99/min and blood pressure is 90/55 mm Hg. Further evaluation of this patient is most likely to show which of the following sets of serum findings? $$$ ACTH %%% Aldosterone %%% Cortisol $$$

• A. ↑ ↓ ↓
• B. ↓ ↑ ↓
• C. ↑ normal ↑
• D. ↓ normal ↑
• E. ↓ normal ↓ (Correct Answer)

Stages of labor Explanation: ***↓ normal ↓*** - This scenario describes **Sheehan's syndrome**, caused by **postpartum pituitary necrosis** due to severe hemorrhage and hypotension during delivery. - Decreased **ACTH** (adrenocorticotropic hormone) leads to secondary **adrenal insufficiency**, causing decreased **cortisol**. **Aldosterone** secretion, primarily regulated by the **renin-angiotensin system**, remains largely normal because only the zona glomerulosa of the adrenal cortex, which produces aldosterone, is regulated directly by the renin-angiotensin-aldosterone system (RAAS), whereas the pituitary regulates the zona fasciculata and zona reticularis. *↑ ↓ ↓* - This pattern (high ACTH, low aldosterone, low cortisol) suggests **primary adrenal insufficiency** (Addison's disease), where the adrenal glands themselves are failing, leading to a compensatory increase in ACTH. However, this patient's condition is due to pituitary damage. - In primary adrenal insufficiency, both **cortisol** and **aldosterone** would be low, and **ACTH** would be elevated due to a lack of negative feedback. *↓ ↑ ↓* - This pattern (low ACTH, high aldosterone, low cortisol) is inconsistent with most common adrenal or pituitary pathologies. Low ACTH and low cortisol would suggest secondary adrenal insufficiency, but high aldosterone does not fit. - **Hyperaldosteronism** with secondary adrenal insufficiency is rare and not indicated by the patient's presentation. *↑ normal ↑* - This pattern (high ACTH, normal aldosterone, high cortisol) suggests **Cushing's disease** (pituitary adenoma secreting ACTH), or an ectopic ACTH tumor, or a state of acute stress. - The patient's **hypotension** and inability to breastfeed point away from Cushing's and towards hypopituitarism. *↓ normal ↑* - This pattern (low ACTH, normal aldosterone, high cortisol) could be seen in states of iatrogenic **exogenous corticosteroid use**, leading to suppressed ACTH and endogenous cortisol, or in an adrenal tumor producing cortisol independent of ACTH. - This is inconsistent with the symptoms of postpartum hemorrhage and inability to lactate, which indicate a **deficit** rather than an excess of pituitary hormones.

Stages of labor US Medical PG Question 2: A 29-year-old G1P0 female at 32 weeks gestation presents to the emergency department with vaginal bleeding. She has had minimal prenatal care to-date with only an initial visit with an obstetrician after a positive home pregnancy test. She describes minimal spotting that she noticed earlier today that has progressed to larger amounts of blood; she estimates 30 mL of blood loss. She denies any cramping, pain, or contractions, and she reports feeling continued movements of the baby. Ultrasound and fetal heart rate monitoring confirm the presence of a healthy fetus without any evidence of current or impending complications. The consulted obstetrician orders blood testing for Rh-status of both the mother as well as the father, who brought the patient to the hospital. Which of the following represents the best management strategy for this situation?

• A. After 28 weeks gestation, administration of RhoGAM will have no benefit
• B. If mother is Rh-positive and father is Rh-negative then administer RhoGAM
• C. If mother is Rh-negative and father is Rh-negative then administer RhoGAM
• D. If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed
• E. If mother is Rh-negative and father is Rh-positive then administer RhoGAM (Correct Answer)

Stages of labor Explanation: ***If mother is Rh-negative and father is Rh-positive then administer RhoGAM*** - This combination creates a risk for **Rh incompatibility**, meaning the fetus could be Rh-positive and the mother's immune system could form antibodies against fetal red blood cells, which can harm the fetus in future pregnancies. - **RhoGAM (Rh immunoglobulin)** administration prevents the mother from forming these antibodies when there's a risk of maternal-fetal blood mixing, as indicated by vaginal bleeding. *After 28 weeks gestation, administration of RhoGAM will have no benefit* - This statement is incorrect; **RhoGAM is routinely administered around 28 weeks gestation** as prophylaxis in Rh-negative mothers, even without bleeding episodes, to prevent sensitization. - In cases of potential fetal-maternal hemorrhage, such as vaginal bleeding, RhoGAM is indicated regardless of gestational age beyond the first trimester. *If mother is Rh-positive and father is Rh-negative then administer RhoGAM* - This scenario does not pose a risk for **Rh incompatibility hemolytic disease of the newborn**, as the mother already possesses the Rh antigen. - RhoGAM is specifically given to Rh-negative mothers to prevent their immune system from reacting to an Rh-positive fetus. *If mother is Rh-negative and father is Rh-negative then administer RhoGAM* - In this case, both parents are **Rh-negative**, meaning the fetus will also be Rh-negative. - There is no risk of **Rh incompatibility** or sensitization, so RhoGAM administration is not indicated. *If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed* - This statement is incorrect and represents a critical misunderstanding of **Rh incompatibility prophylaxis**. - This specific genetic combination creates the highest risk for **Rh sensitization** during pregnancy, especially with events like vaginal bleeding, making RhoGAM administration essential.

Stages of labor US Medical PG Question 3: A 28-year-old primigravid woman at 36 weeks' gestation comes to the emergency department for 2 hours of contractions. Her pregnancy has been uncomplicated. The contractions occur once every 20–30 minutes, last less than 30 seconds, and have been consistent in intensity and duration since onset. During that time there has been an increase in fetal movements. Her temperature is 37.1°C (98.8°F), pulse is 98/min, and blood pressure is 104/76 mm Hg. Pelvic examination shows clear cervical mucus and a firm uterus consistent in size with a 36-week gestation. The cervix is 0% effaced and undilated; the vertex is at -3 station. The fetal heart rate is reassuring. After an hour of monitoring in the emergency department, the character of the contractions and pelvic examination findings remain unchanged. Which of the following is the most appropriate next step?

• A. Admit for continuous monitoring
• B. Reassurance and discharge (Correct Answer)
• C. Administer tocolytics
• D. Perform cesarean delivery
• E. Offer local or regional anesthesia

Stages of labor Explanation: ***Reassurance and discharge*** - The patient's symptoms (contractions every 20-30 minutes, lasting less than 30 seconds, consistent in intensity and duration, **no cervical changes**) are consistent with **Braxton Hicks contractions** rather than true labor. - Given the reassuring fetal movements, normal vital signs, and unchanged cervical examination after an hour of monitoring, **reassurance and discharge** with instructions to return for signs of true labor are appropriate. *Admit for continuous monitoring* - Admission for continuous monitoring is indicated for **true labor**, suspected fetal distress, or complications requiring close observation. - This patient's findings, including lack of cervical change and stable contraction pattern, do not meet criteria for admission. *Administer tocolytics* - **Tocolytics** are used to stop or slow down premature labor. - This patient is at **36 weeks' gestation** (near term) and is not in true labor, making tocolytic administration inappropriate and unnecessary. *Perform cesarean delivery* - **Cesarean delivery** is indicated for obstetric emergencies, fetal distress, or failed vaginal delivery. - There are no indications for an operative delivery at this time; the patient is not in active labor and both mother and fetus are stable. *Offer local or regional anesthesia* - **Local or regional anesthesia** (e.g., epidural) is typically offered for pain management during active labor. - Since the patient is not in active labor, pain management for labor is not necessary.

Stages of labor US Medical PG Question 4: A 22-year-old primigravid woman at 41 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been uncomplicated. She has asthma treated with theophylline and inhaled corticosteroids. She has had 2 surgeries in the past to repair multiple lower limb and pelvis fractures that were the result of a car accident. She is otherwise healthy. Her temperature is 37.2°C (99°F) and blood pressure is 108/70 mm Hg. Examination shows the cervix is 100% effaced and 10 cm dilated; the vertex is at -4 station, with the occiput in the anterior position. Uterine activity is measured at 275 MVUs. Maternal pushing occurs during the contractions. Fetal heart tracing is 166/min and reactive with no decelerations. Epidural anesthesia is initiated for pain relief. After 4 hours of pushing, the vertex is found to be at -4 station, with increasing strength and rate of uterine contractions; fetal heart tracing shows late decelerations. Which of the following is the most likely cause of this patient's prolonged labor?

• A. Deep transverse arrest
• B. Insufficient uterine contraction
• C. Epidural anesthesia
• D. Cephalopelvic disproportion (Correct Answer)
• E. Inefficient maternal pushing

Stages of labor Explanation: ***Cephalopelvic disproportion*** - The history of **multiple lower limb and pelvis fractures** from a car accident suggests a high likelihood of a **contracted or abnormally shaped pelvis**. This can lead to **cephalopelvic disproportion (CPD)**, where the fetal head cannot fit through the maternal pelvis despite adequate uterine contractions (275 MVUs). - The combination of **prolonged labor** (4 hours of pushing with no descent), **vertex at -4 station** even after full dilation, increasing contraction strength, and new **late decelerations** (indicating fetal distress due to impaired oxygenation from prolonged compression) points towards an obstruction. *Deep transverse arrest* - This occurs when the fetal head rotates into the transverse diameter of the pelvis and fails to rotate anteriorly. While it causes **arrest of descent and dilation**, the primary issue is **malposition**, not a fundamental size mismatch. - The occiput is described as in the **anterior position**, which does not immediately suggest deep transverse arrest. *Insufficient uterine contraction* - The uterine activity is measured at **275 MVUs**, which indicates **adequate contraction strength**. Insufficient contractions would typically be below 200 MVUs. - While weak contractions can cause prolonged labor, the current uterine activity suggests this is not the primary problem. *Epidural anesthesia* - Epidural anesthesia can sometimes prolong the second stage of labor by reducing the urge to push or temporarily decreasing the effectiveness of pushing efforts. However, the patient's **strong uterine activity (275 MVUs)** and previous **pelvic fractures** make a mechanical obstruction (CPD) a more specific and likely cause of arrest in this scenario. - Furthermore, the vertex remaining at -4 station for 4 hours despite strong contractions points to a physical barrier rather than just altered pushing dynamics. *Inefficient maternal pushing* - While inefficient maternal pushing can contribute to prolonged labor, the fetus remaining at -4 station for 4 hours with **strong uterine contractions (275 MVUs)** indicates that the issue is likely beyond just inadequate pushing efforts. - The historical detail of **pelvic fractures** points more strongly to an anatomical obstruction rather than simply ineffective maternal exertion.

Stages of labor US Medical PG Question 5: Five minutes after initiating a change of position and oxygen inhalation, the oxytocin infusion is discontinued. A repeat CTG that is done 10 minutes later shows recurrent variable decelerations and a total of 3 uterine contractions in 10 minutes. Which of the following is the most appropriate next step in management?

• A. Restart oxytocin infusion
• B. Emergent Cesarean section
• C. Administer terbutaline
• D. Monitor without intervention
• E. Amnioinfusion (Correct Answer)

Stages of labor Explanation: ***Amnioinfusion*** - **Recurrent variable decelerations** persisting after discontinuing oxytocin and changing maternal position often indicate **cord compression**, which can be relieved by amnioinfusion. - Adding fluid to the amniotic cavity **cushions the umbilical cord**, reducing compression during uterine contractions. *Restart oxytocin infusion* - Reinitiating oxytocin would likely **worsen the recurrent variable decelerations** by increasing uterine contraction frequency and intensity, thereby exacerbating cord compression. - The goal is to alleviate fetal distress, not to intensify uterine activity that is already causing issues. *Emergent Cesarean section* - While an emergent Cesarean section is indicated for **unresolved fetal distress**, it's usually considered after less invasive measures, such as amnioinfusion, have failed. - There is still an opportunity for a simpler intervention to resolve the issue before resorting to surgery. *Administer terbutaline* - Terbutaline is a **tocolytic agent** used to reduce uterine contractions, which can be helpful in cases of tachysystole or hyperstimulation. - In this scenario, the contraction frequency is low (3 in 10 minutes), so reducing contractions is not the primary aim; rather, the focus is on resolving the cord compression causing decelerations. *Monitor without intervention* - **Recurrent variable decelerations** are an concerning sign of **fetal distress** and require intervention to prevent potential harm to the fetus. - Simply monitoring without intervention would be inappropriate and could lead to worsening fetal hypoxemia and acidosis.

Stages of labor US Medical PG Question 6: A 30-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the hospital for regular, painful contractions that have been increasing in frequency. Her pregnancy has been complicated by gestational diabetes treated with insulin. Pelvic examination shows the cervix is 50% effaced and 4 cm dilated; the vertex is at -1 station. Ultrasonography shows no abnormalities. A tocometer and Doppler fetal heart monitor are placed on the patient's abdomen. The fetal heart rate monitoring strip shows a baseline heart rate of 145/min with a variability of ≥ 15/min. Within a 20-minute recording, there are 7 uterine contractions, 4 accelerations, and 3 decelerations that have a nadir occurring within half a minute. The decelerations occur at differing intervals relative to the contractions. Which of the following is the most appropriate next step in the management of this patient?

• A. Vibroacoustic stimulation
• B. Routine monitoring (Correct Answer)
• C. Administer tocolytics
• D. Emergent cesarean delivery
• E. Placement of fetal scalp electrode

Stages of labor Explanation: ***Routine monitoring*** - The presented FHR tracing exhibits a **normal baseline rate** (145/min), **moderate variability** (≥15/min), and the presence of **accelerations**, indicating a reassuring fetal status. - The described decelerations are **variable decelerations** due to their sudden onset, nadir within 30 seconds, and variable relationship to contractions, which are generally benign unless prolonged, deep, or repetitive. Given the otherwise reassuring status, continued routine monitoring is appropriate. *Vibroacoustic stimulation* - This intervention is used to elicit **fetal accelerations** or movement during non-stress tests (NSTs) when the fetus is quiet or shows a non-reactive pattern. - In this case, the fetus is already showing **accelerations** and moderate variability, so stimulation is not needed to assess fetal well-being. *Administer tocolytics* - **Tocolytics** are used to stop or slow down labor, typically in cases of preterm labor or uterine tachysystole causing fetal distress. - This patient is at **38 weeks' gestation** and in active labor, and there are no signs of fetal distress warranting the cessation of contractions. *Emergent cesarean delivery* - **Emergent cesarean delivery** is indicated for acute fetal distress, such as prolonged decelerations, significant bradycardia, or absent variability in conjunction with other concerning FHR patterns. - The FHR tracing described is largely reassuring with moderate variability and accelerations, and the variable decelerations are not indicative of immediate threat, making emergent delivery unnecessary. *Placement of fetal scalp electrode* - A **fetal scalp electrode** provides a more accurate and continuous measure of the FHR, often used when external monitoring is difficult or when there are concerns about the reliability of the tracing. - While it can be useful in some situations, the current tracing is **interpretable as reassuring**, making invasive monitoring currently unnecessary.

Stages of labor US Medical PG Question 7: Thirty minutes after vaginal delivery of a 2780-g (6-lb 2-oz) newborn at term, a 25-year-old woman, gravida 1, para 1, has heavy vaginal bleeding. Her pregnancy was complicated by pre-eclampsia. Her pulse is 111/min and blood pressure is 95/65 mm Hg. Physical examination shows a fundal height 2 inches below the xiphoid process of the sternum. A drug with which of the following mechanisms of action is most appropriate for this patient?

• A. Activation of phospholipase C (Correct Answer)
• B. Depolarization of the motor end plate
• C. Increased synthesis of cyclic AMP
• D. Inhibition of norepinephrine reuptake
• E. Binding to prostaglandin I2 receptors

Stages of labor Explanation: ***Activation of phospholipase C*** - This patient presents with **postpartum hemorrhage (PPH)**, characterized by heavy vaginal bleeding, tachycardia, hypotension, and a poorly contracted uterus (normal fundal height is at the umbilicus immediately after delivery; 2 inches below the xiphoid is high indicating uterine atony). - The most appropriate first-line treatment for uterine atony is **oxytocin**, which acts by binding to G protein-coupled receptors, leading to the **activation of phospholipase C** and an increase in intracellular calcium, causing uterine muscle contraction. *Depolarization of the motor end plate* - This mechanism describes the action of **neuromuscular blocking agents** or agonists at the nicotinic acetylcholine receptor, which are not used for treating postpartum hemorrhage. - The motor end plate is involved in skeletal muscle contraction, not smooth muscle contraction of the uterus. *Increased synthesis of cyclic AMP* - **Increased cyclic AMP** generally leads to smooth muscle relaxation (e.g., beta-2 agonists like terbutaline), which would worsen uterine atony and postpartum hemorrhage. - Tocolytic agents that would cause uterine relaxation would be contraindicated in this scenario. *Inhibition of norepinephrine reuptake* - This mechanism describes the action of certain **antidepressants** (e.g., tricyclic antidepressants, SNRIs) or **stimulants**, which primarily affect the central nervous system and are not used to manage postpartum hemorrhage. - This action does not directly cause uterine contraction. *Binding to prostaglandin I2 receptors* - **Prostaglandin I2 (PGI2)**, also known as prostacyclin, is a potent vasodilator and inhibitor of platelet aggregation. Binding to its receptors would lead to smooth muscle relaxation and would increase bleeding, directly worsening postpartum hemorrhage. - Uterotonic agents like carboprost (PGF2α analog) act on different prostaglandin receptors to induce uterine contraction.

Stages of labor US Medical PG Question 8: A 28-year-old woman, gravida 2, para 1, at 14 weeks' gestation, comes to the physician with a 3-day history of abnormal vaginal discharge. She has not had fever, chills, or abdominal pain. One week ago, her 2-year-old daughter had a urinary tract infection that quickly resolved after antibiotic therapy. The patient reports that she is sexually active with one male partner and they do not use condoms. Vital signs are within normal limits. Pelvic examination shows an inflamed and friable cervix. There is mucopurulent, foul-smelling discharge from the cervical os. There is no uterine or cervical motion tenderness. Vaginal pH measurement shows a pH of 3.5. Which of the following is the most appropriate initial step in management?

• A. Wet mount preparation
• B. Nucleic acid amplification test (Correct Answer)
• C. Amine test
• D. Urine analysis and culture
• E. Potassium hydroxide preparation

Stages of labor Explanation: ***Nucleic acid amplification test*** - The patient's symptoms of **inflamed, friable cervix** and **mucopurulent discharge**, along with a normal vaginal pH (3.5), are highly suggestive of **cervicitis**, commonly caused by *Chlamydia trachomatis* or *Neisseria gonorrhoeae*. - **NAATs** are the most sensitive and specific tests for detecting these organisms, which is crucial for prompt diagnosis and treatment, especially in pregnancy, to prevent adverse outcomes. *Wet mount preparation* - A **wet mount** would be useful for identifying *Trichomonas vaginalis* or *Candida* species and diagnosing **bacterial vaginosis**, but the patient's normal vaginal pH makes these diagnoses less likely. - While it can help rule out other common causes of vaginal discharge, it is **not sensitive enough** to reliably detect *Chlamydia* or *Gonorrhea*. *Amine test* - The **amine test** (or whiff test) is used to detect the release of amines in the presence of **bacterial vaginosis**, typically indicated by a **vaginal pH >4.5**. - The patient's vaginal pH of 3.5 makes **bacterial vaginosis highly unlikely**, so an amine test would not be beneficial in this scenario. *Urine analysis and culture* - While the patient's daughter recently had a **urinary tract infection (UTI)**, the patient's symptoms are localized to the cervix (cervicitis) with **no fever, chills, or abdominal pain** indicative of a UTI. - A urine analysis and culture would be appropriate if bladder symptoms were present, but it **will not diagnose cervicitis** or the specific sexually transmitted infections causing it. *Potassium hydroxide preparation* - A **KOH preparation** is primarily used to identify **fungal elements (hyphae and spores)**, indicating a *Candida* infection, which typically presents with thick, white, "cottage cheese" discharge and itching. - This test is **not useful for diagnosing cervicitis** or bacterial causes of vaginal discharge, and the patient's symptoms are not consistent with candidiasis.

Stages of labor US Medical PG Question 9: A 31-year-old G6P6 woman with a history of fibroids gives birth to twins via vaginal delivery. Her pregnancy was uneventful, and she reported having good prenatal care. Both placentas are delivered immediately after the birth. The patient continues to bleed significantly over the next 20 minutes. Her temperature is 97.0°F (36.1°C), blood pressure is 124/84 mmHg, pulse is 95/min, respirations are 16/min, and oxygen saturation is 98% on room air. Continued vaginal bleeding is noted. Which of the following is the most appropriate initial step in management?

• A. Oxytocin
• B. Blood product transfusion
• C. Uterine artery embolization
• D. Hysterectomy
• E. Bimanual massage (Correct Answer)

Stages of labor Explanation: ***Bimanual massage*** - The patient is experiencing **postpartum hemorrhage (PPH)**, indicated by significant bleeding post-delivery. **Uterine atony** is the most common cause of PPH, and bimanual massage helps stimulate uterine contractions to reduce bleeding. - This is a **first-line, non-pharmacological intervention** that can be rapidly initiated to manage uterine atony. *Oxytocin* - While **oxytocin** is a uterotonic agent used to treat PPH, the initial step is typically **bimanual massage** to physically stimulate the uterus while preparing for medication administration. - Oxytocin infusion would be administered concurrent with or immediately following bimanual massage, but manual compression is often initiated first. *Blood product transfusion* - Blood product transfusion is indicated for significant blood loss and hemodynamic instability, but it is a **supportive measure** rather than an initial intervention to stop the bleeding. - The patient's current **blood pressure (124/84 mmHg)** and **pulse (95/min)** do not immediately suggest severe hypovolemic shock requiring immediate transfusion as the *first* step before attempting to control the source of bleeding. *Uterine artery embolization* - **Uterine artery embolization** is a highly invasive procedure typically reserved for cases where conservative measures, including uterotonic agents and bimanual compression, have failed to control PPH. - It is not an appropriate initial step, as it requires specialized equipment and personnel and would delay immediate management of active bleeding. *Hysterectomy* - **Hysterectomy** is a last-resort intervention for intractable PPH that cannot be controlled by all other methods, including uterotonics, uterine massage, and other surgical or interventional radiology techniques. - It is a highly invasive procedure with significant morbidity and is not considered an initial management step.

Stages of labor US Medical PG Question 10: A 62-year-old woman makes an appointment with her primary care physician because she recently started experiencing post-menopausal bleeding. She states that she suffered from anorexia as a young adult and has been thin throughout her life. She says that this nutritional deficit is likely what caused her to not experience menarche until age 15. She used oral contraceptive pills for many years, has never been pregnant, and experienced menopause at age 50. A biopsy of tissue inside the uterus reveals foci of both benign and malignant glandular cells. Which of the following was a risk factor for the development of the most likely cause of her symptoms?

• A. Menopause at age 50
• B. Never becoming pregnant (Correct Answer)
• C. Using oral contraceptive pills
• D. Menarche at age 15
• E. Being underweight

Stages of labor Explanation: ***Never becoming pregnant*** - **Nulliparity** is a significant risk factor for **endometrial cancer** as it implies longer exposure to unopposed estrogen, which stimulates endometrial proliferation. - The diagnosis of malignant glandular cells in the context of post-menopausal bleeding strongly suggests **endometrial carcinoma**, where nulliparity contributes to increased estrogen exposure over time. *Menopause at age 50* - **Later age of menopause** (e.g., after 52) is a risk factor for endometrial cancer, as it prolongs the duration of estrogen exposure. - Menopause at age 50 is considered within the **average range**, thus not typically an independent risk factor for endometrial cancer. *Using oral contraceptive pills* - **Combined oral contraceptive pills** (estrogen and progestin) actually **reduce the risk** of endometrial cancer. - The progestin component in OCPs counteracts the proliferative effects of estrogen on the endometrium, offering protection. *Menarche at age 15* - **Early menarche** (before age 12) is a risk factor for endometrial cancer due to a longer lifetime exposure to estrogen. - Menarche at age 15 is considered **later than average**, which would typically be a protective factor against endometrial cancer, as it shortens the duration of estrogen exposure. *Being underweight* - **Obesity** is a major risk factor for endometrial cancer because adipose tissue converts androgens to estrogens, leading to higher levels of circulating estrogen. - Being underweight or having a history of anorexia does not increase the risk of endometrial cancer; in fact, it may be associated with **lower estrogen levels**, which could be protective.

Stages of labor Flashcard 1 of 10

Question: Women who are obese, or have had prolonged _____ stage of labor, multiple vaginal deliveries, or previous pelvic surgery are at an increased risk for pelvic floor injury

Answer: second

Stages of labor Flashcard 2 of 10

Question: Hepatitis B can be transmitted from mother to baby during _____

Answer: delivery

Stages of labor Flashcard 3 of 10

Question: On average, what is the rate at which the cervix dilates during the active phase for a nulli? Multiparous? Nulli: _____ cm/hr Mulit: _____ cm/hr

Answer: 1.2

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Stages of labor Flashcard 4 of 10

Question: > _____ weeks = term labor

Answer: 37

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Stages of labor Flashcard 5 of 10

Question: Contractions generating >_____ Montevideo units (MVUs) in a 10-minute interval are considered adequate

Answer: 200

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Stages of labor Flashcard 6 of 10

Question: The transition between the latent and active phase of first stage of labor typically occurs at _____ dilation

Answer: 6 cm

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Stages of labor Flashcard 7 of 10

Question: How do you measure the strength of uterine contractions? _____

Answer: Intrauterine pressure catheter (IUPC)

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Stages of labor Flashcard 8 of 10

Question: What are the cardinal movements of the fetus during delivery? 1. _____ 2. Flexion 3. Descent 4. Internal rotation 5. Extension 6. External rotation 7. Expulsion

Answer: Engagement

Extra Information: 

Stages of labor Flashcard 9 of 10

Question: The components of the bishop score include: _____

Answer: 1. Fetal station 2. Cervical dilation 3. Cervical effacement 4. Cervical position 5. Cervical consistency

Extra Information: 

Stages of labor Flashcard 10 of 10

Question: There are _____ stages of labor

Answer: three

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