NM 704 Exam 2: Questions With In-Depth Solutions
Understand the relationship between the framework used for care related to
labor progress and Cesarean birth rates. Right Ans - -Medical model vs.
physiological model.
-How is slow labor defined varies from provider to provider and even in
research. How a provider defines it will influence their indication for
Cesareans.
-Active management of labor.
Define the stages and phases of labor as defined by Friedman. Right Ans -
First stage: onset of contractions to full dilation
Latent phase: onset of regular contractions
Active phase: When rate of contraction increases
Second stage: Complete dilation to birth of baby
Understand Friedman's definition of onset of labor and how this has been
applied clinically. Right Ans - In his original study, Friedman found the the
mean dilation when the rate of progress increased was approximately 3 cm.
This became widely adopted as the beginning of active phase for all women.
Friedman maintain this was inaccurate due to the variation in women.
Understand the current research on the onset of active phase of labor.
Right Ans - Current research says that active phase is more like 5 or 6 cm
which is very important in preventing women from being diagnosed as in
active labor while still in latent labor. Mistaken diagnosis results in
unnecessary interventions.
What is Friedman's criteria for normal progress in first stage, latent phase?
Right Ans - Nulliparas: <20 hours
Multiparas: <14 hours
What is Friedman's criteria for normal progress in first stage, active phase?
Right Ans - Nulliparas: at least 1.2 cm/hr dilatation
Multiparas: at least 1.5 cm/hr dilatation
What is Friedman's criteria for normal progress in second stage? Right Ans
- Nulliparas: 1 cm/hr descent
Multiparas: 2 cm/hr descent
, Define prolonged latent phase according to Friedman. Right Ans -
*progress is occuring, but more slowly than normal
For nullparas: longer than 20 hours
For multiparas: longer than 14 hours
Define protracted active phase as defined by Friedman. Right Ans -
*progress is occuring, but more slowly than normal
For nulliparas: dilitation slower than 1.2 cm/hr
For mulitparas: dilitation slower than 1.5 cm/hr
Define protracted descent as defined by Friedman. Right Ans - *progress is
occuring, but more slowly than normal
For nulliparas: descent less than 1 cm/hr
For mulitparas: descent less than 2 cm/hr
Define secondary arrest of dilation as defined by Friedman. Right Ans - *No
progress is being made
No dilation in two hours
Dilation began and then stopped
Define arrest of decent as defined by Friedman. Right Ans - *No progress is
being made
No descent in 1 hour
Understand Friedman's method of determining time limits for normal and
prolonged labor. Right Ans - *Calculated the slowest, fastest, and average
rate of progression for each phase and stage
*Upper limit of normal based on typical statistical norm of 95%ile
*Slowest 5% abnormal
Broadly summarize the contemporary research on labor duration. How do
they differ from Friedman's findings. Right Ans - *Average labor lasts
significantly longer than Friedman's studies
*Upper limits for active phase are about 2x as long as Friedman's
*Mean length of active labor is over 2x as long
*Finding of no progress of over 2 hours is not uncommon
*CSL suggests that dx of active phase protraction or labor arrest not be made
until after 6 cm dilitation
Understand the relationship between the framework used for care related to
labor progress and Cesarean birth rates. Right Ans - -Medical model vs.
physiological model.
-How is slow labor defined varies from provider to provider and even in
research. How a provider defines it will influence their indication for
Cesareans.
-Active management of labor.
Define the stages and phases of labor as defined by Friedman. Right Ans -
First stage: onset of contractions to full dilation
Latent phase: onset of regular contractions
Active phase: When rate of contraction increases
Second stage: Complete dilation to birth of baby
Understand Friedman's definition of onset of labor and how this has been
applied clinically. Right Ans - In his original study, Friedman found the the
mean dilation when the rate of progress increased was approximately 3 cm.
This became widely adopted as the beginning of active phase for all women.
Friedman maintain this was inaccurate due to the variation in women.
Understand the current research on the onset of active phase of labor.
Right Ans - Current research says that active phase is more like 5 or 6 cm
which is very important in preventing women from being diagnosed as in
active labor while still in latent labor. Mistaken diagnosis results in
unnecessary interventions.
What is Friedman's criteria for normal progress in first stage, latent phase?
Right Ans - Nulliparas: <20 hours
Multiparas: <14 hours
What is Friedman's criteria for normal progress in first stage, active phase?
Right Ans - Nulliparas: at least 1.2 cm/hr dilatation
Multiparas: at least 1.5 cm/hr dilatation
What is Friedman's criteria for normal progress in second stage? Right Ans
- Nulliparas: 1 cm/hr descent
Multiparas: 2 cm/hr descent
, Define prolonged latent phase according to Friedman. Right Ans -
*progress is occuring, but more slowly than normal
For nullparas: longer than 20 hours
For multiparas: longer than 14 hours
Define protracted active phase as defined by Friedman. Right Ans -
*progress is occuring, but more slowly than normal
For nulliparas: dilitation slower than 1.2 cm/hr
For mulitparas: dilitation slower than 1.5 cm/hr
Define protracted descent as defined by Friedman. Right Ans - *progress is
occuring, but more slowly than normal
For nulliparas: descent less than 1 cm/hr
For mulitparas: descent less than 2 cm/hr
Define secondary arrest of dilation as defined by Friedman. Right Ans - *No
progress is being made
No dilation in two hours
Dilation began and then stopped
Define arrest of decent as defined by Friedman. Right Ans - *No progress is
being made
No descent in 1 hour
Understand Friedman's method of determining time limits for normal and
prolonged labor. Right Ans - *Calculated the slowest, fastest, and average
rate of progression for each phase and stage
*Upper limit of normal based on typical statistical norm of 95%ile
*Slowest 5% abnormal
Broadly summarize the contemporary research on labor duration. How do
they differ from Friedman's findings. Right Ans - *Average labor lasts
significantly longer than Friedman's studies
*Upper limits for active phase are about 2x as long as Friedman's
*Mean length of active labor is over 2x as long
*Finding of no progress of over 2 hours is not uncommon
*CSL suggests that dx of active phase protraction or labor arrest not be made
until after 6 cm dilitation
