NM704 Exam 2 - Questions Complete Solutions With
Clear Explanations
Endogenous Oxytocin Right Ans - one of the hormones involved with labor
and uterine contractions; blood levels are fairly constant before and during
most of labor with a significant rise at the end of second stage that helps
produce the Ferguson reflex; there is no correlation between blood levels and
ctx frequency and strenth
Exogenous Oxytocin Right Ans - Pitocin; used for induction and
augmentation of labor; pharmacokinetics: onset of action (IV) 3-4min, half-life
10-15min, steady state reached in 30-40min; we don't know the full effect for
at least 30min
Tachysystole Right Ans - more than 5ctx in 10min; the major concern of
oxytocin
Pitocin dosages Right Ans - regimens are needed, no way to predict an
individual woman's response, start small and increase every 30" till desired
contraction pattern, "high" dose and "low" dose used but not well or
universally defined
Friedman's first stage of labor Right Ans - begins with onset of regular
contractions and ends with complete dilation; two phases: latent and active
latent stage of labor Right Ans - begins with onset of regular contractions;
<20hr in a nullpara and <14hr in multiparas
active phase of labor Right Ans - begins when rate of dilation/progression
increases(rate of dilation changes abruptly); in Friedman's study it was 3cm
but even Friedman considers this inaccurate due to woman laboring
differently; new research shows active labor to start at 5-6cm in many
women; nullpara at least 1.2cm/hr and multipara at least 1.5cm/hr
Friedman's second stage of labor Right Ans - it begins with complete
dilation with or without the urge to push; nullipara 1cm of descent/hr and
multipara 2cm/hr
, longer duration of second stage Right Ans - increased operative vag
delivery, c/s, increased 3rd or 4th degree lacerations
protraction disorders Right Ans - progress is occuring, but more slowly
than normal; 3 types: prolonged latent phase, prolonged active phase,
protracted descent
arrest disorders Right Ans - no progress being made; 3 types: second arrest
of dilation (no dilation in 2hrs), arrest of descent (no descent in 1hr)
Contemporary research Right Ans - over 20% of women progress at a rate
of less than 1cm/hr; 1st study suggesting 0.5cm/hr may be a normal labor
progression; labor length about twice as long as found by Friedman; two
hours without change in dilation not uncommon; active labor doesn't start
until 5-6cm; labor takes longer (BMIs higher and babies larger);
ACOG/SMFM consensus statement 2014 Right Ans - "Safe prevention of the
Primary Cesarean Delivery", changing how we define and manage slow and
non-progressive labor; most common reason of cesarean birth "labor
dystocia" (slow or no progressive labor)
Contemporary research augmentation Right Ans - at >5cm you may
consider Pitocin when there is a >4hr delay in cervical change; until active
labor do not consider augmentation
well-being of mother and baby Right Ans - the reason why we monitor
labor progress (the big picture)
fetal morbidity and mortality Right Ans - are significantly increased with
protractions and arrest of labor (not in latent phase)... this was related to mid-
forceps delivery
interventions for slow labor Right Ans - Pitocin, amniotomy and warm
water immersion (fewer epidurals)
cesarean indicated? Right Ans - widespread agreement it is not indicated
for latent labor and many c/s for slow/no progress are done in latent labor
Clear Explanations
Endogenous Oxytocin Right Ans - one of the hormones involved with labor
and uterine contractions; blood levels are fairly constant before and during
most of labor with a significant rise at the end of second stage that helps
produce the Ferguson reflex; there is no correlation between blood levels and
ctx frequency and strenth
Exogenous Oxytocin Right Ans - Pitocin; used for induction and
augmentation of labor; pharmacokinetics: onset of action (IV) 3-4min, half-life
10-15min, steady state reached in 30-40min; we don't know the full effect for
at least 30min
Tachysystole Right Ans - more than 5ctx in 10min; the major concern of
oxytocin
Pitocin dosages Right Ans - regimens are needed, no way to predict an
individual woman's response, start small and increase every 30" till desired
contraction pattern, "high" dose and "low" dose used but not well or
universally defined
Friedman's first stage of labor Right Ans - begins with onset of regular
contractions and ends with complete dilation; two phases: latent and active
latent stage of labor Right Ans - begins with onset of regular contractions;
<20hr in a nullpara and <14hr in multiparas
active phase of labor Right Ans - begins when rate of dilation/progression
increases(rate of dilation changes abruptly); in Friedman's study it was 3cm
but even Friedman considers this inaccurate due to woman laboring
differently; new research shows active labor to start at 5-6cm in many
women; nullpara at least 1.2cm/hr and multipara at least 1.5cm/hr
Friedman's second stage of labor Right Ans - it begins with complete
dilation with or without the urge to push; nullipara 1cm of descent/hr and
multipara 2cm/hr
, longer duration of second stage Right Ans - increased operative vag
delivery, c/s, increased 3rd or 4th degree lacerations
protraction disorders Right Ans - progress is occuring, but more slowly
than normal; 3 types: prolonged latent phase, prolonged active phase,
protracted descent
arrest disorders Right Ans - no progress being made; 3 types: second arrest
of dilation (no dilation in 2hrs), arrest of descent (no descent in 1hr)
Contemporary research Right Ans - over 20% of women progress at a rate
of less than 1cm/hr; 1st study suggesting 0.5cm/hr may be a normal labor
progression; labor length about twice as long as found by Friedman; two
hours without change in dilation not uncommon; active labor doesn't start
until 5-6cm; labor takes longer (BMIs higher and babies larger);
ACOG/SMFM consensus statement 2014 Right Ans - "Safe prevention of the
Primary Cesarean Delivery", changing how we define and manage slow and
non-progressive labor; most common reason of cesarean birth "labor
dystocia" (slow or no progressive labor)
Contemporary research augmentation Right Ans - at >5cm you may
consider Pitocin when there is a >4hr delay in cervical change; until active
labor do not consider augmentation
well-being of mother and baby Right Ans - the reason why we monitor
labor progress (the big picture)
fetal morbidity and mortality Right Ans - are significantly increased with
protractions and arrest of labor (not in latent phase)... this was related to mid-
forceps delivery
interventions for slow labor Right Ans - Pitocin, amniotomy and warm
water immersion (fewer epidurals)
cesarean indicated? Right Ans - widespread agreement it is not indicated
for latent labor and many c/s for slow/no progress are done in latent labor
