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A 35-year-old gravida 1, para 0 is admitted to the labor and delivery unit. She reports intense rectal pressure. Which stage of labor is probable?
- A. First stage, latent
- B. Second stage
- C. Third stage
- D. Fourth stage
Correct Answer: B
Rationale: The correct answer is B: Second stage. In the second stage of labor, the cervix is fully dilated, and the woman experiences the urge to push. The intense rectal pressure reported by the patient indicates the baby's descent into the birth canal, a characteristic of the second stage. In contrast, in the first stage (choices A and C), the cervix is still dilating, and in the fourth stage (choice D), immediate postpartum period, the focus is on maternal stabilization.
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A woman’s pelvis is described as long and narrow with an anteroposterior diameter greater than the transverse diameter. This is known as which type of pelvis?
- A. Platypelloid
- B. Android
- C. Anthropoid
- D. Gynecoid
Correct Answer: C
Rationale: The correct answer is C: Anthropoid. In an anthropoid pelvis, the anteroposterior diameter is greater than the transverse diameter, giving it a long and narrow shape. This type of pelvis resembles the pelvis seen in higher primates. The other choices are incorrect because:
A: Platypelloid pelvis has a transversely wide and short shape.
B: Android pelvis has a heart-shaped inlet with a prominent sacrum and narrow pubic arch.
D: Gynecoid pelvis has a round inlet and a wide pubic arch, typically seen in females and ideal for childbirth.
A 28-year-old woman without risk factors has now reached the second stage of labor. What is the optimal position for her at this point?
- A. Supine
- B. Lateral recumbent
- C. Lithotomy
- D. Squatting
Correct Answer: B
Rationale: The optimal position for a 28-year-old woman in the second stage of labor is the lateral recumbent position (Choice B). This position helps maximize pelvic diameter and blood flow to the uterus, facilitating labor progress. It also reduces the risk of fetal heart rate abnormalities compared to the supine position (Choice A). Lithotomy position (Choice C) can hinder the descent of the baby and increase the risk of perineal trauma. Squatting (Choice D) may be uncomfortable and less effective in promoting efficient labor progress compared to the lateral recumbent position.
What changes in hormones initiate labor?
- A. decreased progesterone, decreased estrogen, absence of oxytocin
- B. increased progesterone, decreased estrogen, absence of oxytocin
- C. increased progesterone, decreased estrogen, presence of oxytocin
- D. decreased progesterone, increased estrogen, effects of oxytocin
Correct Answer: D
Rationale: The correct answer is D because during labor, progesterone levels decrease, estrogen levels increase, and oxytocin plays a key role in initiating contractions. Progesterone inhibits contractions, so its decrease is necessary for labor to start. Estrogen helps stimulate uterine contractions. Oxytocin, released from the brain, triggers and enhances contractions.
Option A is incorrect because an absence of oxytocin would not initiate labor. Option B is incorrect because increased progesterone would inhibit labor. Option C is incorrect because oxytocin is needed to initiate labor.
How long is the expected length of the third stage of labor?
- A. 60 minutes or less
- B. 30 minutes or less
- C. 1 hour for a multiparous person, 2 hours for a nulliparous person
- D. 3 hours for a multiparous person, 4 hours for a nulliparous person
Correct Answer: C
Rationale: The correct answer is C: 1 hour for a multiparous person, 2 hours for a nulliparous person. This is based on the typical duration of the third stage of labor, which involves the delivery of the placenta. In general, the third stage is expected to last around 5-30 minutes. However, for safety reasons and to allow for variations in individual cases, it is recommended to extend the time frame to 1 hour for multiparous individuals (those who have given birth before) and 2 hours for nulliparous individuals (those giving birth for the first time). This extended time frame ensures that healthcare providers have enough time to monitor and intervene if necessary without rushing the delivery of the placenta.
Other choices are incorrect because they provide either too short (A and B) or too long (D) timeframes for the third stage of labor, which could lead to inadequate monitoring or unnecessary interventions.
Arrange the seven cardinal movements of labor, in order.
- A. Descent
- B. Expulsion
- C. Extension
- D. External rotation
Correct Answer: A
Rationale: The correct order of the seven cardinal movements of labor is: Descent, Flexion, Internal Rotation, Extension, Restitution, External Rotation, and Expulsion. Descent is the first cardinal movement, as the baby moves down the birth canal. Flexion follows to allow the baby's head to pass through the pelvis. Internal Rotation, Extension, and Restitution then occur to facilitate the baby's shoulders and body turning in alignment with the mother's pelvis. External Rotation follows to help the shoulders rotate to the correct position for delivery. Finally, Expulsion is when the baby is born. This sequence ensures a smooth and safe delivery. The other choices are incorrect as they are not part of the specific sequence of cardinal movements during labor.