NM704 EXAM 2 QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Endogenous Oxytocin
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
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
more than 5ctx in 10min; the major concern of oxytocin
Pitocin dosages
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
begins with onset of regular contractions and ends with complete dilation; two phases:
latent and active
latent stage of labor
, begins with onset of regular contractions; <20hr in a nullpara and <14hr in multiparas
active phase of labor
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
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
increased operative vag delivery, c/s, increased 3rd or 4th degree lacerations
protraction disorders
progress is occuring, but more slowly than normal; 3 types: prolonged latent phase,
prolonged active phase, protracted descent
arrest disorders
no progress being made; 3 types: second arrest of dilation (no dilation in 2hrs), arrest of
descent (no descent in 1hr)
Contemporary research
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
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Endogenous Oxytocin
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
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
more than 5ctx in 10min; the major concern of oxytocin
Pitocin dosages
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
begins with onset of regular contractions and ends with complete dilation; two phases:
latent and active
latent stage of labor
, begins with onset of regular contractions; <20hr in a nullpara and <14hr in multiparas
active phase of labor
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
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
increased operative vag delivery, c/s, increased 3rd or 4th degree lacerations
protraction disorders
progress is occuring, but more slowly than normal; 3 types: prolonged latent phase,
prolonged active phase, protracted descent
arrest disorders
no progress being made; 3 types: second arrest of dilation (no dilation in 2hrs), arrest of
descent (no descent in 1hr)
Contemporary research
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
