questions 1

Stages of Labor

Topic updated on 11/13/17 3:49pm

Stage Timing Description Notes
Stage 1
Latent Starts at regular uterine contractions

1-6 hrs Highly variable duration, cervix effaces and slowly dilates
  • Continous FHR monitoring
    • doppler
    • fetal scalp electrode (FSE)
  • Monitor uterine activity
    • tocodynamometer
    • internal uterine pressure catheter
  • Analgesic
    • epidural
    • meperidine
Ends at cervix dilation to 4 cm
Active Starts cervix dilation to 4 cm

4-6 hrs Regular and intense contractions. Cervix effaces and dilates quickly. Fetal head progressively descends into the pelvis.
Ends at full cervix dilation to 10 cm 
Stage 2 Starts at complete cervical dilation

1-2 hrs

Baby undergoes all stages of cardinal movements: 

2) Flexion 
3) Internal

4) Extension 
5) External rotation 

  • Maternal effort accelerated delivery
  • Perineum control
  • Episiotomies
  • Once head delivered
    • suction nose and mouth
    • evaluate nuchal cord
  • Deliver shoulders
  • gentle downward pressure on head
    • deliver anterior shoulder
    • easy upward force
    • deliver posterior shoulder
  • Deliver body
  • Clamp and cut cord
  • Give infant to mother in warmer
  • Send umbilical cord blood for
    • ABO & Rh testing
    • blood gases
Ends at delivery of baby
Stage 3
Starts after baby is delivered

0-1/2hrs Placenta separates and uterus contracts to establish hemostasis
  • Wait for signs of placental separation
    • uterus firms/rises in abdomen
    • gush of blood
    • lengthening of cord
  • Apply gentle / constant traction
    • may take 30 minutes
Ends at delivery of placenta
Stage 4
Immediate postpartum 2 hrs Period with significant physiologic changes
  • Systematic evaluation of
    • cervix
    • vagina
    • vulva
    • perineum
    • periurethra
  • Monitor for postpartum complications
2 hrs postpartum



Qbank (1 Questions)

(M2.OB.253) A 29-year-old G2P1 at 40 weeks gestation presents to the hospital with regular uterine contractions at 10 minute intervals that have been steadily increasing in strength. Physical examination reveals a cervix dilated to 3 cm with 60% effacement. You tell the patient that she is in labor and estimate that her cervix is dilating at a rate of 1.5 cm per hour. Which of the following will mark the end of the first stage of labor in this patient? Topic Review Topic

1. Delivery of the placenta
2. Maximal cervical dilation
3. Delivery of the infant
4. Positive fern test
5. A fetal head station of +2


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