Stages of labor Practice Questions

Q: You are the intern on the labor and delivery floor. Your resident asks you to check on the patient in Bed 1. She is a 27-year-old prima gravida with no significant past medical history. She has had an uncomplicated pregnancy and has received regular prenatal care. You go to her bedside and glance at the fetal heart rate tracing (Image A). What is the most likely cause of this finding?

Fetal head compression. ***Fetal head compression*** - The image shows **early decelerations**, which are characterized by a gradual decrease and return of the fetal heart rate, mirroring the **contraction pattern**. - Early decelerations are considered benign and are typically caused by **vaginal stimulation** or **fetal head compression** during contractions, increasing vagal tone. *Congenital heart block* - Congenital heart block would manifest as a **persistent bradycardia** (low baseline heart rate) or significant rhythm abnormalities, not decelerations synchronized with contractions. - This condition is often associated with maternal **autoimmune diseases** such as lupus, which is not indicated in this patient's history. *Fetal distress* - Fetal distress is typically indicated by **late decelerations** (decelerations that occur after the peak of the contraction) or **prolonged decelerations**, often accompanied by reduced variability. - While other forms of decelerations can signify distress, early decelerations are generally considered reassuring. *Cord compression* - Cord compression typically causes **variable decelerations**, which are abrupt, unpredictable drops in fetal heart rate varying in duration, intensity, and timing relative to contractions. - These decelerations often have a 'U' or 'V' shape, which is different from the mirrored pattern seen in early decelerations. *Utero-placental insufficiency* - This condition is the cause of **late decelerations**, which are characterized by a gradual decrease in fetal heart rate that begins after the peak of the contraction and returns to baseline after the contraction ends. - Late decelerations reflect **fetal hypoxemia** due to insufficient placental blood flow, a more concerning finding than early decelerations.

Q: A 28-year-old primigravid woman at 36 weeks' gestation comes to the emergency department for 2 hours of contractions. Her pregnancy has been uncomplicated. The contractions occur once every 20–30 minutes, last less than 30 seconds, and have been consistent in intensity and duration since onset. During that time there has been an increase in fetal movements. Her temperature is 37.1°C (98.8°F), pulse is 98/min, and blood pressure is 104/76 mm Hg. Pelvic examination shows clear cervical mucus and a firm uterus consistent in size with a 36-week gestation. The cervix is 0% effaced and undilated; the vertex is at -3 station. The fetal heart rate is reassuring. After an hour of monitoring in the emergency department, the character of the contractions and pelvic examination findings remain unchanged. Which of the following is the most appropriate next step?

Reassurance and discharge. ***Reassurance and discharge*** - The patient's symptoms (contractions every 20-30 minutes, lasting less than 30 seconds, consistent in intensity and duration, **no cervical changes**) are consistent with **Braxton Hicks contractions** rather than true labor. - Given the reassuring fetal movements, normal vital signs, and unchanged cervical examination after an hour of monitoring, **reassurance and discharge** with instructions to return for signs of true labor are appropriate. *Admit for continuous monitoring* - Admission for continuous monitoring is indicated for **true labor**, suspected fetal distress, or complications requiring close observation. - This patient's findings, including lack of cervical change and stable contraction pattern, do not meet criteria for admission. *Administer tocolytics* - **Tocolytics** are used to stop or slow down premature labor. - This patient is at **36 weeks' gestation** (near term) and is not in true labor, making tocolytic administration inappropriate and unnecessary. *Perform cesarean delivery* - **Cesarean delivery** is indicated for obstetric emergencies, fetal distress, or failed vaginal delivery. - There are no indications for an operative delivery at this time; the patient is not in active labor and both mother and fetus are stable. *Offer local or regional anesthesia* - **Local or regional anesthesia** (e.g., epidural) is typically offered for pain management during active labor. - Since the patient is not in active labor, pain management for labor is not necessary.

Question 1

You are the intern on the labor and delivery floor. Your resident asks you to check on the patient in Bed 1. She is a 27-year-old prima gravida with no significant past medical history. She has had an uncomplicated pregnancy and has received regular prenatal care. You go to her bedside and glance at the fetal heart rate tracing (Image A). What is the most likely cause of this finding?

Accepted Answer

Fetal head compression

Answer

Congenital heart block

Answer

Fetal distress

Answer

Cord compression

Answer

Utero-placental insufficiency

Question 2

A 27-year old primigravid woman at 37 weeks' gestation comes to the emergency department because of frequent contractions for 4 hours. Her pregnancy has been complicated by hyperemesis gravidarum which subsided in the second trimester. The contractions occur every 10–15 minutes and have been increasing in intensity and duration since onset. Her temperature is 37.1°C (98.8°F), pulse is 110/min, and blood pressure is 140/85 mm Hg. Uterine contractions are felt on palpation. Pelvic examination shows clear fluid in the vagina. The cervix is 50% effaced and 3 cm dilated. After 4 hours the cervix is 80% effaced and 6 cm dilated. Pelvic examination is inconclusive for the position of the fetal head. The fetal heart rate is reassuring. Which of the following is the most appropriate next step?

Accepted Answer

Perform ultrasonography

Answer

Administer oxytocin

Answer

Perform external cephalic version

Answer

Administer misoprostol

Answer

Perform Mauriceau-Smellie-Veit maneuver

Question 3

A 28-year-old primigravid woman at 36 weeks' gestation comes to the emergency department for 2 hours of contractions. Her pregnancy has been uncomplicated. The contractions occur once every 20–30 minutes, last less than 30 seconds, and have been consistent in intensity and duration since onset. During that time there has been an increase in fetal movements. Her temperature is 37.1°C (98.8°F), pulse is 98/min, and blood pressure is 104/76 mm Hg. Pelvic examination shows clear cervical mucus and a firm uterus consistent in size with a 36-week gestation. The cervix is 0% effaced and undilated; the vertex is at -3 station. The fetal heart rate is reassuring. After an hour of monitoring in the emergency department, the character of the contractions and pelvic examination findings remain unchanged. Which of the following is the most appropriate next step?

Accepted Answer

Reassurance and discharge

Answer

Admit for continuous monitoring

Answer

Administer tocolytics

Answer

Perform cesarean delivery

Answer

Offer local or regional anesthesia

Stages of labor — MCQs

Stages of labor — MCQs

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