PHYSIOLOGY IN LABOR AND BIRTH

1. According to the principles of Active Management, which of the following is

NOT an indication that labor has started?
(Marks: 1)
a. Bloody show
b. Contractions - painful & regular
c. Effacement of the cervix
d. Rupture of membranes
2. From the following descriptions, determine which stage of labor these clients
are most likely to have reached.
(Marks: 5)
NOTE: Each answer only applies to ONE question - make sure each answer is unique.
Possible Answers
Client 1: - Contractions began 24 hours ago, coming every
10-15 minutes and lasting 40-50 seconds. Backache, pinkish
show

Early first stage

Client 2: - Contractions began 12 hours ago, coming every

5-10 minutes and lasting 55 seconds. Backache, feeling of
pressure in bottom

Beginning of active
first stage

Client 3: - Contractions began 2 hours ago, coming every 24 minutes and lasting 80-90 seconds. Shaking, feels
pressure in bottom

Active first stage

Client 4: - Contractions began 11 hours ago coming every 45 minutes, lasting 90 seconds. Making grunting noises,
"catch" in breath, pressure in bottom

Transition

Client 5: - Contractions began 10 hours ago, coming every

5-6 minutes and lasting 60-70 seconds. Looking "spaced
out", moaning, bloody show

Second stage

3. Indicate which of the following increases the risk of premature rupture of the
membranes.
(Marks: 5)
NOTE: tick all that apply - there are 5 correct answers
a. Amniocentesis
b. Hypertension
c. Uterine Infection
d. Oligohydramnios
e. Polyhydramnios
f. Smoking
g. Vaginal examinations
4. If your clients membranes have ruptured before labor begins, she may wish to
take precautions to reduce her risk of serious infection. Which of the following
actions are EVIDENCE BASED for this situation?
(Marks: 4)
NOTE: tick all that apply - there are 4 correct answers
a. Avoid vaginal examinations
b. Avoid using the bathtub
c. Avoid environments that she is not used to
d. Avoid sexual intercourse
e. Monitor temperature
f. Use good personal hygiene
5. In women whose membranes rupture before labor begins, what percentage
will go into labor spontaneously (on their own) within 48 hours, if no
intervention is done to start labor medically?
(Marks: 1)
a. 10-20%
b. 40-50%
c. 60-70%
d. 80-90%

6. What is the most common time for the membranes to rupture on their own?
(Marks: 1)
a. Before labor begins
b. Between 1-3 cm dilatation
c. Between 4-5 cm dilatation
d. Between 8-10 cm dilatation
7 . Your client, 41 weeks pregnant with her first baby, calls you to say she thinks
her waters have broken. Match the following indications with their potential
problems.
(Marks: 4)
NOTE: Each answer only applies to ONE question - make sure each answer is unique.
Possible Answers
Blood stained fluid

Usually normal

Strong offensive smell

May indicate fetal distress

Green stained fluid

May indicate placental abruption

Straw colored fluid

May indicate uterine infection

8. If a baby was described as being at +1 station, what would this mean?

(Marks: 1)
a. It is one cm above the cervix
b. It is one cm above the ischial spines
c. It is one cm below the cervix
d. It is one cm below the ischial spines
9. During an EXPECTANT third stage, the following should occur:
(Marks: 1)
Oxytocic drugs given as the anterior shoulder is born
Fundal massage or pressure applied
Cord traction applied
Cord clamped and cut after the baby has taken its first breath
True or False

10. In an actively managed third stage cord traction is used to ensure the
placenta is delivered before the cervix begins to close. The goal is to deliver the
placenta before how many minutes have passed?
(Marks: 1)
a. Up to 6 minutes
b. Up to 30 minutes
c. Up to 1 hour
d. Up to 2 hours
11. What is the physiologically normal range of time for an expectant third stage
of labor?
(Marks: 1)
a. No more than 6 minutes
b. Up to 30 minutes
c. No more than 1 hour
d. Up to 2 hours
12. The following are all risks associated with active management of the third
stage:
(Marks: 1)
Hypovolemia in the baby
Breaking of the umbilical cord
Retained placenta
Uterine prolapse
True or False

13. Indicate which of the following circumstances would mean that an actively
managed third stage would be more appropriate than an expectantly managed
one.
(Marks: 5)
a. Multiple birth
b. Gestational diabetes
c. Previous history of postpartum hemorrhage
d. Maternal preference
e. Rhesus negative mother
f. Mother wants to collect stem cells
g. Mother has had medication during labor
h. Mother is not intending to breastfeed
14. If the mother has chosen an expectant third stage, which of the following
actions is MOST likely to help the placenta separate quickly?
(Marks: 1)
a. Mother being given a saline drip
b. An injection of vitamin K being given to the mother
c. Baby being skin to skin with the mother
d. Cord being clamped and cut immediately after birth
15. Which of the following is NOT an oxytocic drug?
(Marks: 1)
a. Syntometrine
b. Pitocin
c. Hemabate
d. Synthamin
e. Ergometrine
f. Syntocinon

16. Match the correct description to each of the cardinal movements.

(Marks: 6)
NOTE: Each answer only applies to ONE question - make sure each answer is unique.
Possible Answers
Expulsion

head rotates as shoulders line up with widest part of pelvic

outlet

Descent

rest of the body is born

Extension

head rotates to align widest part of head with widest part of

pelvic outlet

Internal rotation

head is born and extends at babys neck

External rotation

baby's head descends into pelvis

Flexion

baby's chin tucks into its chest

17. As the baby's presenting part descends and puts pressure on the cervix, the
mother's body responds by releasing increasing amounts of oxytocin, increasing
the strength of contractions. What is this reflex called?
(Marks: 1)
a. Farquharson's reflex
b. Ferguson's reflex
c. Filigree reflex
d. Fusilim reflex