Quiz 3: Monitoring and management of the first stage of labour

Please choose the one, most correct answer to each question or statement.

1. The latent phase of the first stage of labour is:
   • The period of time the cervix takes to dilate from 3 cm to full dilatation
   • The period of time from the onset of labour to full cervical dilatation
   • The period of time from the onset of labour to 3 cm cervical dilatation
   • The period of time during which the cervix becomes effaced
2. What is the name given to the first oblique line on the partogram?
   • The action line
   • The alert line
   • The normal cervical dilatation line
   • The danger line
3. If a patient’s cervix is 2 cm dilated, when should you perform the next vaginal examination?
   • When there are signs that the patient is in established labour with more regular and painful contractions
   • After 2 hours
   • After 8 hours
   • When the patient wants to bear down
4. A patient presents in the latent phase of labour. After 12 hours she has not progressed to the active phase of labour despite regular contractions. Which of the following is the correct management?
   • She should be discharged home.
   • If there have been no cervical changes, the membranes should be ruptured.
   • If there has been slow dilatation and effacement of the cervix, it may be necessary to rupture the membranes.
   • An oxytocin infusion should be started.
5. A patient is admitted in established labour with regular contractions and ruptured membranes. On vaginal examination the cervix is 5 cm dilated. Where should her cervical dilatation be noted on the partogram?
   • On the alert line opposite 6 cm cervical dilatation
   • At the beginning of the latent phase of labour opposite 6 cm cervical dilatation
   • At the end of the latent phase of labour opposite 6 cm cervical dilatation
   • On the vertical line at the beginning of the active phase of labour opposite 6 cm cervical dilatation
6. You should be satisfied with the progress of labour during the active phase when:
   • Cervical dilatation falls on or to the left of the alert line together with less fetal head palpable above the pelvis.
   • The cervix dilates at a rate of 2 cm per hour
   • Cervical dilatation falls on or to the left of the alert line together with improvement in the station of the presenting part as assessed on vaginal examination
   • There is progressive dilatation and effacement of the cervix
7. What should be your first step in the management of a patient who fails to progress in the active phase of the first stage of labour?
   • Make sure that the patient is in the active phase of the first stage of labour and that her membranes are ruptured.
   • Perform a pelvic assessment to determine whether she has a small pelvis.
   • Evaluate the patient by following the rule of the ‘4 Ps’.
   • Make sure that the patient has adequate analgesia.
8. What should be your second step in the management of a patient who fails to progress in the active phase of the first stage of labour?
   • Determine whether the uterine contractions are adequate.
   • Start an oxytocin infusion.
   • Evaluate the patient by following the rule of the ‘4 Ps’.
   • Make sure that the patient is adequately hydrated.
9. When does a patient have adequate and effective uterine contractions?
   • If she has 2 or more contractions every 10 minutes with each contraction lasting 30 seconds or longer
   • If she has 3 or more contractions every 10 minutes with each contraction lasting 60 seconds or longer
   • If she progresses normally during labour
   • If she has pain with every contraction
10. If a primigravida has poor progress in labour in spite of good, painful uterine contractions, without any moulding, your diagnosis should be:
    • Ineffective uterine contractions
    • Cephalopelvic disproportion
    • A small pelvis
    • Braxton Hicks contractions
11. A patient presents in labour at term with 2 contractions of 35 seconds each every 10 minutes. The cervix is 3 cm dilated and the membranes are bulging. The cervical dilatation is plotted on the alert line of the partogram. After 4 hours the cervix is 4 cm dilated while the other observations are unchanged. What is the correct management?
    • An oxytocin infusion should be started.
    • A Caesarean section should be done.
    • The patient’s membranes should be ruptured.
    • The doctor should be called to examine the patient.
12. What should you do if the cervical dilatation falls on the action line?
    • A Caesarean section should be done immediately.
    • The patient should be given the correct dose of oxytocin in an infusion.
    • The patient must be personally assessed by a doctor, and further management must be under the direction and responsibility of the doctor.
    • After making sure that the patient is in the active phase of the first stage of labour and her membranes are ruptured, she should be managed according to the rule of the ‘4 Ps’.
13. Cephalopelvic disproportion due to a small pelvic inlet should be diagnosed when:
    • There is no further dilatation of the cervix
    • There is 3/5 or more of the fetal head palpable above the pelvic brim and 3+ or more moulding is present
    • There is 2/5 or less of the fetal head palpable above the pelvic brim and 1+ moulding is present
    • The measurements of the pelvic inlet are assessed as small during a pelvic examination
14. A patient at term presents after having been in labour at home for some time. On admission, cephalopelvic disproportion is diagnosed. What is the correct further management of this patient?
    • An oxytocin infusion should be started.
    • A Caesarean section should be done.
    • The patient should be given pethidine and promethazine (Phenergan).
    • The patient should be reassured that she will labour and deliver normally.
15. A primigravida presents in labour at term. She is having 2 contractions of 35 seconds each every 10 minutes. The cervix is 5 cm dilated and the membranes have ruptured. Her cervical dilatation is plotted on the alert line. 4 hours later the cervix is 6 cm dilated and her other observations are unchanged. There are no signs of cephalopelvic disproportion. What is the correct management?
    • An oxytocin infusion should be started.
    • A Caesarean section should be done.
    • She should be given pethidine and hydroxyzine (Aterax).
    • The doctor should be called to examine the patient.
16. A patient at term progresses slowly during the active phase of labour. During a thorough physical examination, an occipito-posterior position with mild caput and 1+ moulding is diagnosed. What should be the further management?
    • An oxytocin infusion should be started.
    • A Caesarean section should be done.
    • The patient should be given pethidine and hydroxyzine (Aterax).
    • Oxytocin is contraindicated. Rather, an intravenous infusion should be started and the patient should be given adequate analgesia.
17. Which of the following patients should receive oxytocin if they developed poor progress due to inadequate uterine contractions during the active phase of labour?
    • A patient with 2+ moulding
    • A primigravida patient with a vertex presentation and no moulding
    • A multipara with a vertex presentation and no moulding
    • A primigravida patient with a breech presentation
18. A patient is being referred from a peripheral clinic to a hospital with the diagnosis of cephalopelvic disproportion. Which of the following is the best management for the patient and her fetus, before the patient is transported?
    • Adequate analgesia, e.g. pethidine and hydroxyzine (Aterax)
    • An infusion with oxytocin to improve uterine contractions
    • 3 nifedipine (Adalat) 10 mg capsules (total 30 mg) should be given orally to suppress labour
    • Oxygen administration with a mask
19. Which one of the following patients is at high risk of cord prolapse?
    • A patient with a breech presentation
    • A patient with a cephalic presentation
    • A patient with a post-term pregnancy
    • A patient who ruptures her membranes when the fetal head is still palpable 3/5 above the pelvic brim
20. What should be done first if a patient, whose cervix is 6 cm dilated, presents with a prolapsed cord?
    • Immediately replace the umbilical cord into the vagina and take steps to lift the presenting part off the cord.
    • An oxytocin infusion should be started in order to deliver the infant as soon as possible.
    • Give the patient oxygen by face mask in order to ensure that the fetus receives enough oxygen.
    • The patient must be rushed to theatre for an emergency Caesarean section.