Quiz 4: The second stage of labour

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

1. When does the second stage of labour begin and end?
   • From the time the patient has an urge to bear down until the infant is completely delivered
   • From the time the cervix is fully dilated until the infant is completely delivered
   • From the beginning of the active phase of the first stage of labour until the cervix is fully dilated
   • From the beginning of the active phase of the first stage of labour until the infant is completely delivered.
2. What would suggest that the patient’s cervix has reached full dilatation?
   • Uterine contractions become stronger with an increase in duration and frequency.
   • The patient becomes restless.
   • Nausea and vomiting occur.
   • All of the above.
3. When is the fetal head engaged?
   • When the widest transverse diameter of the fetal head (i.e. the biparietal diameter) has passed through the entrance of the birth canal
   • When the greatest diameter of the fetal head (i.e. the suboccipito-bregmatic diameter) has passed through the entrance of the birth canal
   • When the occiput has passed through the entrance of the birth canal
   • When the vertex has passed through the entrance of the birth canal
4. How many fifths of the fetal head will be palpable above the brim of the pelvic when engagement has taken place?
   • 5/5
   • 4/5
   • 3/5
   • 2/5
5. When should a patient in the second stage of labour start bearing down?
   • When her cervix is fully dilated
   • When her cervix is fully dilated and 1/5 of the fetal head is still palpable above the pelvic brim
   • When her cervix is fully dilated and 2/5 of the fetal head is still palpable above the pelvic brim
   • When her cervix is fully dilated and 3/5 of the fetal head is still palpable above the pelvic brim
6. When is it safe not to bear down but to wait if the fetal head is 2/5th or more palpable above the pelvic brim in a patient with a fully dilated cervix?
   • If there is no fetal distress and no cephalopelvic disproportion
   • If the patient is a multigravida
   • If the patient is a primigravida
   • You should not wait, as patients with a fully dilated cervix must start to bear down straight away
7. What position should the patient adopt when she delivers?
   • She should lie on her back (i.e. the dorsal position)
   • She should lie on her side (i.e. the lateral position)
   • She should squat upright (i.e. the vertical position)
   • She should choose whichever position she prefers as long as it is practical under the clinical circumstances.
8. How should the fetal condition be assessed when the patient bears down during the second stage of labour?
   • You should listen to the fetal heart rate between contractions only.
   • You should listen to the fetal heart rate immediately after each contraction to determine whether the heart rate remains the same as the baseline rate.
   • You should listen to the fetal heart rate immediately after a contraction every 15 minutes to determine whether the heart rate remains the same as the baseline rate.
   • You should listen to the fetal heart rate immediately after a contraction every 10 minutes to determine whether the heart rate remains the same as the baseline rate.
9. Which of the following indicates satisfactory progress during the second stage of labour?
   • The infant is delivered within 30 minutes of the start of the second stage of labour.
   • The infant is delivered within 45 minutes of the start of the second stage of labour.
   • With every contraction where the patient bears down, the fetal head descends further onto the perineum.
   • The infant is delivered after the patient bears down well with 4 contractions.
10. What is the correct management if there is no progress in the second stage of labour and there are signs of cephalopelvic disproportion?
    • The patient must not bear down but should be evaluated by a doctor as a Caesarean section is needed.
    • An episiotomy should be done to speed up the delivery.
    • An oxytocin infusion should be started to increase the strength of the contractions.
    • The patient should continue bearing down for 30 minutes in a primigravida and 45 minutes in a multigravida before any further management is carried out.
11. The perineum should be supported during the second stage of labour in order to:
    • Prevent the patient from passing faeces
    • Prevent the fetal head from being delivered too fast
    • Help the internal rotation of the fetal head
    • Increase flexion of the fetal head so that only the smallest diameter of the head has to pass through the vagina
12. In which of the following circumstances should an episiotomy be done?
    • An episiotomy should be done routinely in all primigravida patients.
    • An episiotomy should be done at the delivery of a preterm infant to prevent birth injury.
    • An episiotomy should be done routinely in all patients who have had a previous episiotomy.
    • An episiotomy should be done routinely in all patients who have had a previous third-degree tear.
13. A prolonged second stage of labour is diagnosed when:
    • The infant is not delivered within 30 minutes after the cervix has reached full dilatation in a multigravida, and within 45 minutes in a primigravida.
    • The infant is not delivered within 45 minutes after the cervix has reached full dilatation in a multigravida, and within 60 minutes in a primigravida.
    • The infant is not delivered within 30 minutes after the patient has started bearing down in a multigravida, and within 45 minutes in a primigravida.
    • The infant is not delivered within 45 minutes after the patient has started bearing down in a multigravida, and within 60 minutes in a primigravida.
14. A patient who has progressed normally during the earlier part of the active phase of the first stage of labour, progresses slower from 8 cm to full dilatation of the cervix. What complication during the second stage of labour is she at an increased risk of?
    • Poor contractions during the second stage of labour due to exhaustion of the uterus
    • A prolonged second stage of labour
    • Poor attempts at bearing down during the second stage of labour due to exhaustion of the patient
    • There is no increased risk of complications as the second stage of labour should be short
15. How should a patient with a prolonged second stage of labour be managed if cephalopelvic disproportion has been excluded?
    • An assisted delivery is usually needed.
    • The patient should be allowed to bear down for a further 30 minutes.
    • An oxytocin infusion should be started to increase the strength of the contractions.
    • A Caesarean section must be done.
16. What complication during the second stage is a patient with a body mass index of 40 or more at an increased risk of?
    • Poor contractions during the second stage of labour due to exhaustion of the uterus
    • Impacted shoulders (i.e. shoulder dystocia)
    • Difficulty with breathing during the second stage
    • Poor attempts at bearing down during the second stage of labour due to exhaustion of the patient
17. What complication would you expect if the infant’s head at delivery is held back, does not fall forward on the perineum, and does not undergo the normal rotation?
    • Fetal death
    • A congenital abnormality of the infant’s neck and shoulders
    • Impacted shoulders (i.e. shoulder dystocia)
    • The birth of a preterm infant because the small shoulders prevent normal rotation during delivery
18. What should be the initial management of impacted shoulders (i.e. shoulder dystocia)?
    • The patient’s buttocks should be moved to the end of the bed in order to allow good posterior traction on the infant’s head.
    • Arrangements must be made for an emergency Caesarean section.
    • An immediate attempt must be made to deliver the infant’s posterior arm.
    • Pressure should be applied to the fundus of the uterus in order to deliver the infant quickly.
19. If initial attempts at delivering the anterior shoulder are not successful, what should be the further management of impacted shoulders (i.e. shoulder dystocia)?
    • Pressure should be applied to the fundus of the uterus as this is the easiest method of freeing the shoulders.
    • The shoulders must be rotated through 180° so that the posterior shoulder can be delivered under the symphysis pubis.
    • The infant’s clavicle must be fractured in order to free the shoulders.
    • The infant’s posterior arm must be delivered.
20. Which statement about suctioning an infant’s airways at delivery is correct?
    • The mouth and then the nose of all infants should be suctioned after delivery of the head but before the shoulders are delivered.
    • Only infants with meconium-stained liquor should have their nose and then their mouth suctioned after delivery of the head but before the shoulders are delivered.
    • Only preterm infants should be routinely suctioned at delivery as they have an increased risk of respiratory distress after birth.
    • All infants need not be routinely suctioned after delivery unless they fail to breathe spontaneously.