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NM 704 EXAM 2 QUESTIONS AND ANSWERS
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NM 704 EXAM 2 QUESTIONS AND ANSWERS
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NM 704 EXAM 2 QUESTIONS AND ANSWERSUnderstand the relationship between the framework used for care related to labor
progress and Cesarean birth rates. - Answers- -Medical model vs. physiological model.
-How is slow labor defined varies from provider to provider and even in research. How a
provider defines it will influence their indication for Cesareans.
-Active management of labor.
Define the stages and phases of labor as defined by Friedman. - Answers- First stage:
onset of contractions to full dilation
Latent phase: onset of regular contractions
Active phase: When rate of contraction increases
Second stage: Complete dilation to birth of baby
Understand Friedman's definition of onset of labor and how this has been applied
clinically. - Answers- In his original study, Friedman found the the mean dilation when
the rate of progress increased was approximately 3 cm. This became widely adopted as
the beginning of active phase for all women. Friedman maintain this was inaccurate due
to the variation in women.
Understand the current research on the onset of active phase of labor. - Answers-
Current research says that active phase is more like 5 or 6 cm which is very important in
preventing women from being diagnosed as in active labor while still in latent labor.
Mistaken diagnosis results in unnecessary interventions.
What is Friedman's criteria for normal progress in first stage, latent phase? - Answers-
Nulliparas: <20 hours
Multiparas: <14 hours
What is Friedman's criteria for normal progress in first stage, active phase? - Answers-
Nulliparas: at least 1.2 cm/hr dilatation
Multiparas: at least 1.5 cm/hr dilatation
What is Friedman's criteria for normal progress in second stage? - Answers- Nulliparas:
1 cm/hr descent
Multiparas: 2 cm/hr descent
Define prolonged latent phase according to Friedman. - Answers- *progress is
occuring, but more slowly than normal
For nullparas: longer than 20 hours
For multiparas: longer than 14 hours
Define protracted active phase as defined by Friedman. - Answers- *progress is
occuring, but more slowly than normal
For nulliparas: dilitation slower than 1.2 cm/hr
, For mulitparas: dilitation slower than 1.5 cm/hr
Define protracted descent as defined by Friedman. - Answers- *progress is occuring,
but more slowly than normal
For nulliparas: descent less than 1 cm/hr
For mulitparas: descent less than 2 cm/hr
Define secondary arrest of dilation as defined by Friedman. - Answers- *No progress is
being made
No dilation in two hours
Dilation began and then stopped
Define arrest of decent as defined by Friedman. - Answers- *No progress is being
made
No descent in 1 hour
Understand Friedman's method of determining time limits for normal and prolonged
labor. - Answers- *Calculated the slowest, fastest, and average rate of progression for
each phase and stage
*Upper limit of normal based on typical statistical norm of 95%ile
*Slowest 5% abnormal
Broadly summarize the contemporary research on labor duration. How do they differ
from Friedman's findings. - Answers- *Average labor lasts significantly longer than
Friedman's studies
*Upper limits for active phase are about 2x as long as Friedman's
*Mean length of active labor is over 2x as long
*Finding of no progress of over 2 hours is not uncommon
*CSL suggests that dx of active phase protraction or labor arrest not be made until after
6 cm dilitation
Identify the criteria for normal and prolonged labor progress based on contemporary
research. - Answers- Rate of progress in active labor:
0.3-0.5 cm/hour
or
0.5-0.7 cm/hour for nulliparas
0.5-1.3 cm/hour for multiparas
Know the relationship between length of labor and maternal and neonatal complications
according to Friedman. - Answers- Labor disorders, with the exception of prolonged
latent phase, are associated with significant increase in risk to the fetus
Know the relationship between length of labor and maternal and neonatal complications
according to contemporary research. - Answers- *Not associated with increase in
complications
*No increase in neurologic abnormalities
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