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00:01 Now let's discuss the first stage of labor. 00:05 So in review of all of our stages of labor, let's remember that Stage 1 starts from onset of labor until 10 centimeters dilated. 00:13 Stage 2 is 10 centimeters dilated until the delivery of the infant. 00:17 And Stage 3 starts with the delivery of the infant and ends with delivery of the placenta. 00:22 So in Stage 1 we have contractions that are causing cervical change and they are also causing the fetus to descend in the pelvis. 00:31 We can further divide Stage 1 into latent labor which is onset of contractions until 4 centimeters dilated. 00:38 And into the active phase. 00:40 This is from 4 centimeters dilated to 10 centimeters dilated. 00:45 Now let's consider normal. 00:47 For our primiparous first time moms, the latent labor can last to 6 to 11 hours. 00:52 For multiparous 4 to 8 hours. 00:54 In the active phase we expect the cervix to change 1.2 centimeters per hour for out first time moms. 01:01 And 1.5 centimeters per hour for our multiparous moms. 01:06 So we have an abnormal first stage labor. 01:08 What causes that? Well, when we think of the 3 P's. 01:12 Power, Passenger and Pelvis. 01:16 With power we're talking about the strength of contractions. 01:20 Now how do we measure the strength of the contractions. 01:23 Typically in labor our moms are going to have a monitor on that tells us them externally how often they are contracting. 01:30 If we want to know how strong the contractions are, we place an intrauterine pressure catheter that measures something called "The Montevideo Units." The Montevideo units are a measurement that are taken over 10 minute strip looking at all of the contractions and measuring the area under the curb. 01:48 We expect it to be 180 to 220 Montevideo units to say the contractions are adequate. 01:55 If those contractions are not adequate, we're going to start a medication called Pitocin. 02:01 This is a synthetic form of oxytocin and this makes the contractions stronger. 02:07 Now our next P is passenger. 02:09 So what can go wrong with our passenger to make the first stage of labor abnormal. 02:14 Well we could have malrepresentation of our passenger such as a breech presentation, a face presentation or brow presentation. 02:22 That will prevent the passenger from coming down the pelvis. 02:24 Or the passenger could be having fetal heart rate issues. 02:30 Now, our next P is the pelvis. 02:33 Now there is no way to determine what type of pelvis a patient has prior to labor. 02:38 But just to note, there are 4 different types of pelvises. 02:41 And depending on the type of pelvis that can ease the delivery or it can make the delivery more difficult. 02:48 So the gynecoid pelvis is one that allows the head to always rotate to also put anterior making vaginal delivery pretty easy. 02:57 Anthropoid pelvis more common in African American women cause the fetal head to rotate to the occipit posterior position. 03:05 While they can still have a vaginal delivery, sometimes that can be a little difficult. 03:09 And sometimes it requires an operative vaginal delivery to get those last little maneuvers to have the fetal head go underneath the pubic symphysis. 03:17 The platypeloid pelvis will cause the fetal head to be in a transverse position. 03:23 If you remember from our previous lecture, we need that fetal head to occipit anterior or occipit posterior so that only 9 and half centimeters of the fetal vertex is trying to pass through the pelvis. 03:35 Remember that the fetal pelvis is largest at 10 centimeters at it's largest point. 03:40 A transverse presentation is not going to be able to be pass through the pelvis. 03:44 And an android pelvis is more like a guy's pelvis and that is heart shaped. 03:50 And in this type of presentation the fetal head has difficulty even engaging.
The lecture Labor Stage 1: Fetal Heart Rate Tracing by Veronica Gillispie, MD, FACOG is from the course Intrapartum Care. It contains the following chapters:
What is the range for a normal baseline fetal heart tracing?
How would you describe an acceleration in the fetal heart tracing in a fetus with gestational age greater than 32 weeks?
A 27 year old G1P0 at 42 weeks gestational age is admitted for induction of labor. She is on pitocin and her last cervical exam was unchanged from the one prior at 5cm/80% effaced/-2 station with a Category 1 fetal heart tracing and experiencing contractions every 5-6 minutes. Pitocin infusion was increased to help progression of labor at that time. 20 minutes later, she is having 1 contraction every minute and fetal heart tracing has a baseline of 165 with absent variability and two late deceleration over a 20 minute strip. What category is the fetal heart tracing and what is the next best step in management?
Which of the following fetal heart tracings is a Category 2 tracing?
Which of the following is true of a category 3 strip?
A 29 year old G4P3 woman at 40 weeks gestational age was admitted to the labor ward in spontaneous active labor. Her last cervical exam was 7cm dilation/90% effacement/-2 station with bulging bag of water (intact membranes) and fetal heart tracing was unremarkable with a baseline heart rate of 140 beats per minute and moderate variability with out any decelerations. 30 minutes later she felt a large gush of fluid with her contraction and the fetal heart tracing started displaying regular early decelerations with each contraction. How can this phenomenon be best described?
All of the following is true of a sinusoidal pattern on a fetal heart tracing, except...?
Which of the following statements is true of tachysystole?
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