Subject: OBSTETRICS

Topic: 2.02 Labor

Lecturer: Dr. Junio
Date: August 6, 2015

APPENDIX
Labor Patterns (regardless if nulli or multipara) e.g. Pregnant mother
Review Friedman’s Labor Curve (Dra. Junio mentioned she might takes 2hr to dilate 1cm
ask us to interpret graphs during the exam). Broken lines indicate o doing IE hourly can predispose the mother and the baby to
normal course. infection, even with gloves  do IE q2
o How to report IE findings?
 Cervix is 5cm dilated, 80% effaced, midposition, cephalic
presentation at station 0, with intact membranes

III. Protracted Descent

 fetal descent of <1cm/hr for nullipara and <2cm/hr for
multipara

IV. Secondary Arrest in Dilatation

Figure 1 Disorder in the preparatory division: prolonged latent phase  no change in dilatation for at least 2hr

V. Prolonged Deceleration Phase

 no engagement at 9cm dilatation
 rarely occurs alone, mostly related to secondary arrest

VI. Failure in Descent

 no engagement and no descent in 1hr

VII. Arrest in Descent

 with engagement but no descent in 1hr

Questions
Figure 2 Disorders in the dilatational division. A. Protracted active phase 1. You are monitoring a primipara in labor. Upon plotting her
dilatation. B. Protracted descent. labor progress, you came up with this graph.

Figure 3 Disorders in the pelvic division. A. Secondary arrest in dilatation. B.

Prolonged deceleration phase. C. Failure in descent. D. Arrest in descent.
1. At what hour will sedation have the most effect?
rd
I. Prolonged Latent Phase a. 0-3 hour
th
b. 3-6 hour
 latent phase can last up to several days or weeks th
c. 4-6 hour
 e.g. Upon IE, mother is 2cm dilated and you advise her to th
d. 6-8 hour
prepare for labor and come to you when it begins. But
2. At what time does the patient enter active labor?
after 1 week, she comes to you and not in labor. Repeat IE rd
a. 2-3 hour
reveals she is still 2cm dilated. You may consider this as th
b. 3-4 hour
prolonged latent phase. th
c. 4-5 hour
o no need to intervene if there is good feto-maternal th
d. 5-6 hour
status
3. This labor curve is compatible with which of the following
conditions?
II. Protracted Active Phase Dilatation
a. prolonged latent phase
 1.2 and 1.5cm is hard to differentiate in the clinics thus
b. protracted active phase dilatation
rule of thumb there should be at least 1cm/hr dilatation

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c. hypertonic dysfunction
d. secondary arrest of dilatation
4. The above condition is a disorder in what functional division of
labor?
a. preparatory division
b. dilatational division
c. pelvic division
d. none of the above
5. Who among the following women has an abnormal pattern of
labor?
a. 32y/o G3P2(2002), started labor 10hr ago, 2cm dilated,
50% effaced
b. 25y/o G1P0, entered active phase of labor at 4cm
dilatation 6hr ago, currently 7cm dilated
c. 28y/o G4P2(3003) delivered 20 minutes after full cervical
dilatation
d. 34y/o G5P4(4004) with a rate of 2cm/hr dilatation
6. A 20y/o primigravid came in labor, 38AOG. IE showed 7cm
dilatation, BOW ruptured, station -1. After 1 hour, cervix
became fully dilated with fetal head still at station -1. Your
impression is:
a. dysfunctional labor, failure of descent
b. dysfunctional labor, arrest of descent
c. prolonged deceleration phase
d. protracted active phase

Rationale:
rd
A. 0-3 hour  corresponds with the preparatory division –
little cervical dilatation thus sedation and conduction
analgesia can arrest this division
th
B. 3-4 hour  active labor starts at 3-5cm
D. secondary arrest of dilatation  no change in dilatation for
th
at least 2hr (bet. 6-8 hr)
C. pelvic division  see figure3
B. 25y/o G1P0, entered active phase of labor at 4cm dilatation
6hr ago, currently 7cm dilated  rule of thumb is at least
1cm/hr thus she should be 10cm dilated already
A. dysfunctional labor, failure of descent  no engagement
(station -1) and no descent in 1hr

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