First Stage Management
Active labor begins at ___ cm.
6 cm
Active-phase arrest requires ___ hours of adequate contractions.
4 hours
When should pushing begin according to ACOG?
When complete cervical dilation is achieved.
No laboring down!
Delayed pushing may prolong the second stage and has not demonstrated a consistent benefit in spontaneous vaginal delivery.
Before 6 cm, this phase of labor may demonstrate substantial variability without representing pathologic labor.
Latent phase
What medication does ACOG recommend for labor augmentation?
Oxytocin (Pitocin)
According to ACOG, neuraxial anesthesia should be offered during this portion of labor.
Any stage of labor
Active-phase arrest requires ___ hours of inadequate contractions with ___.
6 hours, oxytocin
How many hours of pushing defines a prolonged second stage in a nulliparous and multiparous patient?
Nulliparous: >3 hours
Multiparous: >2 hours
What intervention does ACOG recommend during induction or augmentation to reduce labor duration?
Amniotomy
(Reduces by about 4 hours!)
What is the evidence-based maximum dose of oxytocin established by ACOG?
No maximum dose has been established!
Adequate uterine activity is traditionally defined as at least ___ MVUs per ___ minutes.
200 MVUs per 10 minutes
What three conditions must be present before diagnosing active-phase arrest?
A patient has second-stage arrest. Before proceeding directly to cesarean, ACOG says you should consider this alternative if she is an appropriate candidate.
Operative vaginal delivery
Why can external tocodynamometry be insufficient when evaluating labor dystocia?
It can assess frequency and duration but does not reliably quantify contraction intensity.
What fetal complication is particularly important to consider when rupturing membranes with a high or unengaged presenting part?
Umbilical cord prolapse
How does ACOG define a conservatively protracted active phase?
<1 cm cervical dilation over 2 hours
List 4 factors that can affect the duration of the second stage.
Before attempting operative vaginal delivery, these two fetal characteristics must be appropriately determined.
Station and position
What should NOT automatically be considered an indication for cesarean delivery during a slow but progressive active phase?
Slow cervical change alone, as long as there is cervical change at least every 4 hours and maternal/fetal status is reassuring.
According to ACOG, what finding allows second-stage arrest to be identified before the traditional time thresholds?
Lack of fetal rotation or descent despite adequate contractions, pushing efforts, and time.
Name THREE non-fetal factors that influence whether operative vaginal delivery is appropriate.