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14 - Trabajo de parto

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Diego Padilla

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Preguntas resueltas

What is the definition of labor?

Period of regular contractions of the uterus that cause effacement and dilation of the cervix.
It begins in the 40th week after the first day of the last menstrual period.
a) The first affirmation is correct, and the second is incorrect.
b) The first affirmation is incorrect, and the second is correct.
c) Both affirmations are correct.
d) Both affirmations are incorrect.

What is the classification of gestational age?

Abortion: Less than 20 weeks of gestation.
Immature labor: From 21 to 28 weeks of gestation.
Preterm labor: From 29 to before 37 weeks of gestation.
Term labor: From 37 to before 41 weeks of gestation.
Post-term labor: After 41 weeks of gestation.
a) Only the first and last affirmations are correct.
b) The first, second, and third affirmations are correct.
c) All affirmations are correct.
d) The fourth and fifth affirmations are correct.

What are the phases of labor?

First or latent phase: Beginning of contractions to complete dilation.
Second or active phase: Complete dilation to birth of the fetus.
Third phase: Period between the birth of the neonate and the expulsion of the placenta.
Fourth phase: First hour after the expulsion of the placenta.
a) Only the first and second affirmations are correct.
b) The second and third affirmations are correct.
c) All affirmations are correct.
d) Only the fourth affirmation is correct.

What are the cardinal movements of labor?

Engagement: Begins weeks before labor in nulliparous women and when labor begins in multiparous women.
Flexion of the neck: Allows for the descent of the occiput.
Descent: As the cervix thins and the lower segment lengthens.
Internal rotation: Vertex rotates from transverse to posterior.
Extension: When the head passes through the pubis.
External rotation or restitution: Rotates the shoulders to an AP position.
a) Only the first, second, and third affirmations are correct.
b) The third, fourth, and fifth affirmations are correct.
c) All affirmations are correct.
d) Only the sixth affirmation is correct.

What is the fetal situation?

When the head is above the ischial spines, it is denominated -1 to -5.
When the head is below the ischial spines, it is denominated +1 to +5.
In situation 0, the head is at the level of the ischial spines.
a) Only the first and second affirmations are correct.
b) The second and third affirmations are correct.
c) All affirmations are correct.
d) Only the third affirmation is correct.

What is the fetal attitude?

These changes in fetal attitude are observed with respect to the fetal vertex as the head loses flexion.
A: Vertex SO-B (9.5 cm).
B: Sinciput O-F (12 cm).
C: Forehead O-M (13.5 cm).
D: Face SM-B (9.5 cm).
a) Only the first affirmation is correct.
b) The first and second affirmations are correct.
c) All affirmations are correct.
d) Only the fourth affirmation is correct.

What are the factors that intervene in labor?

Power: contractions and pushing.
Clinical assessment of uterine contractions in terms of frequency, duration, and intensity.
Bony pelvis and soft tissue.
Clinical assessment of the upper, middle, and lower straits.
Palpation of the cervix to evaluate its consistency (firm or lax), degree of effacement, dilation of the cervical orifice, and location of the cervical orifice in relation to the axis of the birth canal (posterior, middle, or anterior).
a) Only the first and second affirmations are correct.
b) The second and third affirmations are correct.
c) All affirmations are correct.
d) Only the fourth and fifth affirmations are correct.

What should be evaluated during labor?

Intravenous hydration.
Concomitant diseases or complications (preeclampsia).
Vaginal examination should not be routine as it increases infectious morbidity.
In the active phase, cervical assessment should be performed every 2 hours.
Monitoring of fetal heart rate.
Monitoring of the characteristics of amniotic fluid.
a) Only the first, second, and fourth affirmations are correct.
b) The third, fourth, and fifth affirmations are correct.
c) All affirmations are correct.
d) Only the sixth affirmation is correct.

What is the duration of the latent phase of labor?

Maximum duration of 20 hours in nulliparous women and 14 hours in multiparous women.
a) The affirmation is incorrect.
b) The affirmation is correct.
c) The affirmation is partially correct.
d) It is not possible to determine based on the text.

What is the duration of the active phase of labor?
First stage
Second stage
Third stage
First stage: 5 hours in primiparous women and 2 hours in multiparous women.
Second stage: 50 minutes in primiparous women and 20 minutes in multiparous women.
Third stage: 10 minutes.
a) Only the first and second affirmations are correct.
b) The second and third affirmations are correct.
c) All affirmations are correct.
d) Only the third affirmation is correct.

What is an episiotomy and what are the different types and degrees?

An episiotomy is an incision made in the perineum to facilitate vaginal delivery.
There are three types of episiotomy: midline, mediolateral, and lateral.
There are four degrees of episiotomy, depending on the extent of the incision.

What is the definition of labor?

Period of regular contractions of the uterus that cause effacement and dilation of the cervix.
It begins in the 40th week after the first day of the last menstrual period.
a) Only the first statement is correct.
b) Only the second statement is correct.
c) Both statements are correct.
d) Both statements are incorrect.

What is the classification of gestational age for labor?

Abortion: Less than 20 weeks of gestation.
Immature labor: From 21 to 28 weeks of gestation.
Preterm labor: From 29 to before 37 weeks of gestation.
Term labor: From 37 to before 41 weeks of gestation.
Post-term labor: After 41 weeks of gestation.
a) I, II, III, IV and V are correct.
b) I, II, III and IV are correct.
c) II, III, IV and V are correct.
d) I, II, IV and V are correct.

What are the phases of labor?

First or latent phase: Beginning of contractions to complete dilation.
Second or active phase: Complete dilation to birth of the fetus.
Third phase: Period between the birth of the neonate and the expulsion of the placenta.
Fourth phase: First hour after the expulsion of the placenta.
a) Only the first and second statements are correct.
b) Only the third and fourth statements are correct.
c) All statements are correct.
d) All statements are incorrect.

What are the cardinal movements of labor?

Engagement: Begins weeks before labor in nulliparous women and when labor begins in multiparous women.
Flexion of the neck: Allows the descent of the occiput.
Descent: As the cervix thins and the lower segment lengthens.
Internal rotation: Vertex rotates from transverse to posterior.
Extension: When the head passes through the pubis.
External rotation or restitution: Rotates the shoulders to an AP position.
a) I, II, III and IV are correct.
b) II, III, IV and V are correct.
c) All statements are correct.
d) All statements are incorrect.

What is the fetal situation?

When the head is above the ischial spines it is denominated -1 to -5.
When the head is below the ischial spines it is denominated +1 to +5.
In situation 0, the head is at the level of the ischial spines.
a) Only the first and second statements are correct.
b) Only the third statement is correct.
c) All statements are correct.
d) All statements are incorrect.

What is the fetal attitude?

These changes in fetal attitude are observed with respect to the fetal vertex as the head loses flexion.
A: Vertex SO-B (9.5 cm).
B: Sinciput O-F (12 cm).
C: Forehead O-M (13.5 cm).
D: Face SM-B (9.5 cm).
a) Only the first statement is correct.
b) Only the second, third and fourth statements are correct.
c) All statements are correct.
d) All statements are incorrect.

What are the factors that intervene in labor?

Power: contractions and pushing.
Bony pelvis and soft tissue.
Clinical assessment of the uterine contractions in terms of frequency, duration and intensity.
Clinical assessment of the upper, middle and lower pelvic straits.
Palpation of the cervix to evaluate its consistency (firm or lax), degree of effacement, dilation of the cervical orifice, and location of the cervical orifice in relation to the axis of the birth canal (posterior, middle or anterior).
a) I, II and III are correct.
b) II, III and IV are correct.
c) III, IV and V are correct.
d) All statements are correct.

What is the duration of the latent phase of the first stage of labor?

Maximum duration of 20 hours in nulliparous women and 14 hours maximum in multiparous women.
a) Only the first statement is correct.
b) Only the second statement is correct.
c) Both statements are correct.
d) Both statements are incorrect.

What is the duration of the active phase of the second stage of labor?
First stage
Second stage
Third stage
First stage: 5 hours in primiparous women and 2 hours in multiparous women.
Second stage: 50 minutes in primiparous women and 20 minutes in multiparous women.
Third stage: 10 minutes.
a) Only the first and second statements are correct.
b) Only the third statement is correct.
c) All statements are correct.
d) All statements are incorrect.

Material
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Preguntas resueltas

What is the definition of labor?

Period of regular contractions of the uterus that cause effacement and dilation of the cervix.
It begins in the 40th week after the first day of the last menstrual period.
a) The first affirmation is correct, and the second is incorrect.
b) The first affirmation is incorrect, and the second is correct.
c) Both affirmations are correct.
d) Both affirmations are incorrect.

What is the classification of gestational age?

Abortion: Less than 20 weeks of gestation.
Immature labor: From 21 to 28 weeks of gestation.
Preterm labor: From 29 to before 37 weeks of gestation.
Term labor: From 37 to before 41 weeks of gestation.
Post-term labor: After 41 weeks of gestation.
a) Only the first and last affirmations are correct.
b) The first, second, and third affirmations are correct.
c) All affirmations are correct.
d) The fourth and fifth affirmations are correct.

What are the phases of labor?

First or latent phase: Beginning of contractions to complete dilation.
Second or active phase: Complete dilation to birth of the fetus.
Third phase: Period between the birth of the neonate and the expulsion of the placenta.
Fourth phase: First hour after the expulsion of the placenta.
a) Only the first and second affirmations are correct.
b) The second and third affirmations are correct.
c) All affirmations are correct.
d) Only the fourth affirmation is correct.

What are the cardinal movements of labor?

Engagement: Begins weeks before labor in nulliparous women and when labor begins in multiparous women.
Flexion of the neck: Allows for the descent of the occiput.
Descent: As the cervix thins and the lower segment lengthens.
Internal rotation: Vertex rotates from transverse to posterior.
Extension: When the head passes through the pubis.
External rotation or restitution: Rotates the shoulders to an AP position.
a) Only the first, second, and third affirmations are correct.
b) The third, fourth, and fifth affirmations are correct.
c) All affirmations are correct.
d) Only the sixth affirmation is correct.

What is the fetal situation?

When the head is above the ischial spines, it is denominated -1 to -5.
When the head is below the ischial spines, it is denominated +1 to +5.
In situation 0, the head is at the level of the ischial spines.
a) Only the first and second affirmations are correct.
b) The second and third affirmations are correct.
c) All affirmations are correct.
d) Only the third affirmation is correct.

What is the fetal attitude?

These changes in fetal attitude are observed with respect to the fetal vertex as the head loses flexion.
A: Vertex SO-B (9.5 cm).
B: Sinciput O-F (12 cm).
C: Forehead O-M (13.5 cm).
D: Face SM-B (9.5 cm).
a) Only the first affirmation is correct.
b) The first and second affirmations are correct.
c) All affirmations are correct.
d) Only the fourth affirmation is correct.

What are the factors that intervene in labor?

Power: contractions and pushing.
Clinical assessment of uterine contractions in terms of frequency, duration, and intensity.
Bony pelvis and soft tissue.
Clinical assessment of the upper, middle, and lower straits.
Palpation of the cervix to evaluate its consistency (firm or lax), degree of effacement, dilation of the cervical orifice, and location of the cervical orifice in relation to the axis of the birth canal (posterior, middle, or anterior).
a) Only the first and second affirmations are correct.
b) The second and third affirmations are correct.
c) All affirmations are correct.
d) Only the fourth and fifth affirmations are correct.

What should be evaluated during labor?

Intravenous hydration.
Concomitant diseases or complications (preeclampsia).
Vaginal examination should not be routine as it increases infectious morbidity.
In the active phase, cervical assessment should be performed every 2 hours.
Monitoring of fetal heart rate.
Monitoring of the characteristics of amniotic fluid.
a) Only the first, second, and fourth affirmations are correct.
b) The third, fourth, and fifth affirmations are correct.
c) All affirmations are correct.
d) Only the sixth affirmation is correct.

What is the duration of the latent phase of labor?

Maximum duration of 20 hours in nulliparous women and 14 hours in multiparous women.
a) The affirmation is incorrect.
b) The affirmation is correct.
c) The affirmation is partially correct.
d) It is not possible to determine based on the text.

What is the duration of the active phase of labor?
First stage
Second stage
Third stage
First stage: 5 hours in primiparous women and 2 hours in multiparous women.
Second stage: 50 minutes in primiparous women and 20 minutes in multiparous women.
Third stage: 10 minutes.
a) Only the first and second affirmations are correct.
b) The second and third affirmations are correct.
c) All affirmations are correct.
d) Only the third affirmation is correct.

What is an episiotomy and what are the different types and degrees?

An episiotomy is an incision made in the perineum to facilitate vaginal delivery.
There are three types of episiotomy: midline, mediolateral, and lateral.
There are four degrees of episiotomy, depending on the extent of the incision.

What is the definition of labor?

Period of regular contractions of the uterus that cause effacement and dilation of the cervix.
It begins in the 40th week after the first day of the last menstrual period.
a) Only the first statement is correct.
b) Only the second statement is correct.
c) Both statements are correct.
d) Both statements are incorrect.

What is the classification of gestational age for labor?

Abortion: Less than 20 weeks of gestation.
Immature labor: From 21 to 28 weeks of gestation.
Preterm labor: From 29 to before 37 weeks of gestation.
Term labor: From 37 to before 41 weeks of gestation.
Post-term labor: After 41 weeks of gestation.
a) I, II, III, IV and V are correct.
b) I, II, III and IV are correct.
c) II, III, IV and V are correct.
d) I, II, IV and V are correct.

What are the phases of labor?

First or latent phase: Beginning of contractions to complete dilation.
Second or active phase: Complete dilation to birth of the fetus.
Third phase: Period between the birth of the neonate and the expulsion of the placenta.
Fourth phase: First hour after the expulsion of the placenta.
a) Only the first and second statements are correct.
b) Only the third and fourth statements are correct.
c) All statements are correct.
d) All statements are incorrect.

What are the cardinal movements of labor?

Engagement: Begins weeks before labor in nulliparous women and when labor begins in multiparous women.
Flexion of the neck: Allows the descent of the occiput.
Descent: As the cervix thins and the lower segment lengthens.
Internal rotation: Vertex rotates from transverse to posterior.
Extension: When the head passes through the pubis.
External rotation or restitution: Rotates the shoulders to an AP position.
a) I, II, III and IV are correct.
b) II, III, IV and V are correct.
c) All statements are correct.
d) All statements are incorrect.

What is the fetal situation?

When the head is above the ischial spines it is denominated -1 to -5.
When the head is below the ischial spines it is denominated +1 to +5.
In situation 0, the head is at the level of the ischial spines.
a) Only the first and second statements are correct.
b) Only the third statement is correct.
c) All statements are correct.
d) All statements are incorrect.

What is the fetal attitude?

These changes in fetal attitude are observed with respect to the fetal vertex as the head loses flexion.
A: Vertex SO-B (9.5 cm).
B: Sinciput O-F (12 cm).
C: Forehead O-M (13.5 cm).
D: Face SM-B (9.5 cm).
a) Only the first statement is correct.
b) Only the second, third and fourth statements are correct.
c) All statements are correct.
d) All statements are incorrect.

What are the factors that intervene in labor?

Power: contractions and pushing.
Bony pelvis and soft tissue.
Clinical assessment of the uterine contractions in terms of frequency, duration and intensity.
Clinical assessment of the upper, middle and lower pelvic straits.
Palpation of the cervix to evaluate its consistency (firm or lax), degree of effacement, dilation of the cervical orifice, and location of the cervical orifice in relation to the axis of the birth canal (posterior, middle or anterior).
a) I, II and III are correct.
b) II, III and IV are correct.
c) III, IV and V are correct.
d) All statements are correct.

What is the duration of the latent phase of the first stage of labor?

Maximum duration of 20 hours in nulliparous women and 14 hours maximum in multiparous women.
a) Only the first statement is correct.
b) Only the second statement is correct.
c) Both statements are correct.
d) Both statements are incorrect.

What is the duration of the active phase of the second stage of labor?
First stage
Second stage
Third stage
First stage: 5 hours in primiparous women and 2 hours in multiparous women.
Second stage: 50 minutes in primiparous women and 20 minutes in multiparous women.
Third stage: 10 minutes.
a) Only the first and second statements are correct.
b) Only the third statement is correct.
c) All statements are correct.
d) All statements are incorrect.

Vista previa del material en texto

Padilla Benítez Diego Joel 
Grupo 2 
TRABAJO DE PARTO 
Definición: Periodo de las contracciones regulares del útero que provocan el borramiento y la 
dilatación del cuello uterino. Se inicia en la 40 semana después del primer día de la FUR. 
Clasificación de edad gestacional 
 Aborto: Menor de las 20 semanas de gestación. 
 Parto inmaduro: Desde 21 hasta 28 semanas de gestación. 
 Parto pretérmino: Desde 29 hasta antes 37 semanas de gestación. 
 Parto término: Desde 37 hasta antes 41 semanas de gestación. 
 Parto postérmino: Después de las 41 semanas de gestación. 
 
Fases del trabajo de parto 
 Primera fase o latente: Inicio de las contracciones a la dilatación completa. 
 Segunda fase o activa: Dilatación completa al nacimiento del feto. 
 Tercera fase: Periodo entre el nacimiento del neonato, hasta la expulsión de la placenta. 
 Cuarta fase: Primera hora posterior a la expulsión de la placenta. 
 
Primera etapa del trabajo de parto 
Latente: Las contracciones son cada vez más intensas, 
prolongadas, frecuentes y mejor coordinadas. 
Activa: Comienza cuando hay 3-4 cm de dilatación, 
contracciones muy intensas y regulares. Cada 2 a 3 
minutos. 
Segunda etapa del trabajo de parto 
Después la dilatación completa hasta la expulsión de 
bebe. 
Latente: Duración máxima de 20 horas en nulíparas y 
14 horas máximas, en multíparas. 
Activa: 
 Primera etapa: 5 horas primigestas y 2 horas en multigestas. 
 Segunda etapa: 50 min primigestas y 20 min en multigestas. 
 Tercera fase: 10 minutos. 
Factores que intervienen en el parto 
Potencia: contracciones y pujo. Valoración clínica de las contracciones uterinas en cuanto a 
frecuencia, duración e intensidad. 
Pelvis ósea y tejido blando. 
 
Padilla Benítez Diego Joel 
Grupo 2 
Valoración clínica del estrecho superior, medio e inferior. 
1. Estrecho superior: Diámetro transverso 13 cm. diámetro antero posterior 12 cm: Conjugado 
obstétrico es 1.5- 2.0 centímetros más corto que la conjugada diagonal. 
2. Estrecho medio: medición subjetiva por Espinas isquiáticas prominentes y arco su público estrecho. 
3. Estrecho inferior: guíame transverso o isquiático menor de 8 cm, tuberosidades isquiáticas. 
Palpación del cuello uterino 
 Evaluar la consistencia del cuello uterino (firme o laxo). 
 Grado de borramiento 
 Dilatación del orificio cervical 
 Ubicación del orificio cervical en relación con el eje del Canal del parto (posterior, medio o 
anterior). 
Movimientos cardinales del trabajo de parto 
 Encajamiento: Inicia a semanas antes del T. de parto en nulíparas y cuando comienza en 
trabajo de parto en multíparas. 
 Flexión del cuello: Permite el descenso del occipucio. 
 Descenso: Conforme el cuello uterino se adelgaza y el segmento inferior se larga. 
 Rotación interna: Vértice gira de transverso a posterior. 
 Extensión: Cuando la cabeza pasa por el pubis. 
 Rotación externa o restitución: Gira los hombros oposición AP. 
Feto situación 
• Cuando la cabeza está por arriba de lubinas isquiáticas se denomina - 1 - 5 
• Cuando la cabeza está por debajo de las espinas isquiáticas se denomina + 1 + 5 
• En la situación 0, la cabeza se halla a nivel de las espinas isquiáticas. 
Feto actitud 
Estos cambios en la actitud fetal se observan con respecto al vértice fetal conforme la cabeza va 
perdiendo la flexión. 
A: Vértice SO-B (9.5 cm) 
B: Sincipucio O-F (12 cm) 
C: Frente O-M (13.5 cm) 
D: Cara SM-B (9.5 cm)Trabajo de parto: 
En el trabajo de parto es importante valorar 
 Hidratación intravenosa. 
 Enfermedades concomitantes o complicaciones (preeclampsia). 
 La exploración vaginal no debe ser rutinariamente pues aumenta la morbilidad infecciosa. 
 En la fase activa la valoración del cuello debe realizarse cada 2 horas. 
Padilla Benítez Diego Joel 
Grupo 2 
 Vigilancia de la frecuencia cardíaca fetal. 
 Vigilancia de las características del líquido amniótico. 
 
Segundo periodo del trabajo de parto 
Dilatación completa para la expulsión del feto, hay sensación de descenso, necesidad de pujar, se 
hace revisión del cuello uterino, permitirá adoptar posición cómoda y eficaz, se hace uso de anestesia 
o el pudendo. 
Tercera etapa del trabajo de parto 
Ordenamiento del cordón y pinzamiento, tracción suave del cordón umbilical, maniobra de brand-
andrews, administración de agentes oxitócicos, realizar raspado manual con gasa del fondo del útero 
y revisión de esta calidad, revisión completa de La placenta. 
Cuarta etapa del trabajo de parto 
La primera hora después del parto, valoración cada 15 minutos de signos vitales, Involución uterina, 
hemorragia posparto, valorar periné en busca de hematomas. 
Episiotomía: Es la incisión en el periné para facilitar el parto vaginal, es no se amplía con el fin de 
acortar el periodo de expulsión, esta puede ser: 
 Media: Facilidad de reparar, menor dolor, menor dispareunia y cicatriza mejor. 
 Medio lateral: Menos probable extensión anal, provoca más dolor y dispareunia, además de 
pérdida excesiva de sangre. 
Línea media 
 Primer grado: Sólo la mucosa. 
 Segundo grado: Mucosa y tejidos subcutáneos, incluidos los músculos del cuerpo perineal. 
 Tercer grado: Dentro o a través del esfínter anal. 
 Cuarto grado: A través de la mucosa anal 
El parto 
1. Realizar episiotomía. 
2. Proteger al periné mediante la maniobra de Ritgen modificada. 
3. Alumbrar la cabeza y se realiza la rotación externa 
4. Aspiración de secreciones de boca y nariz 
5. Se visualiza la presencia o no de circulares de cordón