A gravida 3, para 2 is attempting a vaginal birth without the use of pain medicine or anesthesia. Following spontaneous rupture of membranes, the patient’s cervical exam was 5 cm dilated, 60% effaced, -2 station. Which therapeutic intervention is appropriate for this patient?

Correct Answer: C

Rationale: The correct answer is C: Sitting on birthing ball. This position helps to open up the pelvis, allowing gravity to assist in descent of the baby. It also promotes optimal positioning for the baby, reducing the risk of malpresentation. The other choices (A, B, D) do not provide the same benefits in terms of promoting optimal fetal positioning and utilizing gravity to aid in labor progress. Ambulation with assistance may not provide as much support for the pelvis, squatting with support from the partner may not be as stable or comfortable for the mother, and resting on hands and knees may not encourage as much engagement of the baby's head in the pelvis.

Correct Answer: B

Rationale: Rationale for Choice B (Correct Answer): - A 21-year-old gravida 2, para 1 with one previous low-transverse cesarean section for CPD is the best candidate for TOLAC. - Low-transverse incisions have the lowest risk of uterine rupture during labor. - CPD is not a contraindication for TOLAC. - Young age and low parity are favorable factors for successful TOLAC. - Therefore, this candidate has the highest likelihood of a successful VBAC. Summary for Other Choices: - Choice A: Classical cesarean section carries a high risk of uterine rupture; prematurity increases this risk. - Choice C: Low-transverse incision is favorable, but the indication for the previous cesarean (late decelerations) may indicate an ongoing fetal concern. - Choice D: T-shaped incision increases the risk of uterine rupture; macrosomia is a risk factor for failed TOL

Correct Answer: A

Rationale: Step-by-step rationale: 1. Increased estrogen levels lead to softening of the cervix, causing the mucus plug to be expelled. 2. Contractions usually start after the mucus plug is expelled, not before. 3. The mucus plug is typically expelled before the membranes rupture. 4. Effacement and dilation of the cervix prepare the body for labor but are not directly related to the expulsion of the mucus plug. In summary, Choice A is correct as increased estrogen leads to the expulsion of the mucus plug, indicating impending labor. Choices B, C, and D are incorrect as they do not accurately explain the relationship between the mucus plug and impending labor.

Correct Answer: A

Rationale: The active phase of labor according to ACOG begins at 6 cm dilation. At this point, contractions become stronger and more frequent, leading to faster cervical dilation. This stage signifies significant progress towards delivery. Choice B (3 cm) is incorrect as it falls within the early phase of labor. Choice C (5 cm) is also incorrect as it is near the beginning of the active phase but not the specific transition point. Choice D (10 cm) is incorrect as it marks full dilation and the transition to the second stage of labor.

Correct Answer: C

Rationale: The correct answer is C: 1 hour for a multiparous person, 2 hours for a nulliparous person. This is based on the typical duration of the third stage of labor, which involves the delivery of the placenta. In general, the third stage is expected to last around 5-30 minutes. However, for safety reasons and to allow for variations in individual cases, it is recommended to extend the time frame to 1 hour for multiparous individuals (those who have given birth before) and 2 hours for nulliparous individuals (those giving birth for the first time). This extended time frame ensures that healthcare providers have enough time to monitor and intervene if necessary without rushing the delivery of the placenta. Other choices are incorrect because they provide either too short (A and B) or too long (D) timeframes for the third stage of labor, which could lead to inadequate monitoring or unnecessary interventions.