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 for optimal fetal positioning and descent. It also helps relieve pressure on the cervix, promoting dilation. Ambulation (A) may slow down labor progress, squatting (B) can increase pressure on the cervix and hinder descent, and resting on hands and knees (D) may not be as conducive to gravity-assisted descent.

Correct Answer: B

Rationale: The correct answer is B: A 21-year-old gravida 2, para 1 with one previous low-transverse cesarean section for CPD. This candidate is the best choice for a trial of labor after cesarean (TOLAC) because a low-transverse incision has the lowest risk of uterine rupture during labor compared to classical, T-shaped, or vertical incisions. Additionally, the indication for the previous cesarean section being cephalopelvic disproportion (CPD) suggests that the pelvis may have been the limiting factor in the previous delivery, making a TOLAC a reasonable option. The other choices have higher risks of uterine rupture (classical incision, T-shaped incision) or indications that may increase the likelihood of complications during TOLAC (prematurity, late decelerations).

Correct Answer: A

Rationale: The correct answer is A because the mucus plug is expelled due to increased estrogen levels before contractions start. Estrogen stimulates the production of mucus that forms the plug, which is then released as a result of hormonal changes signaling the body to prepare for labor. This process occurs before labor contractions begin. Choice B is incorrect because the mucus plug is typically expelled before the membranes rupture during labor. Choice C is incorrect because effacement and dilation of the cervix do not directly cause the expulsion of the mucus plug. Choice D is incorrect because labor can begin even if the mucus plug has not been expelled, and the plug itself does not create a space for the fetus.

Correct Answer: A

Rationale: The active phase of labor begins at 6 cm dilation according to ACOG guidelines. At this point, the cervix is significantly dilated, signaling the transition to active labor. This stage is crucial as it signifies the acceleration of labor progress and typically involves stronger contractions leading to efficient cervical dilation. Choices B, C, and D are incorrect as they do not align with the established criteria for the active phase of labor. Choice B (3 cm) is too early for active labor, choice C (5 cm) is close but not quite at the threshold for active labor, and choice D (10 cm) is actually the full dilation stage, not the beginning of active labor. Hence, choice A (6 cm) is the correct answer.

Correct Answer: C

Rationale: The correct answer is C because the expected length of the third stage of labor, which is the delivery of the placenta, is typically around 1 hour for a multiparous person (someone who has given birth before) and around 2 hours for a nulliparous person (someone who is giving birth for the first time). This is based on the normal physiological process of the uterus contracting to expel the placenta. Choice A and B are incorrect as they provide specific time limits that are not generally applicable to all individuals. Choice D is incorrect as it suggests longer durations which are beyond the typical range for the third stage of labor.