A midwife is monitoring a mother who was admitted to the delivery unit about 5 hours ago. She notes a cervical dilatation of 5 cm and contractions are occurring every 5 minutes lasting between 50 and 55 seconds. The mother is in what phase of labour?

1. A

   Latent phase

2. B

   Active phase

3. C

   Transition phase

4. D

   Second stage of labour

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2022

Explanation

• The active phase of the first stage of labor is characterized by cervical dilatation from approximately 4 to 7 cm.
• During this phase, contractions become more regular and stronger, typically occurring every 3 to 5 minutes and lasting 45 to 60 seconds.
• The patient's clinical presentation of 5 cm dilatation and contractions every 5 minutes lasting 50-55 seconds aligns perfectly with the criteria for the active phase.

Why Other Options Were Wrong

• Option A: The latent phase involves cervical dilation from 0 up to 3-5 cm and milder, less frequent contractions. The patient's dilation of 5 cm and strong, regular contractions exceed the parameters of the latent phase.
• Option C: The transition phase is the final, most intense part of the first stage, with dilation from 8 to 10 cm and very strong, frequent contractions (every 2-3 minutes). The patient's 5 cm dilation is not advanced enough for this phase.
• Option D: The second stage of labor begins only after the cervix is fully dilated to 10 cm and involves the pushing and expulsion of the fetus. The patient's cervix is only 5 cm dilated.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of the phases of the first stage of labor based on clinical assessment as background academic context rather than a clinical decision trigger.
• Accurately identifying the phase of labor is crucial for the nurse to provide appropriate interventions, pain management, and emotional support tailored to the mother's needs.
• During the active phase, the nurse's role includes closely monitoring fetal well-being (fetal heart rate), assessing maternal vital signs, encouraging coping mechanisms (breathing techniques, position changes), and keeping the patient and family informed of progress.
• What if? If the patient's cervical dilation was 9 cm, contractions were every 2 minutes, and she reported feeling an overwhelming urge to push and increased anxiety, the nurse would identify this as the transition phase and prepare for imminent delivery.

How to Approach the Question

• First, identify the key clinical data provided in the scenario: cervical dilatation (5 cm) and contraction pattern (every 5 minutes, lasting 50-55 seconds).
• Next, recall the definitions and characteristics of the different stages and phases of labor.
• Compare the patient's data to the standard criteria for each phase of the first stage of labor.
• The latent phase is typically 0-3 cm (or up to 5 cm in some definitions, but with milder contractions). The patient's contraction pattern is too strong and regular for the latent phase.
• The active phase is characterized by dilation from 4-6 cm to 7 cm with contractions every 3-5 minutes. This perfectly matches the patient's status.
• The transition phase involves dilation from 8-10 cm. The patient is not there yet.

Concept Tested & Keywords

• Concept Tested: Identification of the phases of the first stage of labor based on clinical assessment.
• Stem keywords: cervical dilatation, 5 cm, contractions, every 5 minutes, lasting 50 and 55 seconds, phase of labour
• Lead-in keywords: what phase
• Clinical cues: Cervical dilatation of 5 cm: Indicates labor has progressed beyond the initial latent phase.
• Clinical cues: Contraction pattern (every 5 mins, 50-55s duration): Suggests established, effective labor consistent with the active phase.

Question ID

QIllh-7-omm_mmV-sP4D2e

Copy ID

Reference Book

E6 Obstetrics Williams p. 22-40