NM704 Exam 3: Questions With Fully Explained
Solutions
Is there a consensus on what defines the onset of labor? Right Ans - No.
Onset of labor is a always a diagnosis that is made retrospectively. There is no
standard definition or criteria of what that means exactly. Eventually it will
become clear whether or not a woman is in labor, but in the moment it is hard
to discern.
What are some of the ways onset of labor could be defined? Right Ans - 1.
Painful contractions at least every 5 minutes lasting at least 40 seconds and
cervix mostly or completely effaced
2. Beginning of regular contractions that are are perceived by the woman
3. Regular contractions with cervical change
4. When a woman says she is in labor (e.g., bloody show, sleep and emotional
changes, strengthening contractions, GI symptoms, sleep changes, etc.)
How did Friedman define onset of active labor? Right Ans - The point in
time where cervical dilation begins to change rapidly. He suggested that this
usually occurs around 3-4cm. According to Friedman, labor can be divided
into distinct phases.
How does current research conflict with Friedman's definition? Right Ans -
Current research demonstrates that many women may not be in active labor
until closer to 6cm. It suggests more a continuous paradigm of changes rather
than distinct phases.
Describe anticipatory guidance in relation to labor onset/ early labor:
Right Ans - The way labor is depicted in contemporary media does not
generally include early labor, which is perhaps why so many women and their
families are surprised by it. Detailed education on this preparatory phase of
labor is very important for that reason. The benefits of delaying admission
until active labor should be discussed when doing this teaching, but not all
women are able to manage early labor at home.
What assessments can be done to evaluate a woman for possible onset of
labor? Right Ans - 1. History and chart review
2. Physical Exam
, 3. Pelvic Exam
What four methods can be used to diagnose spontaneous rupture of
membranes? Right Ans - 1. Observation of fluid coming from cervical os
2. Arborization test ("fern test")
3. pH test (nitrazine test)
4. Rapid immunoassays
What are the pros and cons of these methods? Right Ans - More than one of
these tests should be used in combination to make the most accurate
diagnosis.
Visualization of fluid coming out of the cervical os can be the most definitive if
it is obvious. Blood, semen, vaginal infection etc can alter both the pH test and
the ferning test and cause false positive results. Data on the
sensitivity/specificity of the Radioimmunoassay tests is inconclusive. They are
designed to detect the specific biomarkers contained in amniotic fluid. These
should not be relied upon exclusively to determine membrane status.
Why is it important to know for sure if a woman's membranes have ruptured?
Right Ans - It may change the management of her care (i.e. does she need to
deliver promptly, did her membranes rupture preterm, what is her GBS
status)
•False positive may lead to unnecessary intervention
•False negative may increase risk of complications
Why is it recommended to delay admission to the hospital until active labor?
Right Ans - Delaying admission until active labor is associated with fewer
interventions.
Risks of early admission include increased rate of
◦Cesarean birth
◦Oxytocin augmentation
◦Epidural analgesia
◦Other interventions such as fetal scalp electrodes and intrauterine pressure
catheters
However, it is clear from the qualitative literature that, women seem to want
much more professional support during early labor than we currently
provide.
Solutions
Is there a consensus on what defines the onset of labor? Right Ans - No.
Onset of labor is a always a diagnosis that is made retrospectively. There is no
standard definition or criteria of what that means exactly. Eventually it will
become clear whether or not a woman is in labor, but in the moment it is hard
to discern.
What are some of the ways onset of labor could be defined? Right Ans - 1.
Painful contractions at least every 5 minutes lasting at least 40 seconds and
cervix mostly or completely effaced
2. Beginning of regular contractions that are are perceived by the woman
3. Regular contractions with cervical change
4. When a woman says she is in labor (e.g., bloody show, sleep and emotional
changes, strengthening contractions, GI symptoms, sleep changes, etc.)
How did Friedman define onset of active labor? Right Ans - The point in
time where cervical dilation begins to change rapidly. He suggested that this
usually occurs around 3-4cm. According to Friedman, labor can be divided
into distinct phases.
How does current research conflict with Friedman's definition? Right Ans -
Current research demonstrates that many women may not be in active labor
until closer to 6cm. It suggests more a continuous paradigm of changes rather
than distinct phases.
Describe anticipatory guidance in relation to labor onset/ early labor:
Right Ans - The way labor is depicted in contemporary media does not
generally include early labor, which is perhaps why so many women and their
families are surprised by it. Detailed education on this preparatory phase of
labor is very important for that reason. The benefits of delaying admission
until active labor should be discussed when doing this teaching, but not all
women are able to manage early labor at home.
What assessments can be done to evaluate a woman for possible onset of
labor? Right Ans - 1. History and chart review
2. Physical Exam
, 3. Pelvic Exam
What four methods can be used to diagnose spontaneous rupture of
membranes? Right Ans - 1. Observation of fluid coming from cervical os
2. Arborization test ("fern test")
3. pH test (nitrazine test)
4. Rapid immunoassays
What are the pros and cons of these methods? Right Ans - More than one of
these tests should be used in combination to make the most accurate
diagnosis.
Visualization of fluid coming out of the cervical os can be the most definitive if
it is obvious. Blood, semen, vaginal infection etc can alter both the pH test and
the ferning test and cause false positive results. Data on the
sensitivity/specificity of the Radioimmunoassay tests is inconclusive. They are
designed to detect the specific biomarkers contained in amniotic fluid. These
should not be relied upon exclusively to determine membrane status.
Why is it important to know for sure if a woman's membranes have ruptured?
Right Ans - It may change the management of her care (i.e. does she need to
deliver promptly, did her membranes rupture preterm, what is her GBS
status)
•False positive may lead to unnecessary intervention
•False negative may increase risk of complications
Why is it recommended to delay admission to the hospital until active labor?
Right Ans - Delaying admission until active labor is associated with fewer
interventions.
Risks of early admission include increased rate of
◦Cesarean birth
◦Oxytocin augmentation
◦Epidural analgesia
◦Other interventions such as fetal scalp electrodes and intrauterine pressure
catheters
However, it is clear from the qualitative literature that, women seem to want
much more professional support during early labor than we currently
provide.
