NM 704 Exam 3
NM704 Exam 3 Study Guide Graded A
2025
When does active labor begin?
Active labor beings when the rate of cervical dilation sharply increases
What does contemporary research believe to be the rate of dilation when active labor
beings?
5-6 cm dilation
Describe anticipatory guidance you would give to one in labor onset and early labor
-guidance during the prenatal period can help pregnant persons prepare for the onset of
labor
-give specific instructions on when and how to contact the provider for SDM when labor
starts
-this emphasizes that labor onset is a gradual process and difficult to distinguish
-consider all factors in decision making (support persons, coping status, comfort level
leaving the birth site, transportation, weather, how far they live, will they get rest at
home)
-explain lack of labor rooms and/or staff to accommodate people not needing medical
care during early labor
-address diet, rest, coping strategies, benefits of continuous labor support during early
labor
What are the components of the history and chart review you would evaluate for a
person presenting in possible onset of labor?
-Uterine contractions (onset, when, frequency, length, strength, interrupts activity,
sleep, where are they felt, coping strategies, any other pains)
-Vaginal fluids (spotting, bleeding, leaking fluid)
-Fetal status (movement, is it the same or has it changed)
-Fatigue (recent sleep activity, rest and activity)
-Hydration (eating and drinking normally, recent food and drink intake, appetite, N/V,
voiding at a normal amount, urine light/dark or concentrated)
NM 704 Exam 3
,NM 704 Exam 3
-Environment/Transportation/Support (time of day, how far away do they live, access to
transportation, is home quiet for rest)
-Coping (affect, how do they sound, stop talking with contractions, sound
anxious/relaxed/energetic/exhausted, general appearance, coping in the
providers/patients view, what have they been doing)
-Other: signs of UTI (stimulate contractions), recent sexual intercourse or digital vaginal
exam (spotting/bleeding),
What are the components of a Physical Exam for a person presenting for onset of labor?
-Head to Toe exam
-Maternal vital signs
-FHR assessment
-Urine dip for proteins or ketones
-Leopold's maneuver
-Abdominal Palpation
What are the components of a Pelvic Exam for a person presenting for onset of labor?
-Digital Vaginal exam for cervical dilation, effacement, position and consistency
-Fetal Station
-If possibility of ROM deferre digital exam and use a speculum to assess for pooling of
fluid or to obtain laboratory specimens
-Performing serial cervical exams with cervical changes noted is a more accurate
indication of labor
What are the components of preforming a speculum exam to diagnose SROM?
-Fluid leaking from the cervical os (cough or Valsalva maneuver, sit up for 30 minutes
and reevaluate)
-Color (clear, straw or cloudy, white creamy flecks of vernix)
-Smell (has a distinct musty odor, foul-smelling indicates infection)
-Bleeding
-observe vaginal walls for discharge
-not visible cervical dilation, length and effacement or a bulging bag
Describe the arborization (fern) test
-dried fluid will give "ferning" appearance under the microscope
-collect fluid from posterior cervix
-let dry for 10 minutes and then look
NM 704 Exam 3
, NM 704 Exam 3
-fern pattern is caused by crystallization due to high sodium chloride and protein
concentrations in amniotic fluid
-ferning is not affected by meconium presence, small amounts of blood or pH changes
What can cause false positives in the Arborization test?
cervical mucus
fingerprints
significant amount of blood
semen
-these can all show fern-like patterns
What can cause false negatives in the Arborization test?
not enough residual amniotic fluid
Describe the ph test (nitrazine test)
pH paper to test for presence of fluid which is typically alkaline
-if present paper will turn DARK BLUE
-collect from posterior cervix and swab onto the paper
-can also touch the paper to the labia or perineum where you see fluid
What can cause a false positive in the pH test (nitrazine test)?
blood
semen
urine
bacterial vaginosis
trichomoniasis
-can use a wet prep to determine the presence of these as they can coexist with
ruptured membranes
What can cause a false negative in the pH test (nitrazine test)?
not enough residual amniotic fluid present
Describe the Rapid Immunoassay test (AmniSure)
-Vaginal fluid collected and swished in a tube with solvent. Then a test strip is inserted
into a vial
-2 line = POSITIVE
-1 line= Negative
NM 704 Exam 3
NM704 Exam 3 Study Guide Graded A
2025
When does active labor begin?
Active labor beings when the rate of cervical dilation sharply increases
What does contemporary research believe to be the rate of dilation when active labor
beings?
5-6 cm dilation
Describe anticipatory guidance you would give to one in labor onset and early labor
-guidance during the prenatal period can help pregnant persons prepare for the onset of
labor
-give specific instructions on when and how to contact the provider for SDM when labor
starts
-this emphasizes that labor onset is a gradual process and difficult to distinguish
-consider all factors in decision making (support persons, coping status, comfort level
leaving the birth site, transportation, weather, how far they live, will they get rest at
home)
-explain lack of labor rooms and/or staff to accommodate people not needing medical
care during early labor
-address diet, rest, coping strategies, benefits of continuous labor support during early
labor
What are the components of the history and chart review you would evaluate for a
person presenting in possible onset of labor?
-Uterine contractions (onset, when, frequency, length, strength, interrupts activity,
sleep, where are they felt, coping strategies, any other pains)
-Vaginal fluids (spotting, bleeding, leaking fluid)
-Fetal status (movement, is it the same or has it changed)
-Fatigue (recent sleep activity, rest and activity)
-Hydration (eating and drinking normally, recent food and drink intake, appetite, N/V,
voiding at a normal amount, urine light/dark or concentrated)
NM 704 Exam 3
,NM 704 Exam 3
-Environment/Transportation/Support (time of day, how far away do they live, access to
transportation, is home quiet for rest)
-Coping (affect, how do they sound, stop talking with contractions, sound
anxious/relaxed/energetic/exhausted, general appearance, coping in the
providers/patients view, what have they been doing)
-Other: signs of UTI (stimulate contractions), recent sexual intercourse or digital vaginal
exam (spotting/bleeding),
What are the components of a Physical Exam for a person presenting for onset of labor?
-Head to Toe exam
-Maternal vital signs
-FHR assessment
-Urine dip for proteins or ketones
-Leopold's maneuver
-Abdominal Palpation
What are the components of a Pelvic Exam for a person presenting for onset of labor?
-Digital Vaginal exam for cervical dilation, effacement, position and consistency
-Fetal Station
-If possibility of ROM deferre digital exam and use a speculum to assess for pooling of
fluid or to obtain laboratory specimens
-Performing serial cervical exams with cervical changes noted is a more accurate
indication of labor
What are the components of preforming a speculum exam to diagnose SROM?
-Fluid leaking from the cervical os (cough or Valsalva maneuver, sit up for 30 minutes
and reevaluate)
-Color (clear, straw or cloudy, white creamy flecks of vernix)
-Smell (has a distinct musty odor, foul-smelling indicates infection)
-Bleeding
-observe vaginal walls for discharge
-not visible cervical dilation, length and effacement or a bulging bag
Describe the arborization (fern) test
-dried fluid will give "ferning" appearance under the microscope
-collect fluid from posterior cervix
-let dry for 10 minutes and then look
NM 704 Exam 3
, NM 704 Exam 3
-fern pattern is caused by crystallization due to high sodium chloride and protein
concentrations in amniotic fluid
-ferning is not affected by meconium presence, small amounts of blood or pH changes
What can cause false positives in the Arborization test?
cervical mucus
fingerprints
significant amount of blood
semen
-these can all show fern-like patterns
What can cause false negatives in the Arborization test?
not enough residual amniotic fluid
Describe the ph test (nitrazine test)
pH paper to test for presence of fluid which is typically alkaline
-if present paper will turn DARK BLUE
-collect from posterior cervix and swab onto the paper
-can also touch the paper to the labia or perineum where you see fluid
What can cause a false positive in the pH test (nitrazine test)?
blood
semen
urine
bacterial vaginosis
trichomoniasis
-can use a wet prep to determine the presence of these as they can coexist with
ruptured membranes
What can cause a false negative in the pH test (nitrazine test)?
not enough residual amniotic fluid present
Describe the Rapid Immunoassay test (AmniSure)
-Vaginal fluid collected and swished in a tube with solvent. Then a test strip is inserted
into a vial
-2 line = POSITIVE
-1 line= Negative
NM 704 Exam 3
