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NM 704 FINAL EXAM NEWEST 2026 ACTUAL EXAM
COMPLETE 100 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+||NEWEST EXAM!!!
What are the benefits and risks of delayed pushing when
epidural is used? - ANSWER-Evidence is inconsistent.
- different definitions of delayed pushing used in different
studies. (1hr vs 2hr delay)
- different study designs.
-Much of the evidence on delayed pushing suggests that
delayed pushing results in longer second stages but
shorter periods of active pushing, fewer operative vaginal
deliveries, and equal or superior outcomes in terms of
birthing people and neonatal complications
-Other studies found that birthing people who delayed
pushing had an increased rate of operative vaginal birth,
cesarean birth, fever and postpartum hemorrhage.
-In October of 2018, ACOG issued a new practice advisory
on delayed vs. immediate pushing for nulliparous birthing
people with epidurals. It was endorsed by ACNM. This
showed no difference in the spontaneous birth rate with
,2|Page
the 2 approaches, and higher rates of chorioamnionitis
and postpartum hemorrhage with delayed pushing.
-ACOG published a practice advisory based on one study,
though the language in the advisory is rather ambiguous (
i.e., "given the evidence it is reasonable to choose
immediate pushing"). It is likely that this ambiguity of the
language will not stop a large practice shift in many
institutions that were routinely doing delayed pushing.
Delayed pushing - ANSWER-resisting the urge to push
once fully dilated
this allows the pregant person to rest for 1-2hrs prior to
pushing
current criteria for normal duration of the second stage. -
ANSWER-Nulliparous - 2.8-3.6 hrs regardless of epidural
(2010 study)
MEdian length 0.6-1.1 nulliparous
Median length 0.1-0.4 for multiparous
maternal and neonatal complications associated with a
prolonged second stage of labor. - ANSWER-Prolonged
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2nd stage labor is associated with increased ris of
maternal morbidity, infection, hemorrhage and 3/4th
laceration
What is the impact of the following on the occurrence of
genital tract laceration:
Coached versus spontaneous pushing
Birthing person position for birth
Antepartum perineal massage
Use of heat (warm compresses) on the perineum during
birth
Perineal massage during birth
Hand maneuvers used by the attendant during birth -
ANSWER-Coached vs spontaneous: no difference
Position: slight increase when in an upright/squatting
position. lithotomy has highest incidence of tears
Antepartum Perineal massage: decreased rate
Perineal massage during birth: decreased rate
Heat: decreased rate
Hand maneuvers used by attendant during birth:
decreased rate via textbook, ACOG states not enough
evidence
, 4|Page
Prolonged second stage - ANSWER-In a nulliparous
woman, the diagnosis of a prolonged second stage should
be considered when the second stage exceeds 3 hours if
regional anesthesia has been administered or 2 hours if
no regional anesthesia is used. In multiparous women, the
diagnosis can be made when the second stage exceeds 2
hours with regional anesthesia or 1 hour without. A
prolonged second stage of labor warrants a clinical
reassessment of the woman, fetus, and expulsive forces
At least 2 hours of pushing in multiparous women
At least 3 hours of pushing in nulliparous women
What is the the impact of routine episiotomy on:
Risk of 3rd and 4th-degree lacerations
Long term pelvic floor functioning (urinary or anal
incontinence, the strength of pelvic floor)
Degree of genital tract trauma
Postpartum pain
Sexual function
Neonatal outcomes - ANSWER-no difference in neonatal
outcomes but increased risk in other areas
NM 704 FINAL EXAM NEWEST 2026 ACTUAL EXAM
COMPLETE 100 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+||NEWEST EXAM!!!
What are the benefits and risks of delayed pushing when
epidural is used? - ANSWER-Evidence is inconsistent.
- different definitions of delayed pushing used in different
studies. (1hr vs 2hr delay)
- different study designs.
-Much of the evidence on delayed pushing suggests that
delayed pushing results in longer second stages but
shorter periods of active pushing, fewer operative vaginal
deliveries, and equal or superior outcomes in terms of
birthing people and neonatal complications
-Other studies found that birthing people who delayed
pushing had an increased rate of operative vaginal birth,
cesarean birth, fever and postpartum hemorrhage.
-In October of 2018, ACOG issued a new practice advisory
on delayed vs. immediate pushing for nulliparous birthing
people with epidurals. It was endorsed by ACNM. This
showed no difference in the spontaneous birth rate with
,2|Page
the 2 approaches, and higher rates of chorioamnionitis
and postpartum hemorrhage with delayed pushing.
-ACOG published a practice advisory based on one study,
though the language in the advisory is rather ambiguous (
i.e., "given the evidence it is reasonable to choose
immediate pushing"). It is likely that this ambiguity of the
language will not stop a large practice shift in many
institutions that were routinely doing delayed pushing.
Delayed pushing - ANSWER-resisting the urge to push
once fully dilated
this allows the pregant person to rest for 1-2hrs prior to
pushing
current criteria for normal duration of the second stage. -
ANSWER-Nulliparous - 2.8-3.6 hrs regardless of epidural
(2010 study)
MEdian length 0.6-1.1 nulliparous
Median length 0.1-0.4 for multiparous
maternal and neonatal complications associated with a
prolonged second stage of labor. - ANSWER-Prolonged
,3|Page
2nd stage labor is associated with increased ris of
maternal morbidity, infection, hemorrhage and 3/4th
laceration
What is the impact of the following on the occurrence of
genital tract laceration:
Coached versus spontaneous pushing
Birthing person position for birth
Antepartum perineal massage
Use of heat (warm compresses) on the perineum during
birth
Perineal massage during birth
Hand maneuvers used by the attendant during birth -
ANSWER-Coached vs spontaneous: no difference
Position: slight increase when in an upright/squatting
position. lithotomy has highest incidence of tears
Antepartum Perineal massage: decreased rate
Perineal massage during birth: decreased rate
Heat: decreased rate
Hand maneuvers used by attendant during birth:
decreased rate via textbook, ACOG states not enough
evidence
, 4|Page
Prolonged second stage - ANSWER-In a nulliparous
woman, the diagnosis of a prolonged second stage should
be considered when the second stage exceeds 3 hours if
regional anesthesia has been administered or 2 hours if
no regional anesthesia is used. In multiparous women, the
diagnosis can be made when the second stage exceeds 2
hours with regional anesthesia or 1 hour without. A
prolonged second stage of labor warrants a clinical
reassessment of the woman, fetus, and expulsive forces
At least 2 hours of pushing in multiparous women
At least 3 hours of pushing in nulliparous women
What is the the impact of routine episiotomy on:
Risk of 3rd and 4th-degree lacerations
Long term pelvic floor functioning (urinary or anal
incontinence, the strength of pelvic floor)
Degree of genital tract trauma
Postpartum pain
Sexual function
Neonatal outcomes - ANSWER-no difference in neonatal
outcomes but increased risk in other areas
