NM704 EXAM 3 QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED LATEST UPDATE 100% GUARANTEED
PASS
Is there a consensus on what defines the onset of labor?
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?
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?
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?
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:
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?
1. History and chart review
2. Physical Exam
3. Pelvic Exam
What four methods can be used to diagnose spontaneous rupture of
membranes?
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?
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?
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?
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.
Describe the evidence between early labor admission and the associated
interventions.
The evidence is compelling. There have been lots of studies on this and the difference
is cesarean rates shown in the studies is quite large.
Describe the qualitative research on women's experience of early labor.
SOLUTIONS VERIFIED LATEST UPDATE 100% GUARANTEED
PASS
Is there a consensus on what defines the onset of labor?
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?
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?
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?
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:
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?
1. History and chart review
2. Physical Exam
3. Pelvic Exam
What four methods can be used to diagnose spontaneous rupture of
membranes?
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?
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?
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?
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.
Describe the evidence between early labor admission and the associated
interventions.
The evidence is compelling. There have been lots of studies on this and the difference
is cesarean rates shown in the studies is quite large.
Describe the qualitative research on women's experience of early labor.
