A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which finding is most indicative that preterm labor is occurring?

The cervix is effacing and dilated to 2 cm

Irregular, mild uterine contractions are occurring every 15-30 minutes

Estriol is not found in maternal saliva

Fetal fibronectin is present in vaginal secretions

Answer and Explanation

The Correct Answer is A

A. The cervix is effacing and dilated to 2 cm. Cervical changes, including effacement and dilation, are the most definitive signs of preterm labor. Uterine contractions alone do not confirm preterm labor unless they result in cervical dilation, indicating that labor is progressing.

B. Irregular, mild uterine contractions are occurring every 15-30 minutes. Irregular contractions, known as Braxton Hicks contractions, can be common in pregnancy and do not necessarily indicate preterm labor. True preterm labor involves regular contractions that lead to cervical changes.

C. Estriol is not found in maternal saliva. The absence of estriol in maternal saliva does not confirm or rule out preterm labor. Salivary estriol testing is not a widely used or reliable diagnostic tool for determining the onset of preterm labor.

D. Fetal fibronectin is present in vaginal secretion. Fetal fibronectin (fFN) is a protein found in vaginal secretions between 22-34 weeks of pregnancy and can indicate a risk of preterm labor, but its presence alone does not confirm that labor is actively occurring. A positive fFN test means the patient may be at increased risk for preterm labor, but cervical changes remain the best indicator of actual labor.

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Correct Answer is B

Explanation

A. Quantity of vaginal bleeding. While both placenta previa and abruptio placentae can cause vaginal bleeding, the amount alone does not differentiate between the two conditions. Placenta previa typically causes painless, bright red bleeding, whereas abruptio placentae often presents with concealed or variable bleeding, making quantity an unreliable distinguishing factor.

B. Presence of abdominal pain. Abdominal pain is a key differentiating factor. Placenta previa is characterized by painless vaginal bleeding, while abruptio placentae causes sudden, severe abdominal pain due to placental detachment and uterine muscle irritation. This makes the presence or absence of pain an important assessment finding.

C. Leopold's maneuver results. While Leopold’s maneuvers help determine fetal position and presentation, they do not provide definitive information about the location of the placenta or differentiate between placenta previa and abruptio placentae. Ultrasound is a more reliable diagnostic tool for this purpose.

D. Maternal blood pressure. Although abruptio placentae can lead to hypovolemic shock and blood pressure changes due to hemorrhage, maternal blood pressure alone is not a primary diagnostic criterion for differentiating between the two conditions. Other clinical findings such as pain and ultrasound results are more useful for diagnosis.

A. Apply Oxygen B. Increase IV Pitocin C. Apply downward pressure on the woman's fundus D. Flex the woman's thighs sharply toward her abdomen

Correct Answer is D

Explanation

A. Apply oxygen. While oxygen may be administered if fetal distress is present, it does not directly resolve shoulder dystocia, which is a mechanical issue requiring immediate positional maneuvers to free the impacted shoulder.

B. Increase IV Pitocin. Increasing oxytocin (Pitocin) is contraindicated in shoulder dystocia because it can cause stronger contractions, worsening the impaction and increasing the risk of fetal injury or uterine rupture.

C. Apply downward pressure on the woman's fundus. Fundal pressure should never be applied in shoulder dystocia, as it can further wedge the fetal shoulder against the pubic bone, increasing the risk of brachial plexus injury and fetal distress.

D. Flex the woman's thighs sharply toward her abdomen. The McRoberts maneuver, which involves sharply flexing the mother’s thighs to widen the pelvic outlet, is the first-line intervention for shoulder dystocia. This maneuver helps rotate the pelvis and reposition the fetal shoulder, increasing the chances of a successful vaginal delivery.

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A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which finding is most indicative that preterm labor is occurring?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is D

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