A primigravida client at 39 weeks gestation is admitted to the labor and delivery unit. During the initial assessment, which finding would be the most important indicator that the client is in active labor?
1Contractions occurring every 10 minutes, each lasting 30 seconds
2Bloody show with expulsion of the mucus plug
3Rupture of membranes with clear amniotic fluid
4Cervical dilation of 6 cm with contractions every 3 minutes lasting 60 seconds✓ 정답
해설
Active labor is defined by cervical dilation of 6-10 cm with regular, strong contractions. Option 4 shows 6 cm dilation and contractions every 3 minutes, indicating active labor. Other options represent early labor or normal findings.
Clinical Judgment
This question assesses the ability to differentiate the stages of labor and identify the most objective and definitive indicator defining Active Labor among them. The key is asking for the 'most important indicator'. Active labor is a phase of the first stage of labor, characterized by rapid cervical change. The ACOG (American College of Obstetricians and Gynecologists) has redefined the start of active labor as reaching 6cm of cervical dilation. Therefore, while other options (contraction pattern, bloody show, rupture of membranes) are all signs that labor may be progressing, the definitive clue confirming active labor is actual cervical change, specifically 6cm dilation. Option 4 clearly meets this criterion (6cm dilation), and the contraction pattern (every 3 minutes, lasting 60 seconds) also aligns with the typical pattern of active labor.
Memory Tip:
Cervix is King! When judging active labor, the condition of the cervix (Cervix) is king (King). Remember 6cm. You can memorize it as "At 6cm, it's Active."
KR vs US:
While 3-4cm dilation is sometimes used as a criterion for active labor in Korea, the NGN/US standard uses 6cm as a clear benchmark, following ACOG recommendations. This is a modern approach to prevent unnecessary early interventions. Therefore, when choosing the 'most important indicator' on a US exam, you must select the option that includes 6cm.
Clinical Practice Guide
Once active labor (cervical dilation of 6 cm or more) is confirmed, nursing interventions are focused on: 1) continuous monitoring of fetal heart rate and contractions, 2) offering or enhancing pain management options (such as epidural anesthesia), 3) strengthening psychological support for delivery, 4) vigilance for signs of complications such as amniotic fluid color, severe pain, and fetal heart rate abnormalities.
Caution:
In SATA (Select All That Apply) questions, if asked "What are the signs of active labor?", it is easy to fall into a trap. Rupture of Membranes or Bloody Show are signals that labor may have started or is progressing, but they are not indicators that confirm active labor. You must include cervical dilation of 6 cm and regular, strong contractions (every 2-5 minutes, lasting 45-90 seconds).
Active Labor (활성 진통) — A stage of the first stage of labor, when cervical dilation progresses rapidly from 6 cm to 10 cm. It is accompanied by regular and strong contractions.
Cervical Dilation (자궁경부 개대) — The degree to which the cervix opens during labor. It is measured in centimeters (cm), and when it reaches 10 cm, it is fully dilated, allowing the fetus to pass through the birth canal.
Primigravida (초산부) — A woman experiencing her first pregnancy.
Bloody Show (점액성 피사출) — Bloody show.
Rupture of Membranes (양막 파열) — Rupture of the amniotic sac, causing amniotic fluid to leak out. It can occur naturally or be artificially induced.