# Situation: A 22-year-old primigravida at 39 weeks' gestation comes to a Basic Emergency Obstetric and Newborn Care (BEmONC)-capable birthing facility of a Rural Health Unit (RHU) because of contractions. Her prenatal course has been normal, and the fetus is in a vertex presentation. Several hours later, she is in active labor with intact membranes. Her blood pressure on admission was 112/72 mmHg. Consider each finding below as occurring alone, with all other findings normal. Which finding can be expected as a physiologic change of labor?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629577  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 22-year-old primigravida at 39 weeks' gestation comes to a Basic Emergency Obstetric and Newborn Care (BEmONC)-capable birthing facility of a Rural Health Unit (RHU) because of contractions. Her prenatal course has been normal, and the fetus is in a vertex presentation.

Several hours later, she is in active labor with intact membranes. Her blood pressure on admission was 112/72 mmHg. Consider each finding below as occurring alone, with all other findings normal. Which finding can be expected as a physiologic change of labor?

## 보기

1. White blood cell count of 22,000/mm³ (22 × 10⁹/L) **✔ 정답**
2. Blood pressure of 150/96 mmHg during and 142/90 mmHg between contractions
3. Pulse rate of 122/min between contractions
4. Temperature of 38.2 °C (100.8 °F)

**정답: 1**

## 해설

The white blood cell count may rise to about 25,000 to 30,000/mm³ during labor without infection, so 22,000/mm³ alone is expected and is interpreted with other signs. Blood pressure normally rises during contractions, which is why it is measured between them; a reading of 142/90 mmHg between contractions, up from 112/72 mmHg, is hypertension rather than a labor effect. A temperature of 38.2 °C (100.8 °F) is fever, and a resting pulse above 120/min is not a normal labor change; both need assessment.

## 심화 해설

The expected physiologic change
Labor is a period of intense physical work, and several laboratory values and vital signs change as a result. One of the most striking is the white blood cell count, which may rise to about 25,000 to 30,000/mm³ during labor without any infection. A count of 22,000/mm³ (22 × 10⁹/L) in a woman with no other abnormal findings is therefore within the expected range. A rise in white blood cells is a recognized physiologic change of labor, but it is always interpreted together with temperature, pulse, and other signs.

Why white blood cells rise
The stress of labor and the physical effort of contractions release stress hormones that mobilize white blood cells into the circulation. This leukocytosis does not by itself indicate infection. Because of it, a single high count in labor is not used alone to diagnose chorioamnionitis or other infections; fever, maternal or fetal tachycardia, uterine tenderness, and foul-smelling amniotic fluid are more meaningful signs.

Blood pressure in labor
Blood pressure normally rises during contractions, which is why it is measured between contractions. This client's reading during a contraction (150/96 mmHg) could partly reflect that effect, but her reading between contractions is 142/90 mmHg, up from 112/72 mmHg on admission. Watch out! A reading of 140/90 mmHg or higher between contractions is in the hypertensive range and is not a labor effect. It needs follow-up for hypertensive disorders of pregnancy.

Pulse and temperature
A resting pulse of 122/min between contractions is not a normal labor change; it can point to dehydration, infection, hemorrhage, or uncontrolled pain. A temperature of 38.2 °C (100.8 °F) is fever. Labor may cause a slight rise in temperature from exertion and dehydration, but a true fever calls for assessment for infection, particularly when membranes have ruptured, although here they are intact.

| Finding | Expected in labor? | Action |
| --- | --- | --- |
| WBC 22,000/mm³ | Yes, up to about 25,000 to 30,000/mm³ | Interpret with other signs |
| BP 142/90 mmHg between contractions | No; hypertensive range | Report and monitor |
| Pulse 122/min at rest | No | Assess for dehydration, infection, bleeding, pain |
| Temperature 38.2 °C | No; fever | Assess for infection |

Exam takeaway
Leukocytosis up to about 25,000 to 30,000/mm³ can be normal in labor; hypertension between contractions, fever, and a resting pulse above 120/min are not. Key point! When an item says to consider each finding alone, judge each value against its normal labor range rather than looking for a combined picture.

## 임상 시나리오

Physiologic Changes in LaborWhich finding is expected in active labor
The white blood cell count can rise to about 25,000 to 30,000/mm³ in labor without infection; interpret it with other signs.

Measure blood pressure between contractions. A reading of 140/90 mmHg or higher between contractions is hypertension, not a labor effect.

A temperature of 38.2 °C is fever, and a resting pulse above 120/min needs assessment.

CautionDo not dismiss fever, tachycardia, or hypertension between contractions as normal labor changes.

## 핵심 개념

- **Leukocytosis** — A raised white blood cell count, which can occur in labor without infection.
- **Hypertension in pregnancy** — Blood pressure of 140/90 mmHg or higher, measured between contractions during labor.
- **Chorioamnionitis** — Infection of the fetal membranes and amniotic fluid, suggested by fever and tachycardia in labor.
- **Active labor** — The phase of labor with regular contractions and progressive cervical dilation.

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