A 32-week pregnant woman is hospitalized with vaginal discharge, and her fibronectin test is positive. What kind of labor does it indicate?

1. A

   Post-term labor

2. B

   Prolonged labor

3. C

   Preterm labor

4. D

   Precipitated labor

Appeared in: NORCET 1 - 2020

Explanation

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• Preterm labor is defined as the onset of labor before 37 completed weeks of gestation. The patient is at 32 weeks, which falls within this definition.
• Fetal fibronectin (fFN) is a protein that helps the amniotic sac adhere to the uterine lining. It is normally absent from cervicovaginal secretions between 22 and 34 weeks.
• A positive fFN test during this period indicates a disruption of the maternal-fetal interface and is a strong predictor of preterm delivery, often within 7-14 days.
• The presence of vaginal discharge is a common symptom associated with cervical changes and the onset of labor.

Why Other Options Were Wrong

• Option A: Post-term labor refers to a pregnancy that extends beyond 42 weeks of gestation. The patient is at 32 weeks, which is preterm.
• Option B: Prolonged labor, or failure to progress, describes an abnormally slow progression of labor (e.g., cervical dilation). It is a diagnosis made during the course of labor, not a prediction based on a test.
• Option D: Precipitated labor is an extremely rapid labor that lasts less than three hours from the onset of contractions to delivery. It cannot be predicted by a fibronectin test and is diagnosed after the birth has occurred.

Related Visual

• Visual 1: Infographic: An illustration showing the location of fetal fibronectin, acting as 'glue' between the amniotic sac and the uterus. A second panel could show this 'glue' breaking down, leading to a positive fFN test result from a vaginal swab.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Diagnosis of preterm labor based on gestational age and biochemical markers as background academic context rather than a clinical decision trigger.
• A positive fFN test in a symptomatic woman at less than 34 weeks is a critical finding that prompts interventions to improve neonatal outcomes.
• Nursing management includes preparing for the administration of antenatal corticosteroids (like Betamethasone) to accelerate fetal lung maturity and potentially tocolytic agents to temporarily stop contractions.
• Continuous fetal heart rate and uterine activity monitoring are essential to assess for fetal distress and labor progression.

How to Approach the Question

• First, identify the key clinical data in the question: gestational age (32 weeks), a key symptom (vaginal discharge), and a diagnostic test result (positive fibronectin test).
• Define the term 'preterm.' Any pregnancy less than 37 completed weeks is preterm.
• Recall the significance of the fetal fibronectin (fFN) test. A positive result between 22-34 weeks is a strong indicator of impending preterm labor.
• Evaluate each option against the clinical data. 'Preterm labor' is the only option that aligns with a 32-week gestation and a positive fFN test.
• Eliminate the other options based on their definitions: 'Post-term' relates to gestation beyond 42 weeks, 'prolonged' relates to the duration of labor itself, and 'precipitated' refers to an unusually fast labor.

Concept Tested & Keywords

• Concept Tested: Diagnosis of preterm labor based on gestational age and biochemical markers.
• Stem keywords: 32-week pregnant, vaginal discharge, fibronectin test positive
• Lead-in keywords: What kind of labor
• Clinical cues: Gestational age of 32 weeks indicates the pregnancy is preterm.
• Clinical cues: A positive fibronectin test is a strong predictor of imminent preterm labor.

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