BHU NO-2019
Obstetrics & Gynaecology
Medium
A nurse is caring for a primigravida during labor. What does the nurse observe that indicates birth is about to take place?
Appeared in: BHU NO-2019
Explanation
- The bulging of the perineum is a definitive sign of the second stage of labor.
- This physical sign indicates that the fetal presenting part has descended low into the birth canal and is pressing on the pelvic floor.
- Perineal bulging is immediately followed by crowning, where the widest part of the fetal head is visible at the vaginal opening, and then birth.
- It is the most direct and observable indicator that the baby's expulsion is imminent.
Why Other Options Were Wrong
- Option A: This describes the progression of contractions during the active and transition phases of the first stage of labor. While it indicates labor is advancing, it does not signify that birth is immediately imminent.
- Option C: Irritability and difficulty following instructions are classic behavioral signs of the transition phase, which is the final part of the first stage of labor, occurring just before the cervix is fully dilated.
- Option D: An increase in bloody show (a mix of mucus and blood) occurs as the cervix continues to dilate and efface, typically during the transition phase and early second stage. However, it is not as definitive an indicator of imminent birth as the physical bulging of the perineum.
Related Visual
Clinical Relevance
- Nursing practice connection: Knowing Signs of Imminent Birth / Second Stage of Labor helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Recognizing perineal bulging is a critical nursing assessment. It signals the need to prepare for immediate delivery, including notifying the provider, preparing delivery equipment, and positioning the mother.
- The nurse's role shifts to guiding the mother in pushing efforts, monitoring fetal heart rate more frequently (e.g., every 5-15 minutes), and providing comfort measures like perineal support.
- Failure to recognize this sign can lead to an uncontrolled or unattended delivery, increasing the risk of perineal trauma for the mother and complications for the newborn.
How to Approach the Question
- First, identify the core of the question: it asks for the most specific sign that birth is 'about to take place,' meaning it is imminent.
- Next, mentally review the stages of labor (First, Second, Third, Fourth) and their key characteristics.
- Evaluate each option against these stages. Option A (stronger contractions) and Option C (irritability) are classic signs of the transition phase of the first stage. They indicate birth is getting closer, but not that it's happening right now.
- Option D (increased bloody show) is also associated with the transition phase but is less precise.
- Analyze Option B (perineal bulging). This is a physical manifestation of the baby's head descending onto the pelvic floor, which occurs during the second stage and directly precedes crowning and birth.
- Conclude that perineal bulging is the most direct and definitive indicator among the choices that birth is imminent.
Concept Tested & Keywords
- Concept Tested: Signs of Imminent Birth / Second Stage of Labor
- Stem keywords: primigravida, labor, birth is about to take place
- Lead-in keywords: indicates
- Clinical cues: The question asks for the sign that indicates birth is 'about to take place', which points to the most immediate or definitive sign of the final phase of labor.
Question ID
QXWdglRspY6kBx7xwrUHYC
Reference Book
E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 40-48
E6 Physiology Guyton 4SAE Part 3 p. 66-68
Practise the full BHU NO-2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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